Credit: Darrow Montgomery

Melissa Esposito walked two miles in the snow to get to her third prenatal appointment. It had been so hard to get a time with the doctor, she was scared to reschedule.

Danielle Lloyd endured pregnancy in the food and maternal care desert that is Southeast D.C. She worried about the 40-minute drive from her home to the hospital.

Capri Brown waited two hours to see a doctor after she told a nurse that her water broke. Her epidural hurt more than her contractions.

Renikia Smith was taken aback after she gave birth—her doctor told her that she didn’t have time to do her planned tubal ligation.

Tara Olson, a doula, is tired of watching doctors squeeze bottles of Johnson & Johnson baby shampoo in women’s vaginas as they give birth.

***

These are common tales of pregnancy from the District of Columbia, one of the worst places in the United States, and in the developed world, to deliver a child.

Thus far in 2018, D.C.’s rate of maternal mortality—women who die in pregnancy, childbirth, or in the year that follows—is 36.1 per 100,000 live births while the nationwide rate is 20.7, according to an analysis of data from the Centers for Disease Control and Prevention. And internationally, the U.S. is the only developed country to show a steady increase in maternal mortality from 1990 to 2015, according to a 2017 report funded by the Bill & Melinda Gates Foundation.

Embedded in these numbers is a yet more sinister fact: Black women are three to four times more likely than white women to die from childbirth in the U.S. The District is a case in point. Dr. Roger A. Mitchell, D.C.’s chief medical examiner, testified at a December public hearing on maternal mortality that 75 percent of the maternal deaths D.C. recorded between 2014 and 2016 were black women.

As these numbers emerged, D.C. saw the closure of two maternity wards that served predominantly black and low-income women. Providence Hospital in Northeast closed its maternal and infant care department in October of 2017 without so much as a press release. United Medical Center in Southeast, the city’s only public hospital, permanently closed its maternity unit two months later, after reports of improper handling of patients. Among other issues, the hospital had failed to address, with an HIV-positive woman, the risks of vaginal delivery. The closures have left women east of the Anacostia River without local access to care and have stretched other city hospitals thin.

In late 2017, Ward 6 Councilmember Charles Allen introduced the Maternal Mortality Review Committee Establishment Act. The idea was to form “a multi-disciplinary committee to review all pregnancy-associated deaths occurring during pregnancy, childbirth, or in the year after,” and deliver an annual report based on the findings under the Office of the Chief Medical Examiner (OCME).

“Mortality is the tip of the iceberg,” said Dr. Constance Bohon, practicing doctor and assistant clinical professor of obstetrics and gynecology at the George Washington University School of Medicine, at the December hearing, which dealt with the bill. “The morbidity is where we’re going to be able to prevent more deaths, by looking at those numbers.”

Morbidity is “any health condition attributed to and/or aggravated by pregnancy and childbirth that has a negative impact on the woman’s wellbeing,” by the World Health Organization’s definition.

At its worst, morbidity is a near miss—a brush with death.

Allen wanted to add morbidity studies to the bill. In the committee print, “severe maternal morbidity” is when a woman receives four or more units of blood products or is admitted to an intensive care unit while pregnant or within one year of giving birth. These women are still alive to talk about their D.C. childbirth experiences.

But in February, Allen struck “severe maternal morbidities” from the review committee bill, saying “The inclusion of morbidities would expand the MMRC’s scope beyond OCME’s current capacity.”

***

Sharnita Brice’s first birth felt like a near miss. She remembers seeing blood everywhere. She had gone into labor at 38 weeks with intense contractions. Then she hemorrhaged, and her son was no longer stirring in her womb—he wasn’t breathing. He had no heartbeat. Somehow, she says, her placenta had detached from the wall of the uterus, cutting off her baby’s oxygen supply and making her bleed heavily.

“Time froze,” she says. “Time literally stopped.” It was 2015 and she was 24 years old, laying in a pool of blood and waiting for the ambulance to come and get her. She wondered how she’d gotten here and if she’d ever be the same. She wouldn’t. Next time she gave birth, she thought, she’d have different insurance and a much better experience. She didn’t.

A D.C. resident, she’d planned her first pregnancy carefully. She wanted to deliver at a birth center rather than a hospital because she didn’t want to deal with what she perceived as the culture of hospitals. “In hospitals, you’re on a clock,” she says. “They want to hurry up and get you in and out. The first thought is intervention instead of naturally letting the body go through labor. Our bodies know how to give birth, but they’re quick to give C-sections, inductions, and epidurals. I feel like that’s because there’s money in the business.”

Because she couldn’t find a D.C. birth center that accepted her insurance, she chose one more than an hour away in Arnold, Maryland. But the birth center wasn’t equipped for emergency cesarean sections, so Brice went by ambulance to Anne Arundel Medical Center to have her son, Shiah. She wasn’t able to see him until days later. To quell the depression that followed she’d constantly have to tell herself, “I went through something very traumatic and I’m still here.”

About two years later, Brice became pregnant with her second child. This time she decided to give birth at MedStar Washington Hospital Center, not far from her home in the Takoma-Brightwood area of Northwest. She was covered by AmeriHealth.

Right when she hit the 32 week mark, she got a letter from her insurance company. “They sent me mail stating that they were not in partnership with MedStar Washington Hospital Center and that I wasn’t allowed to go there anymore, after I had been seen there my entire pregnancy and now I’m in my third trimester. When I contacted them, they were just like ‘No, we’re not partnered with them anymore, you can’t be seen there.’ But other places wouldn’t accept me because I was too far gone in my pregnancy. They just acted like it wasn’t their concern.”

After that, Brice missed a month and a half of prenatal visits, and she was considered a high-risk pregnancy given her first birth. She kept trying to contact AmeriHealth, and was finally able to continue with her midwife at Washington Hospital Center.

She still planned to have a vaginal birth despite pressure from the hospital’s midwives to schedule a C-section. At 41 weeks, she went into labor. Days passed and she was still laboring, and doctors told her she needed a C-section because there was too much stress on the baby. Completely exhausted, she agreed. They told her all she’d feel was a little pressure and then she’d be able to have skin-to-skin contact with her baby. But when they began operating, she could feel everything. “I was screaming the entire process about how much pain my stomach was in,” she says.

Then something went wrong with her baby. Her son inhaled meconium—the usually dark green substance of a baby’s first bowel movement. They had to rush him out of the room and he ended up in intensive care for days. She says her doctors told her they weren’t sure when it could have happened. Once again, she wasn’t able to hold her child, named Seven.

In a statement, Washington Hospital Center said, “We regret to hear of negative experiences our patients described to [City Paper].”

She hasn’t gone back to full-time work since birth and doesn’t know when she will. A talented painter, she now stays home with her children and expresses her creativity through her art. It’s been cathartic. She just wants to be home with her children.

***

Credit: Darrow Montgomery

Parsed out, nearly every element of Brice’s story is familiar for pregnant women in D.C. The more than 30 women City Paper interviewed—most of them mothers at each stage of pregnancy and birth, but also doctors, doulas, midwives, and other experts—reported similar hurdles, and many additional ones.

Problems begin with the most basic of tasks: scheduling prenatal medical appointments.

When Lexa Lemieux, 37, of Shaw first discovered that she was pregnant she called her OB-GYN to schedule an appointment at GW Medical Faculty Associates, and was told that she could see a doctor in three months. “I discovered I was pregnant on February 15th, and they were like, ‘She can see you for the first time at the end of June, or the end of May,’ or something. And I’m like, ‘I’ll be past my first trimester by the time you can see me!’” says Lemieux.

Lemieux and her husband decided against seeing her regular doctor due to wait time and instead went to the first person available within the practice. To do that, they had to travel to Bethesda. Following that appointment, Lemieux attempted to make an appointment with the same doctor in Bethesda, but couldn’t get in. She then went to a third doctor within the same practice.

A limited number of available appointments means high competition for available slots. This also means moms-to-be may have to see whichever doctor is available rather than receiving consistent care from the same physician.

It snowed on the day of Melissa Esposito’s third prenatal appointment. The city was nearly shut down, but the appointment had been so hard to get that she and her husband decided to walk almost two miles in the wet cold to the office.

Esposito, now 36, had already been through a confusing number of weeks trying to see a doctor. Her insurance company, Kaiser Permanente, told her that it was their policy to schedule her first prenatal appointment eight weeks after she suspected she was pregnant. She finally saw a doctor, confirmed she was pregnant, and scheduled a follow-up appointment. But when they arrived at Kaiser Permanente Capitol Hill Medical Center in the snow for the third appointment, the office was closed.

In a statement, Kaiser Permanente tells City Paper that it often delays the first appointment for two months: “For a low-risk pregnancy, we have general guidelines to schedule the first prenatal visit for the seventh or eighth week of pregnancy. We usually recommend this time period because it optimizes the chance to see the fetal heartbeat.”

When Celia Valdespino, also 36, first moved from Miami to D.C. she was six months pregnant. “I didn’t think it would be very hard to find a doctor,” she says. Her insurance was through her husband’s military job, so she had to see a doctor at Walter Reed National Military Medical Center. It took her three hours round-trip to go to that appointment. “I had to take the bus and then Metro and then walk,” she says.

She was soon able to switch her insurance plan in order to theoretically have more flexibility in the location of future doctor’s appointments. She attempted to schedule at GW Medical Faculty Associates. “I called GW in December and they said, ‘Oh, we don’t have any appointments until March.’” And I was like, ‘Alright, well, the baby is due March 6th, so what do you want me to do?’ Finally they got me an appointment in the Bethesda office. And that just got me into the system.”

Esposito, Lemieux, and Valdespino are all financially stable with excellent health insurance for these, their first pregnancies. Yet they were consistently thwarted by confusing and overbooked systems.

Women who live in the city’s maternity care deserts—including those with good jobs and insurance—face the same scheduling issues, but also deal with increased travel times and a lack of access to healthy food.

Sharon Culver lives in River Terrace in Northeast but works in Fort Washington, Maryland as a teacher. It’s a struggle for her to get from there to her appointments at Washington Hospital Center, where she plans to give birth. “I do often think about how far it is,” she says. “It’s very chaotic and tricky. Even just coming from my house can be a bit much. If there was something closer, in our ward, that would be beneficial.” She is 31, and due on Oct. 8.

Danielle Lloyd, 33, had to travel from her home in the Capitol View area of Southeast to get to Sibley Memorial Hospital in Northwest to be induced to give birth to her now 10-month-old daughter, Demi. It’s a 40-minute trip without traffic. “It was scary because if I went into labor at home in the middle of the day, we might have a problem,” she says.

“It’s not just access to healthcare in wards 7 and 8,” says Lloyd. “I mean, the area in which I live is a food desert.” Lloyd goes to Maryland and other parts of D.C. for groceries, something that she notes is a luxury to be able to do.

She had to do a lot of vetting of doctors and plenty didn’t have availability. It was not her choice to give birth to her child at Sibley, but the obstetrician that she chose only delivered at Sibley.

It was the same for Kiara Haughton, which is why she traveled from her home in Southeast to Sibley to have daughter Zora in April. “Unless you literally live in Foxhall or off MacArthur Boulevard, there’s nothing convenient to Sibley,” says Haughton, 31. “Those appointments, I’d take the day off or half the day.” It took her more than an hour to get to the hospital when she went to have her labor induced, and she ended up giving birth via an unplanned C-section.

These are the mothers fortunate enough to have stable housing in D.C. Those who don’t face additional hurdles. Jessica Crawford, who is 28 and gave birth to a daughter, Jazarah, on Aug. 18, lived in transitional housing at Mary Claire House in Northeast through So Others Might Eat, or SOME, a nonprofit that serves the poor in D.C. The scariest aspect about pregnancy in the District for her is what she has found to be a lack of dedicated, quality housing for pregnant women experiencing homelessness and housing instability.

Now that her daughter has been born, she has to move because the house is only for adults experiencing persistent mental illness. “I should be nesting, but there’s really no way for me to nest or prepare a space for my child,” she said in the last weeks of her pregnancy.

A caseworker helped her get approved for an apartment, but it wasn’t available until weeks after her due date. “To be moving around after birth and with a newborn is stressful,” she says. “I’m just so grateful that I’ll have housing, so I’m willing to do it.”

Scheduling and keeping doctor’s appointments and travel times have also played hugely into Crawford’s pregnancy. It took her two bus rides in the D.C. summer heat to get from Mary Claire House to MedStar Georgetown for her prenatal appointments.

“I knew it wouldn’t be easy when I decided to keep my baby, but I don’t believe that anyone should have to give up their children or not have their children because they’re poor or because they’re homeless,” she says. “Having this baby is the best thing that ever happened to me, and I know I’m going to be a good mother if I have available resources. The problem is they can give me job training and education programs but if I don’t have stable housing none of that is going to be helpful.”

Crawford, who is white, adds that experiencing housing instability while pregnant is an issue that she has seen primarily hurt black women. She is frequently the only white person in her programs. “It’s heartbreaking seeing all these women suffering,” she says. “How long has this been going on and why has it continued to go on?”

Credit: Darrow Montgomery

Capri Brown, who has also experienced homelessness in the area, says that giving birth to her second child, her now 2-year-old son Dominic, was a nightmarish ordeal at Howard University Hospital. “When I told the nurse to go tell my doctor that I think my water broke, the doctor came in two hours later,” she says. She was then administered an epidural. She hadn’t felt her epidural when she gave birth to her now 7-year-old daughter in Virginia, but she felt this one. “This hurt more than my contractions did,” she says.

Her son contracted an infection post-birth and had to stay in the hospital for 5 days, which Brown says was triggered by the huge delay between when she told the nurse that her water broke and when she actually received care. She and her son both spiked fevers during her 30-hour labor and delivery. She remembers that his heart rate dropped and he stopped breathing for a time. “I was just laying in the hospital bed miserable,” she says. “They were really disgusting and rude. Howard is disgusting.” (Howard University did not respond to several requests for comment.)

Now 27, Brown says she felt that hospital staff viewed her as just another “young, dumb girl in here having another baby.”

Experiences like these contribute to a culture of doctor and nurse mistrust. Congress Heights resident Kaliyma Johnson says she felt pressure from doctors to have an abortion in her first trimester. When the 33-year-old was pregnant with her now 3-year-old son, she says that male specialists she saw for her thyroid condition at George Washington University Hospital told her that due to her thyroid complications, she should terminate the pregnancy and have thyroid surgery instead. If she did the surgery, she wouldn’t be able to have a vaginal delivery ever again.

She cried for two days after that. “They were super pushy,” she says. Her female doctor was her saving grace. “My OB was like, ‘You have time, you don’t have to make this decision today.’” She couldn’t see herself terminating the pregnancy, so she pushed on.

Before Renikia Smith, 33, of Southeast D.C. delivered her now almost-2-year-old daughter Samantha, she knew she wanted a tubal ligation to prevent future births. Samantha is her sixth child. But her doctor with Unity Health Care in Northwest had other plans for after the birth. “My doctor told me that she would do my tubal ligation the next day because she was going to go do her pilates,” she says. “She was going to go do her pilates, so she’ll catch me in the morning.”

She went back to Unity when Samantha was due for her 2-month shots. Surrounded by a crowd of women and their babies also in need of shots, she found out that the clinic only had half the shots she needed. “They were like, ‘You have to understand,’” she says. “No, I don’t. This is my child. She needs these shots. I need my child to be immunized before I drop her in daycare.”

Unity responds that it offers free vaccines to children in need through the DC Department of Health’s Vaccines For Children, a federally funded program. “While we do our very best to make sure we always have vaccines in stock, on rare occasions we may run low,” wrote Deputy Chief Medical Officer Dr. Diana Lapp in an emailed statement. She noted that patients can make another appointment or travel to another center to get the shots.

Smith never ended up getting the tubal ligation, and was pregnant again a little more than a year later with her seventh child, a daughter.

***

Credit: Darrow Montgomery

Pregnant women walk through a revolving door of doctors, sometimes seeing five or more of them, and with no guarantee that the doctor a mother likes and has chosen to be her personal provider will deliver her baby. A doctor who meets a woman for the first time when she’s in the delivery room will not be aware of all the intricacies of the patient nor have developed a rapport with her family, all of which puts mental stress on the mother, who is in the midst of producing life.

Sharon Culver says she doesn’t even remember who delivered her first baby four years ago; there were so many people in the room. “You don’t really know what they’re doing,” Culver says.

Kaliyma Johnson’s delivery doctor was a stranger that she met while in labor at GW. “There was a student shadowing my doctor and checking on me,” she says. “When you’re delivering a child, you want experienced people.”

D.C. women who can afford it have found a patch to cover the massive gaps in their care: They hire a doula. The existing medical system in D.C. is not likely to give a woman a consistent doctor—someone who knows a woman’s body, medical history, and desires for delivery. A doula can be that person, but it costs anywhere from hundreds to thousands of dollars.

For their part, doulas see the system in its entirety, over and over again.

Doula Tara Olson, who has served the D.C. area for 10 years and has four children of her own, says that healthcare functions as a system in this country, and therefore it must be assessed and improved on a systemic level, not simply at the level of individual practices.

A number of system-wide practices worry Olson. She has seen doctors mistreat mothers’ bodies frequently throughout the region.

“No one is talking about the way doctors manhandle a woman’s vagina,” she says. “I’ve seen doctors stick four fingers in and push, push, push back and forth because they have an epidural and they don’t feel anything. But she’s going to feel it later. Imagine someone doing that to you right now. You would feel it for days.”

She continues, “Would you squeeze a bottle of baby shampoo up your vagina? That’s what they do. When the baby’s coming out, they squeeze baby shampoo all over the vagina, all over the baby’s head for lubrication. And that’s a standard practice.” George Washington University Hospital, she says, at least uses mineral oil. Either way, most mothers never fully know what has happened to them during birth.

This loss of body autonomy for mothers becomes the elimination of choice. It creates an atmosphere in which their bodies are no longer theirs, but instead completely at the mercy of doctors and nurses and the property of the healthcare system.

And this is the crux of the cesarean problem: If you tell a woman in labor that she needs to have a C-section, she will have the C-section. The hospital’s power over a woman in labor is nearly 100 percent.

One way for mothers to bypass the potential risks of cesarean surgery is to simply choose a hospital that has a lower rate of unplanned C-sections. But that’s not possible when hospitals aren’t required to report their data.

“C-sections, as anybody who works in healthcare knows, are a really, really big problem in this country,” says Erica Mobley, director of operations at The Leapfrog Group, a nonprofit that tracks hospital data, including the rates of C-sections throughout the United States.

Although some mothers choose cesareans for a variety of medical reasons, it is a surgical procedure that comes with the risks of infection, blood clots, increased blood loss, and potential for complications on future deliveries. A May 2015 report by the CDC states that there is a lower morbidity rate for vaginal births, and that the potential for maternal morbidity increases with the number of C-sections given to a patient.

The Office of Disease Prevention and Health Promotion sets a target rate of 23.9 percent for cesarean sections for first-time mothers giving birth in the head-down position, and Leapfrog has adopted that target.

The George Washington University Hospital’s C-section rate increased from 15.7 percent to 22.2 percent over the last year, and Howard University Hospital’s went from 24.1 percent to 25.1 percent, according to Leapfrog. Sibley Memorial Hospital’s rate was 32.7 percent last year, and though its 2018 Leapfrog data is under review, it reported to City Paper a current rate of 34 percent.

In a statement, a Sibley spokesperson said that the average age of a woman giving birth there is 35, while the national average is 28. “Sibley Memorial Hospital is committed to lowering its C-section rates, but at the same time, the hospital recognizes that these efforts must also be balanced against the need to protect the health and safety of mother and child,” the spokesperson wrote.

MedStar Georgetown University Hospital and MedStar Washington Hospital Center didn’t report their rates to Leapfrog this year or last. All hospitals can respond or update their statistics until December 31.

Michelle Cohen is a certified doula who owns a local practice called Savor It Studios. Cohen has seen first-hand how hospitals can influence the possibility of having a C-section. “I have had, over the years, clients births present in similar fashions with similar scenarios, but they are at different hospitals … and the births are managed completely differently,” she says.

Olson says doctors and nurses intervene in births with C-sections and other intrusions on a systemic level. She sees some doctors explain things logically, and others use fear tactics to coerce women into having the cesarean.

“This is America, we litigate,” says Olson. “I think there’s doctors who are worried about liability, more than a midwife would. A midwife is going to let you have a lot more time, a midwife’s not going to say ‘You need to progress a centimeter every two hours in order to not intervene.’ A doctor’s going to say ‘We need to intervene to make this happen.’ In that sense, there’s a lot of unnecessary C-sections, in which just waiting would have helped. Once you’ve intervened, you’ve intervened. You can’t go back.”

The midwifery program at GW is well known within the region for its comprehensive care. Anna Ravvin, 37, of Cleveland Park had an excellent experience delivering both of her children utilizing the program. “I’m a big supporter of the GW midwives. I think they work,” she says.

But fitting in to the criteria of the program is another challenge. According to their website, expecting mothers must, “Be in excellent health. Be committed to natural birth. Have partners who are engaged in the pregnancy and natural childbirth process and additional labor support (a doula).” These parameters filter out women who may not have access to healthy food or a supportive partner. GW did not respond to City Paper’s specific questions about its midwifery program in an emailed statement.

***

Healthcare reimbursement rates in the D.C. area are some of the lowest in the country.

Dr. Angela Marshall, founder of Comprehensive Women’s Health and board member of the nonprofit organization Black Women’s Health Imperative, says that declining reimbursement rates, combined with the high cost of living, creates a divide in who is receiving exceptional maternal care.

“It’s caused a lot of physicians to opt out of insurance companies altogether,” she says. “That leaves an access problem for everybody, but especially for African-American women who may not have the disposable income to be able to pay for concierge practices,” such as doulas.

Most people in D.C. are insured, but that doesn’t mean that the insurance saves them. According to DOH’s Perinatal Health and Infant Mortality Report for 2015-2016, mothers whose births were Medicaid financed were almost two times more likely than mothers with other types of insurance to have a low birth weight baby.

“Just because you happen to have an American Express card doesn’t mean you have a place to use it,” says Councilmember Allen. “So, if you don’t have a high-quality healthcare provider in your community, you don’t have a trusted primary care doctor, you don’t have the acute care you may need, what does that insurance get you?”

Healthcare guidelines also mean that women are permitted only one doctor visit after delivery. While new parents will have a smattering of appointments to check on the health of their newborns, a 6-week postpartum checkup is the only time that a doctor will see a woman about her recovery.

It is estimated that more than half of women do not attend that postpartum care visit. A 2016 report by Maternal and Child Health Journal found that women miss this appointment for a variety of reasons, including problems finding childcare, difficulty with work and school schedules, and the hassle of finding transportation.

Flexibility with insurance and the ability to see a doctor multiple times following childbirth could identify potential health complications before they turn deadly.

Marshall says that women’s health must become a priority if the city wants to see any progress. “I think sometimes the medical community, the powers that be, really haven’t made black women’s health a priority,” she says. “Women’s health in general has been neglected.”

***

Credit: Darrow Montgomery

D.C.’s maternal care tragedy is not new. CDC data from 1987 to 1996 show that the District then had a maternal mortality rate of 22.8 per 100,000 live-born infants, the highest maternal mortality rate after all 50 states. (The data set compared D.C. against states rather than other large cities, and the District had by far the highest percentage of births to black women.)

This April, DC Department of Health released its Perinatal Health and Infant Mortality Report for the 2015-2016 year. Black mothers throughout the city—but particularly mothers living east of the Anacostia River—were significantly disadvantaged. Only 52 percent of non-Hispanic black mothers entered prenatal care in the first trimester compared to 86 percent of non-Hispanic white mothers and 64 percent of Hispanic mothers.

The District’s response continues to be as meager as the data are devastating.

Councilmember Allen’s Maternal Mortality Review Committee became law, sans morbidity studies, in June. The committee had an initial budget of $88,000 for one full-time employee for the first year, and expects to add a second.

Mayor Muriel Bowser will host a “maternal and infant health summit” with “mayors and leaders from across the country” in September, according to a press release. “We are working every day to ensure that all women have equal access to high-quality health care before, during, and after child birth—regardless of background, zip code, or income,” said Bowser in the release.

As far as tangible change, Howard University Hospital and Unity Health Care have partnered to open a new Unity health center in Ward 7 in 2019. It will provide prenatal care, but it won’t be a hospital with a functioning maternity ward. George Washington University Hospital, along with Bowser and her administration, has signed a letter of intent to open a hospital that will provide obstetrics, expected to open in 2023 on the St. Elizabeths East campus in Ward 8.

“If you look at it,” says Ward 7 Councilmember Vince Gray, “the baseball stadium that was housing the Nationals in the District of Columbia at this stage was done in 22 months, which is far faster than what this timetable is currently for the new hospital.”

“It’s a huge issue that we don’t have a hospital east of the river,” says Ebony Marcelle, the director of midwifery at Community of Hope’s Family Health and Birth Center in Northeast, which primarily serves black women from wards 7 and 8. “UMC wasn’t perfect and they definitely have their drama. I get it. However, for me, a lot of times it was like a gateway for my women in Ward 8. It would be a start sometimes for them. It takes two hours to get across town on a bus to Northwest,” she says.

“As far as care is concerned, we have a lot of cultural barriers that we’re not really discussing. I keep sitting in these meetings and everybody looks at the ground when I’m like, ‘Can we talk about the generational distrust?’ Let’s not act like things did not happen. I know I’ve got an auntie that was in the North Carolina unknown sterilization project,” she says. “There’s a reason why we are nervous. Then when you add on the complexity of women in poverty who are trying to survive, their bodies, their health is not a priority. You keep asking her to prioritize herself. She doesn’t know how to.”

***

The bright spots in the morass for the pregnant women of D.C. are friendships and community groups, doulas and midwives. When Marcelle is training midwifery students or talking to residents, she always tells them one thing: “Do not forget how much power you have to impact women’s lives through your care.”

Places like Community of Hope and Mamatoto Village, a maternity support services organization directed by Aza Nedhari, are helping women across the city buck the strains of the healthcare system. Instead of being rushed in and out of medical offices and experiencing doctors who treat them like a cog in a baby-pumping machine, women are getting personal, individualized care from doulas and midwives who are there to advocate for pregnant women.

Renikia Smith, whose doctor rushed to pilates after she requested a tubal ligation, lives in Southeast near Community of Hope’s Conway Health and Resource Center. She receives prenatal and medical care and participates in pregnancy centering groups there. “It’s like family,” she says. “Once you find someone you can trust and you can actually deal with, you don’t want to let them go. It’s hard to find reliable doctors that you actually like and want to be around.” In her centering group, she and the other women painted casts molded from their pregnant bellies with the help of volunteer doula Stephanie Law.

Sylvie Nguyen-Fawley, who lives on Capitol Hill, says she had a wonderful pregnancy. She gave birth to her daughter, Adeline, at 37 via a planned C-section at Sibley. Nguyen-Fawley contributes her positive experience to a number of factors. “I’m privileged,” she says. “I worked at a very supportive office, had sick leave, and had good health insurance.”

She actively sought out connections with other new moms on Capitol Hill in order to build a network of support. “I leaned so much on people. I asked questions and followed up with my own research.”

“Care providers, employers, family—all of these things have to work together,” says Kiara Haughton. “And at any point in time in D.C., especially if you’re black and especially if you’re a black woman, any one of those things can not work and can set you in a tailspin situation.” She hired doula Ravae Sinclair to help her through her pregnancy, and sings her praises.

Jessica Crawford thinks that women should not be punished in their city for having the audacity to be pregnant. “I just want to be a mother,” she says. “I just want the opportunity to focus on what colors I want in my baby girl’s room, to think about things like breastfeeding and where she’s going to go to daycare. I just want to be able to focus on becoming a mother.”

Do you have a pregnancy or childbirth story you want to share? Let us know at washingtoncitypaper.com/pregnancy or email krandall@washingtoncitypaper.com.