Nina Ayers’ doctors told her she had high blood pressure.
They said she was at risk of becoming diabetic, having hypertension and delivering a stillborn baby boy. Scared, and unaware that she had the right to a second opinion, Ayers continued working with doctors at an Oakland County hospital throughout her first pregnancy.
But the doctors were wrong on every account. And Ayers couldn’t help but think that the medical team working with her throughout her pregnancy had made grandiose assumptions about her health simply because she’s Black.
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“They couldn’t help me and they couldn’t even empathize with me,” she said. “It was kind of like they didn’t even hear me, like they cut off their hearing at that point while I was trying to figure out what I could do to take care of my body.”
After three days of labor Ayers gave birth to a healthy baby boy in a hospital room with monitors beeping, nurses swishing around her, and none of her friends or family to share in the joy of newborn life. Ayers didn’t invite her family to the hospital because the doctors had mentally prepared her for a stillbirth for months.
“I was shocked that he was healthy and nothing was wrong with this kid at all,” Ayers said.
That was 11 years ago and Black and Brown mothers in Detroit say this experience is current and common. Microaggressions, assumptions and a lack of empathy in doctor-patient relationships have been attributed to stressful birth processes. So Black women are leading the charge to reverse the odds and give birth in ways that acknowledge and empower women.
Birth Detroit was born out of an effort to create accessible, affordable, and comfortable care for expectant moms in Detroit. The woman of color-led nonprofit is a maternal health practice. Their midwives and doulas provide prenatal, birth, and postpartum care to moms with low-risk pregnancies, and clients don’t pay co-pays and are not billed for receiving care.
The goal is to create a safe and welcoming space for mothers to give birth in the way that the mothers want to give birth. Empowering women to advocate for themselves and understand their own health care and birthing journey is part of the process.
Birth Detroit began serving families with childbirth education in July 2020 and started providing prenatal care that fall, said Elon Geffrard, the nonprofit’s co-founder and program director.
Through Birth Detroit Care they have seen and supported 100 families and 30 Birth Detroit babies have been born. Birth Detroit also provides prenatal education in which 150 parents have participated. The organization is raising funds for a birth center to support more moms in Detroit.
Birth Detroit’s CEO, Leseliey Welch said it’s imperative to build equity within birthing practices. But that’s hard to do given the high cost of health care and the need for accessible spaces. Welch said that racism, sexism and income inequality have contributed to racial disparities within birth practices. That’s why Birth Detroit is so necessary in southeast Michigan.
‘We need good outcomes’
Cristina Robie heard about Birth Detroit through her mom who has worked in Detroit’s community health industry for years. Robie was seven months pregnant when she, her husband and her first-born child moved back to Detroit from Seattle last summer. Robie said she needed to find immediate care and was unsatisfied with her treatment the first time she gave birth.
“I just kind of felt like they weren’t asking me, they were telling me what was going on,” Robie said. “It was like we’re inducing you. And kind of like also, by the way, hurry up and have a baby because like, you know, you’ve been here (a while). This is my second shift. You’re still here.”
When Robie gave birth in 2016 she wanted an unmedicated birth process but said her search for support in Seattle led her to spaces that were co-opted to serve wealthy white women.
When she moved back to the city, Robie said she appreciated the accessibility of Birth Detroit. Black women who are working with and serving all women.
Michigan’s infant mortality rate is higher than the national average and serious racial gaps persist. Black mothers experienced nearly three times the risk of infant death compared to white mothers, according to the state’s Maternal Infant Health Program within the Department of Health and Human Services.
Infant mortality rates in Detroit for Black babies in 2020 was 16.6% compared to 5.8%for white babies. In 2019 the rate of Black infant mortality was 12.2%
There were 9,143 live births in Detroit in 2021 of which 100 infants died, according to the Detroit Health Department. In 2018 there were 47 sleep-related infant deaths in Detroit. The following year there were only 20 sleep-related infant deaths.
While gaps persist, infant mortality rates in Detroit have significantly decreased over the last decade. In 2011, infant mortality was the “number one killer of Detroit children.” Programs like Birth Detroit, Make Your Date at Wayne State, and SisterFriends Detroit, among many other programs have increased access to prenatal care and maternal infant health which have contributed to lowering the disparity.
Detroit Mayor Mike Duggan said the city was at “the lowest number of infant deaths as far back as we have records,” during a press conference last summer.
Infant mortality rates have slightly risen as fewer women had access to transportation and prenatal care during the coronavirus pandemic.
Given the risk, Black expectant moms say they’re happy to see that Birth Detroit is led by other women of color.
“For people of color to feel comfortable getting these services, I think it makes a big difference that the people delivering the services are also people of color,” Robie said. “We need good help. We need good outcomes, like there’s no reason why the Black maternity mortality rate is so high. There’s no reason that it should be that way.”
State records from January explain that women receiving inadequate prenatal care are much more likely to birth a stillborn baby. The state also reported that certain newborns, who have low birth weights, are also more likely not to survive long term.
“In 2020, 34 percent of infants died due to conditions related to prematurity and 17.1% died due to birth defects,” Lindsey Myers wrote in the January 2022 report.
Robie said one of the most important things for her second birth was to not be the only person of color in the room.
“There’s so much happening when you’re giving birth that the last thing that you want to be worrying about is like, am I getting equitable care right now?,” she said.
Robie’s husband is white. She said that he has the best intentions for her but he doesn’t always pick up on microaggressions against her from others, like doctors who may not empathize with her concerns. Robie said that Birth Detroit helps expectant moms ensure their voices are heard and that their wishes are respected during the birthing process.
“Be in control of what’s happening in the room – that is health equity,” Robie said. “Like you have to be able to participate in your own health care and it’s hard to do that when you are trying to convince the person on the other end of your care that you are deserving of that care.”
‘In a place of judgment’
There are also racial disparities within live births. Babies with Black mothers are more likely to have ventilation assistance immediately following delivery, be admitted to the NICU, and receive antibiotics for suspected neonatal sepsis than any other race.
Ayers didn’t have a regular obstetrician prior to being pregnant. She was in school and working and went to the first doctor that was recommended to her.
“I was always at work or in-between commuting to work or trying to go to school,” she said. “So at that point in my life, unless you specifically came to me and said like, this is a place where you can get free OB care I was not going to get it.”
She didn’t have health insurance at the time. Her doctors were annoyed by her lack of medical records. When she asked questions and told them she wasn’t comfortable the doctor told her it was “just her hormones.”
“I felt like maybe it was almost in a place of judgment,” she said. “Like why didn’t you take care of yourself? And I always used to think like, ‘Have you not been poor before?’”
Ayers said it took her almost three years to talk about her traumatic birth experience with her family. Once Ayers shared what happened at the hospital she learned that other women in her family had delivered stillborn babies.
“My mother showed me her little urns that she had from siblings that I never knew were even going to be brought to the Earth because she just never talked about it,” Ayers said. “But she named them.”
The second time Ayers was pregnant she thought it would be different. She had a better job and health insurance. She had planned this pregnancy with her partner. She had already experienced giving birth and knew what to expect.
But her doctors wanted to run tests for health conditions she didn’t have. She had to pay additional expenses that weren’t covered by her insurance.
Refusing to be minimized
Ayers said she wanted to stop engaging in prenatal care through the hospital and decided to reach out to a doula. While scrolling Instagram she saw a Detroit woman’s post about her experience in a doula mentoring program and decided to reach out to her. The doula introduced Ayers to Birth Detroit.
Ayers admitted she was afraid to leave her doctor but refused to be minimized. She said Birth Detroit reviewed her medical history and worked with her to develop a birth plan that fit Ayers’ needs.
“They told me my rights as a birthing person and as a woman receiving care,” Ayers said. “They let me know I didn’t have to have all those invasive cervical exams and I didn’t have to be induced. They told me I was entitled to second opinions.”
When Ayers’ doctor called to schedule an induction at the hospital, Ayers shared that she was receiving alternative care instead. She said the doctor warned that she was again at risk of a stillbirth and closed her file with the practice to prevent her from receiving future care.
“She was so mad,” Ayers said.
When Ayers told Birth Detroit what happened with the hospital she said they were confused. Ayers was healthy and on track to deliver a second healthy baby. She participated in the birth education classes and worked with the providers at Birth Detroit to create a birth plan that worked for her.
“I felt like I was capable of having a baby, not like it was just this thing happening to me,” Ayers said. “It was an intentional thing that I was capable of bringing life to this planet and it was not going to be a traumatic experience.”
Within minutes and just “two pushes,” Ayers gave birth to a second child with the support from Birth Detroit. She was able to do the unmedicated, vaginal birth that she wanted, in the way that she planned with no interruptions.
“I think the whole process was just magical and calming,” she said. “And I didn’t feel overwhelmed or pressure that like I didn’t have my room flooded full of students or doctors or panic, or anything, no stress. It was just like everybody was calm and enjoying that moment.”
Within 48 hours Birth Detroit visited her home to check in on her and the new baby. They brought food and talked to her about her health and her needs. They answered her questions about lactation, gave her resources for assistance, and introduced her to other moms.
Most importantly, they encouraged her to be the best mom that she could be in the way that she wanted.