When longtime Green Bay resident Kateesha Mitchell was pregnant with her first child, she remembers feeling pain in her lower abdomen. Her doctors insisted that the pain was normal, but Mitchell continued to advocate for a closer look. Mitchell, a Black woman who was 19 at the time, spent much of her young life battling undiagnosed chronic pain; so by the time she was pregnant with her first child, she knew exactly how to stand her ground, even when doctors claimed that her symptoms were normal for a pregnant woman.
“No one would listen to me,” Mitchell, now 33, said in an interview. “But I kept being persistent.”
After further observation and scans, Mitchell’s doctors found a cancerous tumor, and her first son had to be delivered five weeks early.
“While I was in surgery, the doctor told my mom that if I hadn’t been persistent that they would not have found that tumor until they were doing my autopsy,” she said.
Black women are three times more likely to die from pregnancy-related complications in comparison to their white counterparts, according to the Center for Disease Control and Prevention. In Wisconsin, Black women are five times more likely to die during childbirth, according to the state Department of Health Services.
Factors that lead to these life-threatening disparities include the quality of health care, chronic conditions and structural racism and bias, according to the CDC. In Brown County, Black women receive the lowest rates of first-trimester health care and are most likely to have premature births, according to the 2018 Community Needs Assessment by Aurora BayCare Medical Center. The assessment explained that these disparities are significant because quality preconception and prenatal care improve health outcomes for both mothers and infants.
For Mitchell, finding quality health care in Green Bay has been a challenge. During each of her pregnancies, she said, she found herself advocating for her symptoms to be taken seriously and being routinely overlooked by her doctors.
“Doctors don’t listen because there’s a lack of Black or other minority OBGYNs in the area,” she said. “I’ve had three different experiences that have basically left me traumatized. I will probably be that way for the rest of my life.”
Emily Jacobson, a Brown County Supervisor and founder of Green Bay Doulas, has seen the struggles Black women face up close. Doulas are trained professionals who provide emotional and physical support during childbirth. Jacobson said that most of the Black women that she works with hired her to act almost as a “bodyguard” against any discrimination during the birthing process.
“Doctors and nurses tend to be on really good behavior when we’re there,” said Jacobson, who added that many of the Black mothers she’s worked with are often treated differently from the white women she has worked with.
Antoinette Wright is one of the only Black doulas affiliated with Green Bay Doulas. She began practicing as a doula in 2017 and is currently studying to be a midwife. Wright said she has personally dealt with inadequate care during childbirth and that it’s important for other healthcare providers, doulas and midwives to simply “be aware.”
“I want for other doulas and midwives to be aware of what their clients of color [might]
suffer from,” Wright said. “Because clients of color versus the white women that we deal with are so different. They’re treated differently.”
“It’s something about being a Black woman here in this environment that is impacting us,” said Dr. Jasmine Zapata, who is the Chief Medical Officer and State Epidemiologist for Community Health Promotion at the Wisconsin Department of Health Services. “There are also cases of implicit bias within the healthcare system that play a role [in how] Black birthing people are treated differently.”
Amy Woods is one of Jacobson’s former clients. Before deciding to hire a doula for her most recent pregnancy, Woods described her experience giving birth in Green Bay as “vulnerable” and ”rushed.”
“Our third [birth] was probably the worst experience, which is part of the reason I got a doula for my fourth baby,” she said.
During Woods’ third pregnancy she suffered an umbilical hernia. Her doctors suggested repairing the hernia once she hit 30 weeks. When she went in to get the surgery, a nurse stopped her and asked if she received all the necessary shots to help with her child’s development before surgery. Woods said the nurse told her she couldn’t send her into surgery knowing that doctors didn’t prescribe the necessary treatments for the surgery.
“They were literally about to perform surgery on me when a random nurse that had never met me advocated for my baby at that moment,” she said. Once Woods finally got the surgery she needed, she welcomed her third child to the world five weeks early. Before being discharged, Woods said she noticed something was off.
“I looked at my husband and I said ‘Gosh, she looks really yellow. I can’t wake her up to eat. Her eyes looked really yellow,’” she said. “I called the nurse and the nurse was like ‘Oh gosh no, that’s just because of your ethnicity.’”
Woods’ doctor authorized another test but her nurse insisted on discharging her due to a lack of hospital beds. Woods and her husband packed up their newborn and left the hospital. Shortly thereafter, the nurse called for Woods to bring her baby back to the hospital immediately because the test results found high levels of jaundice.
“We literally had to go all the way back in a snowstorm,” Woods said. “I’m three days postpartum and that’s what they put us through for a test that otherwise wouldn’t have been done.”
“It literally took my own instincts to say something’s wrong,” she said.
Woods said having Jacobson as a doula for her fourth birth helped her channel her “inner Queen” during her final month of pregnancy. As a doula, Jacobson advocated on Woods’ behalf, which allowed Woods to focus on giving birth.
“I had always wanted a doula but I could never justify the costs,” Woods said.
Zapata said DHS is collaborating with prenatal care programs to explore the use of Medicaid to pay doulas to support women during pregnancy.
“That would be historic for our state,” Zapata said. “We know that particularly community-based doula programs are very, very helpful and there’s evidence that has shown that they have been able to improve maternal-child health outcomes.”
In 2019, Wisconsin was also granted $1.8 million from the CDC to address maternal mortality at the state level, Zapata said. The objectives of the grant include understanding the causes of maternal mortality and other complications and determining what kind of interventions will be most effective.
“This is amazing that this money has been provided to really take a dedicated look at the issue of maternal mortality and find solutions to help reduce those numbers,” said Zapata, adding that the DHS is also working to create a maternal and infant mortality prevention unit within the Bureau of Community Health Promotion.
In February, the United States House of Representatives Black Maternal Health caucus, including Wisconsin Rep. Gwen Moore, introduced a legislative package to improve diversity in maternal health care and address Black maternal health disparities head-on.
“As part of our work to invest in the health of Black mothers, we must diversify the perinatal health care workforce to better reflect the communities they serve. Black mothers need professionals who can serve as a source of support through the birthing experience, who are culturally competent to serve our most vulnerable mothers,” Moore said in a statement.
The package includes investments in maternal mental health, diversifying the perinatal workforce, reimagining payment models so mothers can access higher-quality service.
“We need all hands on deck to combat this issue,” Zapata said.
Back in Green Bay, Woods is spreading awareness by teaming up with Birth Queen, a nonprofit organization that supports and educates Black families on how to enrich their birthing experience and protect their families along the way. In recent months, Woods has worked with Birth Queen Founder Rachel Nicks to host a virtual event and organize other Black moms in the area who are passionate about maternal health.
“I’m super grateful for that organization,” Woods said. “I feel like it’s going to make a difference.”
