When Jaymie Rivera-Clemente reflects on her four pregnancies, there’s a common thread running through them – her healthcare providers failed to properly communicate with her each time.

“I ended up crowning my first child on the toilet simply because the nurse didn’t feel the need to make the difference in the type of pressure that I was feeling,” Rivera-Clemente said.

That was just one of Rivera-Clemente’s poor experiences with doctors and nurses while giving birth, and she’s not alone. Black women often struggle to be heard in those crucial settings, Rivera-Clemente said, and it can have disastrous consequences.

In Texas, where maternal mortality is already high, Black women are more than twice as likely to die as the result of their pregnancy than white women, according to a 2018 report from the Department of State Health Services. The report also said that of the 118 deaths studied, all of which happened in 2012, eight out of every 10 were reasonably preventable. 

Overall in Texas, approximately 14 Black women die for every 100,000 live births. For white women, the rate less than half that. 

Rivera-Clemente, who now works for the advocacy group the Black Mamas Community Collective, Houston State Rep. Shawn Thierry and experts met recently during the Texas Black Legislative Caucus Summit to discuss how to address the high Black maternal mortality rate.

Thierry, D-Houston, has filed several bills this legislative session to expand Medicaid coverage for maternal health and to mandate implicit bias and cultural competency training for medical students and current general practice, pediatrics, obstetrics and gynecology physicians.

The bias training, Thierry said, is crucial to correct inaccurate beliefs among the medical community that Black women have “thicker skin” or can tolerate more pain than their white counterparts, which can lead to mistakes being made when these women are receiving any kind of treatment, not just maternal healthcare.

“I’ve heard people say that African-Americans’ blood coagulates faster,” Thierry said. “This is systematic decades and decades of misinformation and misinformation. That’s how it’s affecting people. I want when you say implicit bias, say racism.”

Despite knowing otherwise, some Black women may end up being afraid to speak up, Thierry said.

“There’s a fear because of stereotypes as a Black woman that if you were to actually speak and advocate for yourself, even when you’re in crisis, that you may be retaliated against,” Thierry said.

Implicit bias, as well as the difficulties in getting healthcare professionals to listen in times of need, can destroy faith in doctors, said Rivera-Clemente, who also now works as a doula – a person trained to provide information, emotional support, and physical comfort to a mother before, during and just after childbirth– helping women get through their pregnancy as smoothly as possible.

(Doulas are often paid for out of pocket and are not covered under Medicaid, making them inaccessible to many low-income women).

“You’re not listening to us [during childbirth], and then we come into the office after we have a baby…I don’t trust you, and I don’t trust you to listen to me now,” Rivera-Clemente said.

Thierry is also working on bills to establish August as Maternal Health Awareness Month and create an online database to track maternal mortality and morbidity across the state.

Beyond legislative action, Dr. Michele Rountree, Ph.D., an associate professor at the Steve Hicks School of Social Workat the University of Texas at Austin, said there also needs to be a focus on diversifying medical schools and the medical field as a whole. 

Rountree said this would go a long way toward improving trust between the Black community and the healthcare field, where just 7 percent are Black, though Blacks comprise nearly 12 percent of the state’s overall population.

“There is a grave underrepresentation in health care in Texas,” Rountree said.

Rountree said the implicit bias and cultural competency training has the chance to improve how the medical community understands Black women, who often face some of the hardest discrimination throughout their lives, which can affect their mental and physical well-being.

“African-American women are disproportionately affected by multiple sexual and reproductive health conditions compared with other races and ethnicities, and research suggests that racism is an underlying determinant of social condition,” Rountree said. 

“For Black women, it’s as though we are living our lives with our foot on the accelerator constantly with the experience of discrimination or anticipation.”

Pending legislation

House Bill 411– Would expand Medicaid coverage for eligible pregnant women to 12 months postpartum compared to just 60 days. 

House Bill 606– Would allow for automatic enrollment in the Healthy Texas Women program for anyone previously covered under CHIP or Children’s Medicaid as soon as they reach 18.