The Painful Truth about Being Pregnant and Black in Nebraska

The baby monitor Lisa Billingsley got at her shower echoed the sounds of a silent nursery weeks after the birth of her first child. Instead, Billingsley herself was monitored by constantly beeping machines. Her son’s first moments were backdropped by starch hospital white and not the bright yellow Billingsley carefully chose for the nursery. 

She did not pace the length of the recently decorated nursery hoping her son would drift into sleep. Instead, she laid with him in her hospital bed with a feeding tube down her throat making it difficult to turn her head to see the infant placed in her arms. Most new parents would be praying for their baby to fall asleep, but Omaha resident Lisa Billingsley was wishing she could stay awake. 

In 2009, Billingsley spent her first three weeks of parenthood hospitalized, unable to eat on her own or walk without assistance after severe blood loss during labor caused the paralyzation of her intestines. 

Delivery by a cesarean section usually takes around 45 minutes, according to the Cleveland Medical Clinic. Billingsley laid on the operating table for 2.5 hours. 

“They ended up having to put me under because I started to tell them that I could feel whatever they were doing,” Billingsley said. “They kept telling me, ‘No, you can’t.’ I said, ‘Yes, I can. I can feel that.’”

Billingsley expected some complications. She was 40 years old and suffers from an autoimmune disease that can cause pregnancy complications. She researched doctors and was on a premium health insurance policy. But she didn’t know in Nebraska, her race alone made the chances of her child dying during birth twice as likely as a white baby. 

The average infant mortality rate per 1,000 births for all birthing people over 40 in Nebraska from 2015 to 2017 was 6.9. The same average for Black birthing people over that same period was 10.9, according to March of Dimes, a national organization that has been working for 80 years to help with the country’s high maternal and infant mortality rates. In recent years, March of Dimes has started programs focusing on making maternal healthcare more accessible and equitable and last year it gave Nebraska a D+ grade for its performance in preterm births, lower than the national grade of a C-. Douglas County received a failing grade.

“I had never even considered what I went through because of my race,” Billingsley said. “But then when I saw that there were reports of so many Black women having so many problems with childbirth, I wondered to myself well then was that part of it?”

Diedre Cooper Owens, the director of the Humanities in Medicine Program at the University of Nebraska-Lincoln, explained doctors ignoring Billingsley’s pain is a common experience for Black patients. 

“Often Black birthing people are not believed when they say they’re experiencing pain or some complication,” Owens said, “There’s a lot of patient blaming that goes on when we think about Black mothers and Black birthing people.”

Black parents in Omaha face significantly higher rates of birthing complications due to a lack of medical care in areas with a majority Black population, lack of access to alternative maternal care like doulas and midwives and an implicit medical bias against Black birthing people, according to Owens.  

“The stats have really been unchanging for decades,” Owens said. “Black women and their children are suffering more — or in the worst cases, dying — because of this legacy of medical racism.”

And despite efforts to change that, including new legislation from State Sen. Machaela Cavanaugh to expand Medicaid coverage for birthing parents, Charles Drew Health Center helping moms in medical deserts or groups like the Women’s Fund of Omaha and Nebraska Friends of Midwives fighting for reproductive rights and the allowance of midwives to practice freely in the state, the gap in mortality rates between white and Black babies remains stubbornly wide.

March of Dimes reported that the disparity ratio in Nebraska showed no improvement in 2020 while the national levels of disparities in preterm births worsened. 

“What are some of the first steps and best practices that are going to happen with medical practitioners in hospital systems to ensure that Nebraska can actually reverse its numbers in terms of maternal morbidity, and mortality and infant mortality?” Owens asked.

The Legacy of Medical Racism in Action 

Candy Zollicoffer, a Black woman who lives in Omaha, faced criticism from her doctor after she refused a lengthy test for gestational diabetes, a type of diabetes that occurs in pregnant people. She was asked to take the test again after failing an initial screening for the condition. 

Black birthing people in the US are 63% more likely to have diabetes than non-Hispanic white birthing people, according to data collected by the Centers for Disease Control and Prevention. However, there is no biological or genetic reason for this disparity and instead is the result of decades of unchanging living conditions for many Black birthing parents in this country, Owens said. Pollution levels, lack of hospitals, underfunded hospitals, and a lack of diverse food offerings are some of the unchanging conditions Dr. Owens cites the poor birth outcomes of Black people across the country. 

Zollicoffer tried to explain she forgot she was not supposed to eat before the test which may have caused the result, but she was sure none of the issues she was facing were the cause of gestational diabetes. Earlier in the pregnancy, Zollicoffer experienced extreme morning sickness and her doctor prescribed medicine known to cause fatigue to combat nausea.  

“I didn’t have the energy to sit up there for three hours, so I asked, ‘Can I just take the one hour test again?’” Zollicoffer said. “The doctor then tells me, ‘Okay, Candy, I’ll play your game,’ and I’m like, this is not a game. I want you to take me seriously here.”

Zollicoffer was confident she knew her body and knew that gestational diabetes was not the cause of her complications. At 34 weeks pregnant she decided to switch doctors and hospitals. Her new doctor diagnosed her with preeclampsia, an often fatal complication characterized by high blood pressure. 

“Once they determined that [preeclampsia] was what was wrong with me and not gestational diabetes, I actually had to be monitored even more closely and then had to deliver my baby a few weeks early,” Zollicoffer said. “Had I not taken the time to advocate for myself I could have put myself and my baby in danger.”

Zollicoffer was not significantly more likely to have preeclampsia because she was Black, however, she was two to three times more likely to die from the complication than a white woman, according to a study conducted by the National Center for Chronic Disease Prevention and Health Promotion.

Though these disparities are longstanding, COVID-19 has shone a harsh light on them as well as inequity in all types of medicine, said Rahul Gupta, chief medical and health officer and senior vice president at March of Dimes. 

“With COVID-19, there’s no reason that there will be some people who are genetically more apt, but you’re seeing two and a half times more African Americans die,” Gupta said. “These pandemics are uncovering the ugly truths that are under the hood.”

Ending the Disparities 

One ugly truth is the prevalence of maternal health care deserts. North Omaha, a neighborhood with a predominantly Black population, has a stark lack of full inpatient care centers. There is only one hospital north of Blondo and east of 145th Street that delivers babies. 

Midwives are medical professionals that typically offer holistic care to parents through their childbearing years and beyond. Doulas serve as a non-medical support person that offers parents physical and emotional support, information and guidance, and advocacy. 

Nebraska is one of 16 states that doesn’t offer a form of licensure for midwives unless they’ve already become a registered nurse in the state. The state is one of seven to prohibit home births with a licensed midwife. 

Calida Gardner, a certified nurse-midwife at Nebraska Medicine, explained that the strict rules in place create complications for all midwives and parents looking for adequate health care. 

“I have strong roots like in the North Omaha community. I can see firsthand what is going on in our community,” Gardner said. “I have a strong desire to … want to help grow and shape our community and help better the health of our community.”

Gardner believes that midwives serve to promote a continuum of help for parents throughout their childbearing years. She explained that anything to help close the gap in maternal outcomes for Black birthing people should be welcomed and will ultimately save lives.

“Midwifery care is all about helping the underserved community to try and develop through the education of women,” Gardner said, “To help them understand how to care for their bodies, how to care for their babies, how to care for their pregnancy.” 

Nebraska does not license doulas, meaning Medicaid will not cover their services. Doulas are not medical professionals and do not deliver babies. Instead, they offer guidance and techniques throughout the birthing process for parents. Limited research suggests doula services can lead to a decreased use of pain relief medication during labor, a decreased incidence of C-sections, a decrease in the length of labor, and a decrease in negative childbirth experiences.

State Sen. Cavanaugh introduced LB416 this session. If passed, the bill would require the state to set aside funds to reimburse doulas at the Medicare rate. Cavanaugh suggests the state avoid creating a barrier of entry for currently practicing by requiring a license. 

“We place a very high premium on families and children here in Nebraska,” Cavanaugh said. “So it makes sense to me that we would be a leader in proactive, strong legislation that improves our outcomes in maternal health”

LB416 includes a requirement for all licensed health care professionals to undergo implicit bias training. The bill also requires state Medicare to cover people with uteruses for a full 12 months postpartum instead of the three months it currently covers. 

Although LB416 would make the changes March of Dimes recommends for combating racial disparities in healthcare, Cavanaugh has tried to introduce a Black maternal health bill in the state legislature before that did not make it out of committee. She says she will continue to try and pass the components of the shutdown bill in smaller pieces starting with LB416.

Charles Drew Health Center has programs currently in place to address racial disparities in maternal health care. The North Omaha-based clinic offers Omaha Healthy Starts, a program aiming to improve infant mortality rates.

Along with Omaha Healthy Starts, Charles Drew works to include Black and other non-white parents in the data for Nebraska in the areas of overall pre and postnatal care, said program manager Kimberley Barnes.

Several organizations work to improve health outcomes for Black birthing parents through providing resources on breastfeeding. In 2015, 69.4% of Black infants breastfed while 85.9% of white infants breastfed, according to data published by the CDC. 

“I wasn’t necessarily encouraged to breastfeed. It was something that I knew I wanted to do and so because of that I took the time to research for myself,” Zollicoffer said. “If you’re a Black woman, if you’re not raised to, or if you’re not around women growing up who breastfed, it’s not going to be a natural inclination to say, ‘Oh, I want to breastfeed too.’”

Entirely unaffected by a parent’s decisions to breastfeed are preterm deliveries which often lead to further health complications for infants. March of Dimes reported that in Nebraska, the preterm birth rate among American Indian/Alaska Native birthing people is 44% higher than the rate among other races.

Despite organizations like Charles Drew promoting prenatal care for people with uteruses in North Omaha, they cannot offer the full delivery care of a hospital. 

Effects of the Maternal Health Gap

Although many parents and babies do not make it after complications like Billingsley and, both birthing parents and their babies are healthy today. However, both parents wonder if their negative experiences could have been avoided.

Billingsley believed her premium insurance and well-researched doctors would be enough to combat her complications. Despite this, she still spent her first moments of parenthood bleeding out on an operating table wondering if her baby was going to make it. 

Billingsley’s son didn’t cry when he was born. In the panic of the operating room, the doctors left her opened up on the table unable to see what was happening to her baby. She remembers turning to her husband for answers and the only thing he could tell her was, ‘He’s cute.’

Her son eventually let out cry and after three weeks he got to go home with his mom who was finally able to bounce him to sleep. Today, both Billingsley and her son are doing well. However, roughly 700 birthing people die annually from complications in during pregnancy and delivery and Black birthing parents are two to three times more likely to experience fatal complications than white birthing parents, according to the CDC. 

Zollicoffer a busy parent of three with another on the way could barely stay awake long enough to work, yet her doctor wanted her to undergo a three hour test despite Zollicoffer’s confidence she did not have gestational diabetes. Feeling unfairly treated and ignored Zollicoffer made the stressful decision to switch doctors well into her pregnancy. Her new doctor diagnosed her with an illness that if unrecognized can kill. 

If she hadn’t made the decision to switch doctors, her child could have been one of 10,500 babies that die because of preeclampsia every year, according to the Preeclampsia Foundation. 

Today Zollicoffer and her son are healthy, but she wonders if her pain and discomfort could’ve been lessened if the doctor listened to what she had to say about her own body. 

“Moms, especially Black moms, have to advocate for themselves because sometimes we are looked at as if we can handle this pain,” Zollicofer said. “There’s this narrative that Black women are so strong that they can handle any type of pain, and yes, we can handle pain, but do we have to?”

contact the writer at news@thereader.com

This story was updated on March 18 at 12:30 p.m. to reflect more inclusive language.