Virginia mother Tiffany Casby cradles her newborn son Zayne, shortly after birthing him at Embrace Midwifery & Birth Center in Richmond in 2017 .(Photo by Cheyenne Varner).

In Virginia, black women are three times more likely to suffer a pregnancy-related death than white women, reflecting a national pattern of racial disparities in maternal health outcomes.

Each year in America, more than 700 women die during or soon after pregnancy, according to the Centers for Disease Control and Prevention, and the ratio of maternal deaths per 100,000 live births has been steadily increasing since the late 1980s.

State lawmakers turned their attention to the problem in the last days of the General Assembly session, tasking the Virginia Department of Health with examining maternal deaths and making prevention recommendations to the governor. Meanwhile, birth workers in Richmond are raising awareness about the issues facing mothers of color, and empowering expectant moms with various means of support and advocacy.

“Black women are three and a half times more likely to die in childbirth; we’re working to change that,” Kenda Sutton-El told a crowd of about 100 last month in downtown Richmond at a panel event on birth equity co-presented by Birth in Color RVA.

The group, of which Sutton-El is a principal member, is a central Virginia network of doulas and birth workers providing “culturally-centered support to pregnant women, families, and the birth community.” The event was held in mid-February inside the airy top floor of The Broada coworking space and “social club for women and gender minorities” housed inside a historic building in the city’s arts district. 

“We consider ourselves a network of practitioners,” says Courtney Glenn,  a co-founder of Birth in Color RVA. “Culturally centered support is integral to the success of birth outcomes for women of color.”

Glenn is a birth worker — a category that includes doulas and midwives  and an advocate who calls America’s rising maternal death rates a “public health crisis” that particularly affects black mothers.

“We already know black women are three to four to times more likely to die of a pregnancy- related cause than white women, right? Black women also have the highest infant mortality rate in the country,” states Glenn. African American babies are now twice as likely to die as white babies, The New York Times reported last year, a racial disparity wider than it was in 1850, when most American black women were enslaved.

In Virginia, the mortality rate for black infants was twice that of white infants, according to a 2008 report by the state’s Office of Minority Health and Public Health Policy. 

The same New York Times report, sourced from government data and research entities like the Brookings Institute, found that disparities persisted for black mothers across socioeconomic markers like education or income level: the babies of black women with advanced college degrees are more likely to die within their first year than babies born to white moms who did not complete high school. 

 “A lot of this can be attributed to substandard care and racism in the medical industry,” says Glenn. In hospitals, Glenn says, white doctors and nurses often downplay laboring black mothers’ pain management requests. A 2016 University of Virginia study found that racial bias plays a part in how soon-to-be-doctors at the school assessed and treated patient pain. 

“Researchers find that a substantial number of white medical students and residents hold false beliefs about biological differences between black and white people (e.g., black people’s skin is thicker; black people’s blood coagulates more quickly) that could affect how they assess and treat the pain experienced by black patients,” reads the study. 

“I’m sort of putting some of my colleagues on blast, but it’s true — everybody doesn’t receive the same experience,” said Dr. Nicole Rankins, a Henrico obstetrician-gynecologist and hospitalist who also participated in the Birth in Color panel. Rankins said she sometimes witnesses doctors and other care providers treat laboring women unequally.

“It can literally be from one room to the next room in the hospital, and people will have a completely different experience.”

The state of birth equity in Virginia and elsewhere in the country is “terrible,” Rankins said.

“Birth equity to me means that every woman should have a safe and fulfilling experience giving birth,” said Rankins, “where she feels respected and supported throughout the process, from the moment she finds out she’s pregnant, until long after she’s given birth. That is not happening for all moms, especially moms of color.”

Nikiya Ellis, a doula and Birth in Color RVA co-founder, says the group formed in part because African-American birth workers felt unwelcome in existing associations in the Richmond area. 

“We are a network to not only support black mothers and mothers of color through our work, but to also to support black birth workers, too,” she said.

The panel was moderated by Cheyenne Varner, a photographer and publisher of the bi-annual Everyday Birth Magazine. Varner has been a doula for three years, a calling she says she’s felt since girlhood, when at seven years old, she became “fully fascinated and engaged” by her mother’s pregnancy with her younger sister. Varner, who is black, has assisted in 25 births across three states, and most of her clients are black women. Varner says they are increasingly seeking support while navigating a flawed medical system. 

“There are so many reasons to choose a birth worker, but that piece of choosing somebody who is not going to view you through their bias, who is not going to disbelieve your pain, who won’t make assumptions about you before you open your mouth — that is so important to black women who are giving birth.” 

Elsewhere in Virginia there are other culturally-centered efforts to decrease the life-threatening risks black women face during pregnancy and childbirth. Sisters Keeper Collective is a Charlottesville-based, woman of color-led organization whose trained doulas, called birth sisters, offer “child birth education, labor support and post-partum care” to women of color. The group formed in 2014 “in response to the poor birth outcomes that disproportionately affect black women in the U.S.”

Varner says her African-American clients often express anxiety during their pregnancies as a reflection of increased media scrutiny of black mothers’ alarming maternal death rates. “These articles and TV news segments often don’t include enough context,” says Varner.

To combat this, in early February she released Life’s Work, a multimedia project that acts as an immersive primer and digital resource for expectant moms. Varner shot a series of photos of pregnant women and their care providers from a “fly on the wall perspective” at Roots Community Birth Center, a black-owned birthing space in Minneapolis, Minn.

For part of the project, Varner recorded the unmistakable swish and beat of an unborn baby’s heart as a midwife held a Doppler ultrasound device to the laboring mother’s swollen belly. By recreating the pregnancy and birth experience through photos, audio and short written descriptions, Varner hopes her project informs and reassures expectant mothers. Still, she holds other healthcare professionals accountable for how mothers of color experience childbirth. 

“Doulas can’t fill the gap entirely. … The medical system needs to make strides to serve people more comprehensively.”

Until then, moms-to-be should educate themselves and remember that they have the ultimate authority over what happens to their bodies.

“The two biggest things that will influence your birth experience are your provider and the hospital,” said Rankins at the panel event.

“Don’t think you have to stay with [a provider] if you get that feeling of, ‘this is not the right person for me,’ or ‘this person doesn’t respect me or listen to me.’ Advocate for yourself at all costs.”