On Monday Vogue released the cover for its infamous September issue, featuring a stripped-back and understated Beyoncé, alongside a very candid feature for the magazine in which she details her experience giving birth to her twins, Rumi and Sir, and how dangerous it ultimately became.
“I was 218 pounds the day I gave birth to Rumi and Sir. I was swollen from toxemia and had been on bed rest for over a month. My health and my babies’ health were in danger, so I had an emergency C-section. We spent many weeks in the NICU.”
“I was in survival mode and did not grasp it all until months later. Today I have a connection to any parent who has been through such an experience. After the C-section, my core felt different. It had been major surgery. Some of your organs are shifted temporarily, and in rare cases, removed temporarily during delivery. I am not sure everyone understands that.”
Beyonce’s account parallels another piece from last January’s Vogue, in which tennis legend and new mother Serena Williams opened up about the medical horror story in which she was trapped during the delivery of her daughter Olympia via emergency C-section. Williams’ C-section was prompted when her heart rate suddenly dropped to dangerously low levels during her contractions. The very next day, she developed blood clots — something for which she’s on high alert owing to a previous injury — along her lungs, and nearly died in the process of convincing the doctors to run the correct tests.
If both Beyoncé and Williams — two wealthy women with celebrity, privilege, and access to the best possible health care — can nearly die, one can easily imagine the risks faced by the average person in the same situation.
When I was born in July of 1991 to seemingly healthy parents, my mom described her labor with me as uneventful — easy, even. By the end of my first week, however, it became increasingly clear that there was something extremely wrong with me. During my first baby wellness check up a few days after I was born, a strange and concerning irregular heart beat was detected. It was later established that the cause of this murmur was a very severe birth defect known as double outlet right ventricle (DORV), which essentially means that I have two large holes on the right side of my heart. My aorta was also in the wrong place. Despite the severity of this condition, doctors wanted to wait for me to grow a bit more before performing a surgery.
Those plans, however, soon went awry. After several episodes within the first few months of my life in which my lips turned purple because my heart was failing, I was taken to Johns Hopkins Children’s Hospital for emergency surgery. Surgeons delicately placed a tube in my heart, patched up the other hole, and wished for the best. The procedure left me with a long and prominent scar straight up and down my chest — and a life expectancy of six years.
When I hit puberty I developed a keen knowledge of the full complexity of my heart and its limitations. There were rules: No competitive sports, don’t take too much Advil, go easy on the coffee, no traveling out of the country — and moving too far away from Johns Hopkins was discouraged.
The summer before my senior year of high school it became apparent I was on borrowed time with my heart. My pulmonary valve collapsed mere moments before my second open heart surgery. I spent the rest of the summer and a good portion of that fall in bed experiencing the worst level of pain I’ve ever had to tolerate. I couldn’t walk up and down stairs, I had to sleep sitting up, and I developed insomnia because of the disorienting pain medicine schedule on which I was placed. I’d get myself comfortable, only to sneeze — which caused my chest to heave, setting off pain through my ribs like fireworks.
Just before that procedure I had worked up the nerve to ask my cardiologist what this all meant for me becoming a mother. My doctor has, thankfully, never sugar-coated anything, so he looked right at me and said that it would be an extremely high risk pregnancy and quite frankly not advised.
Warm salty tears filled my eyes as the reality of that disappointment set in. All those days spent daydreaming with baby dolls, and scrawling potential baby names in my diaries were for naught. I was sixteen, so of course this was world-ending news at the time. The concept of motherhood and all the many ways one can be one like through adopting, surrogacy, or becoming an aunt or a godmother was lost on me.
Exhibiting early signs of an inclination towards journalism, I started researching. Every story I read went the same way: Young mom with heart condition gets pregnant and it was the absolute worst experience of her life in which she and her baby nearly died. At least, that’s the story that was told if that mother was alive to tell it — most of them weren’t.
As I regained my stamina, and my strength to sneeze, I found myself mourning the idea of an alternate timeline. One in which I got to excitedly watch my belly grow over the course of nine months. Where I could peer down at the child I’d borne in search for my nose, the father’s eyes, my mom’s smile. Where, over the course of years, I could witness my own heritage continuing, far into the future.
Every so often I’d come across a story about a young woman who dropped dead while pregnant only to learn retroactively she had some sort of undiagnosed heart condition. Those accounts always left me with the most despair because few things in this world hurt more like the story of a preventable death.
The thing that saved both Beyoncé and Williams, and what I have in common with them, is preventive care. Beyoncé notes the value of knowing that she was experiencing toxemia, which allowed her a better opportunity to manage it. Williams already knew about her likelihood for clots, giving her a vital insight her doctors couldn’t share. I have spent my whole life understanding the complexity of my heart.
Not everyone is so fortunate.
In a emotional and enduring piece by Linda Villarosa in last April’s New York Times, we meet a young woman by the name of Simone Landrum who, after enduring a great deal of suffering during her pregnancy, experienced the ultimate in devastation when her infant was stillborn. Landrum, a woman of low income living in New Orleans, was ignored and dismissed by her doctors early on, and left clueless about what was happening to her body.
My mother had to fire her gynecologist by the time I was born because he was dismissive of her and incompetent — she later learned that a more attentive doctor wouldn’t have completely missed how irregular my heartbeat was.
Black infants are more than twice as likely to die within the first year than their white peers — a racial disparity that has grown since it was first recorded back in 1850. According to the Centers for Disease Control there are, on average, 700 maternal mortality cases per year. Of that figure, black women are more than three to four times as likely to die from pregnancy or pregnancy-related causes than white mothers.
And as ProPublica, in partnership with NPR, reported, no amount of status, as Beyoncé and Williams can attest to, can protect black mothers from this fate.
According to the CDC, black mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women’s health. Put another way, a black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 243 percent more likely to die from pregnancy- or childbirth-related causes. In a national study of five medical complications that are common causes of maternal death and injury, black women were two to three times more likely to die than white women who had the same condition.
Another groundbreaking point established in this same article is the effect that something referred to as physiological “weathering” can have on black women.
But it’s the discrimination that black women experience in the rest of their lives — the double-whammy of race and gender — that may ultimately be the most significant factor in poor maternal outcomes. An expanding field of research shows that the stress of being a black woman in American society can take a significant physical toll during pregnancy and childbirth.
Arline Geronimus, a professor at the University of Michigan School of Public Health, coined the term “weathering” for how this continuous stress wears away at the body. Weathering “causes a lot of different health vulnerabilities and increases susceptibility to infection,” she said, “but also early onset of chronic diseases, in particular, hypertension and diabetes” — conditions that disproportionately affect blacks at much younger ages than whites. It accelerates aging at the cellular level; in a 2010 study, Geronimus and colleagues found that the telomeres (chromosomal markers of aging) of black women in their 40s and 50s appeared 7 1/2 years older on average than those of whites.
Weathering can have particularly serious repercussions in pregnancy and childbirth, the most physiologically complex time in a woman’s life. Stress has been linked to one of the most common and consequential pregnancy complications, preterm birth. Black women are 49 percent more likely than whites to deliver prematurely (and, closely related, black infants are twice as likely as white babies to die before their first birthday). Here again, income and education aren’t protective.
This means that for black women, the risks for pregnancy likely start at an earlier age than many clinicians — and women— realize, and the effects on their bodies may be much greater than for white women.
In a perfect world the black maternal mortality rate wouldn’t still be what it was during the age of slavery. And that would be because doctors would listen to these womens’ concerns, rather than dismissing them, as in Serena Williams’ case. Doctors would realize that our pain and our health is real, and that we are more vulnerable because of our heredity, our lived experience, and frankly, because of how fraught this world is.
A few days after I first read that ProPublica report I met a woman, not even 35 years of age, who was recovering from a hysterectomy that she was given under a dubious rationale. Another friend of mine chronicled on her Instagram feed how fraught her second pregnancy had become. Later that spring, my mom informed me that a friend of a family friend had died after suffering a brain bleed roughly one year after the birth of her child. She was only 26. Erica Garner’s tragic death this past winter, sadly, is also considered another example of black maternal mortality.
It really is a blessing that Beyoncé and Williams spoke out so bravely about how difficult and dangerous the pregnancies were. My own mother almost died delivering my older brother by emergency C-section, and she had to have a hysterectomy shortly after I was born. One of the things my mom has always said about her experience with my brother was that she felt like she couldn’t give birth to him right. There’s an abundance of shame that attaches to stories like my mother’s. You wouldn’t believe how many people apologize to me when they learn about my heart and the potential of a high risk pregnancy.
I’m not ashamed and I’m overjoyed that Beyoncé and Williams aren’t either. Today, I’m celebrating the 10-year anniversary of my second major open heart procedure — the one that my doctors believe will likely be my last. So, forgive me if I feel a little extra joy at the thought of Serena Williams and Queen Bey, shedding their light on women like my mother and myself. It feels like a second birthday if I’m being honest, because all I hope for — besides relief from the levels of systemic racism encroaching on the health and wellness of black women — is a greater awareness of it for all.