Misogyny and racial bias in medicine; I believe her.

 by Karla Lester

Dr. Janelle Green Smith died from the complications of childbirth in January

Nothing activates patriarchal medicine more than a female doctor who decides to have a baby. I thought he was going to punch me in the face. It was 2001 and his name, Dr. Ben G. (as Taylor Swift sings, the smallest man who ever lived), an Emergency Medicine doctor in St. Louis, where I worked as a pediatric hospitalist in the ER and covered the newborn nursery. My job included going to the delivery room and taking care of babies who may be born prematurely or in distress. I was just out of residency training when I took the job as my husband was completing two years of fellowship in pathology at WashU. Over my two years of being a hospitalist in a community hospital, I took care of many children, adolescents and babies who were very ill. I loved working nights with the ER nurses and the labor and delivery nurses. They were awesome at their jobs and good friends and threw me a baby shower before our daughter, Katherine, was born. It was an exciting and stressful and sleep deprived time with our first baby. To say we were obsessed with Katherine is an understatement. We had decided to join practices in Lincoln, Nebraska and move in July to our new home. 

I had an agreement with the administration that I would come back after maternity leave (unpaid, of course) for 16 shifts. I was hired to be an employee of the hospital and had full time benefits with the PTO that I built up to take when Katherine was born. We were paying our medical student loans and my husband was a fellow and I was going to be off work, without pay, so I very much needed the few thousand dollars I had built up. We were notified just before the end of the year that an agency would be taking over staffing the ER and the physicians would no longer be employees of the hospital system, but would be independent contractors under this company and Dr. Ben G. would be in charge of me and the other pediatricians and ER doctors. We would lose our benefits, which would include my PTO I built up. The administration at the hospital told me I would need to come back after my leave and work 16 shifts in order to get access to my PTO. By the way, this is happening across the country with private equity buying up healthcare systems. It’s bad news all around, especially for patients. 

Back to when I thought he was going to punch me. It was my first shift back after maternity leave and Dr. Ben G. just heard that I was moving. I got paged to the ER. “I need to talk to you.” He pulled me into the trauma bay, got in my face, pointing and spitting, “I’ve bent over backwards for you. You lied to me. You deceived me.” I literally didn’t know why this little man was stroking out over my life decisions. How are you relevant in any way? I think the hospital administration told him I was staying, so when he found out I was moving to Lincoln, he flipped out on me. That meant he would need to recruit a new pediatrician and without benefits to offer, was going to be a heavy lift for a weak man. 

Misogyny in medicine. Didn’t give it a name at the time. I went on with my work day (night) and finished out my shifts. It was aggression though and it was harassment and abuse. It was actually quite scary. Shoutout to my MIL who came and stayed with us for a month to take care of Katherine so I could work. 

We moved to Lincoln in July, 2001. My second pregnancy was in 2002, but after a rough night on call without sleep, I started to bleed and cramp at clinic when I was seeing patients. The next day, the ultrasound showed nothing. I had miscarried at 12 weeks and went back to work. At the next partner meeting, a few days after my D&C, after a full clinic day of seeing patients, one of my partners, Sole Bread Winner, as he referred to himself to evoke pity from me many times, came into my office, stood over me, patted me on the shoulder, and instructed me to, “Get back on the horse.” The comment was crude and cruel like Sole Bread Winner. Believe people when they show you who they are. 

Misogyny in medicine. I didn’t give it a name at the time and went on with my busy life. I followed through with my prenatal visits with prospective parents at St. Elizabeth’s and watched the baby bumps grow as mine didn’t. I had panic attacks in the bathroom stall before going into the group prenatal visits. It was never a question that I would continue to do the group prenatal visits because the practice was growing and if I would have brought up my panic attacks, I would have appeared weak and would have been chided. I knew that much. Didn’t name it. Didn’t call it what it was. 

Pediatric call was very busy. I never had a problem with it. I actually enjoyed it and did fine with grinding it out. But, after my miscarriage, when I became pregnant with Audrey, my third pregnancy, I was worried about taking call during the first trimester, so my OB wrote a note to my partners to let them know I shouldn’t take call the first trimester. Again, just like most women in America, there is no paid maternity leave and so I took 12 weeks off and it was during the holidays that I came back and was put on triple call to make up for my absence. After falling asleep driving to one of the hospitals in the middle of the night, after clocking three nights of no sleep, jolted awake when I hit the median, I decided to speak up. I was met with, “Karla, are you okay with taking call like the rest of us?” 

“Of course, I’ve always taken full call. It’s not okay to schedule me for triple call.”  I was dehumanized. Produce for the patriarchy. Punished for my unpaid absence. 

I was always so full of dread to tell them I was pregnant. With Andrew, my fourth and last pregnancy, I was too busy to care about the comments. I also didn’t care about their opinions of whether I should have another child or not. The aggressions continued. Their business plan was for me to be an employed physician, but as a former owner, that wasn’t going to work for me on any level. Call it providence, but this was the time when the vision for my nonprofit, Teach a Kid to Fish, the love of my career, came to me. So, I left my practice of patients and families I loved to move forward with my vision of “creating community solutions for children’s health”. 

This is barely a glimpse into what was to come in my career and the blatant misogyny and entitlement to what I created. I’ve faced so much blatant misogyny in my career as a doctor, she’s her own walking and talking being who could write her own book. But, I didn’t give it a name and I didn’t center myself because there are more pressing issues and crises that exist and deserve my voice and all of our voices. 

Medical misogyny is deadly for patients, especially when mixed with racial bias. Black women in the U.S. are 3 to 4 times more likely to die in childbirth than white women. Black women have the highest maternal mortality rate of any racial/ethnic group in the United States.

Dr. Janell Green Smith, a doctor in nursing and midwife in South Carolina, advocating to end preventable black maternal death in her daily work, died in January from complications of childbirth at age 31 after delivering her first baby at 32 weeks by emergency C-section. Dr. Green Smith focused her work on helping Black women deliver safely, but developed pre-eclampsia and died from complications after childbirth. 

The causes of maternal death driving the Black-White gap are from eclampsia, preeclampsia, postpartum cardiomyopathy, obstetric embolism and hemorrhage. The gap is not explained by individual-level patient risk factors alone. The Black maternal death crisis in the U.S. is multi-causal, related to systemic racism, implicit bias and disparities in healthcare. 

Things will get worse before they get better. Trump and the GOP’s OBBB guts Medicaid by $880 Billion and has created urban and rural OBGYN deserts of care. Dr. Oz says we are “underbabied” in the U.S. as reproductive rights are being stripped away. Erika Kirk recently told young women to have more babies than you can afford. The audience cheered. Their goal is more MAGA babies and silenced women. The Save America Act, if it passes, guts voting rights for women. 

To turn the tide, there are things we can do. Acknowledge that misogyny and racial bias in medicine are real. 

Believe her.

Give it a name. 

Learn how to be an ally.

Go on social media and listen to the stories of black women. I learned from a creator on TikTok who shared the ways white women can support black women and how to be an ally.

“If you work in healthcare and you see that a black woman is in pain and being looked over, pay attention to her. If a black woman is crying or says she’s in a lot of pain or she’s in labor, believe her.  Believe her and treat her as you would a white woman. Make no deference, have no difference. Treat her with empathy, with care and with the oath that you took. If you see a black woman speaking and she’s getting cut off, speak up for her. Don’t sit in silence. ‘I think Kathy was saying something that affords our attention. Let’s give her the opportunity to continue her thought.’Refrain from dismissing lived experience that is happening right now. Seek unity, allyship and connection. When voting, vote for all women.”

My perpetrators were irrelevant in my care for patients who I loved and cared for. My journey in medicine and my role as a mother has been my own. I intentionally didn’t give it a name. Now, grateful for not centering myself, I can learn to be an ally for black women and babies. I listen and I believe fully, knowing the impact of what I went through is multiplied for Black women. It is a call to action to advocate to end preventable Black maternal deaths in America. 

Resources:

Sheshavingababy is a content creator I follow on TikTok. She is an excellent advocate for Black maternal health.

Licia, MD just started residency in OBGYN and is great to follow.  

“Birth Vibes” by Jen Hamilton is a good book to check out. 

Shannon M. Clark, MD, FACOG is a recommended doctor on social media. 

Check out Black Mamas Matter Alliance and download the Impact report to learn more.