1. Robinson-Lane, Sheria G. PhD, RN


A pregnant nursing professor well versed in health disparities takes a path less traveled.


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At age 38 I found myself happily pregnant-11 years after my first child and surprisingly after only one round of in vitro fertilization. Despite the initial disappointment of a vanishing twin, and the adjustment of transitioning from the familiarity of weekly, sometimes daily visits with my reproductive endocrinologist to monthly visits with a new obstetrician, I fell into my geriatric pregnancy with the confidence of a "been there, done that" mom. Since I'm a nursing professor at a university connected to a large teaching hospital, many of my colleagues were surprised to learn that my chosen delivery hospital was a small, moderately rated, older urban hospital in a different city. What they did not understand was the statistic that kept running through my mind.

Figure. Illustration... - Click to enlarge in new window Illustration by Annelisa Ochoa

I knew getting pregnant meant that regardless of my socioeconomic status or education, as a black woman I was more than three times as likely to die during labor or in the weeks afterward compared to my white counterparts. As I read articles about this phenomenon, trying to understand how to best decrease my risk, I was dismayed at the commentary. Response after response was from health care professionals, mostly nurses, touting years of experience and dismissing both the data and the first-person accounts of black mothers who described challenges in communicating with providers and care they believed had been affected by implicit racial bias. With this in mind, I decided to improve my level of comfort-and possibly decrease my level of risk-by having my baby at a hospital that cared for more minorities and delivered more black babies. I quickly settled on the same small, no-frills, "baby friendly" hospital where I'd delivered my son. Eleven years later the hospital looked notably aged, with few updates. The neonatal ICU was still a level IV though-capable of caring for babies born as early as 26 weeks. I knew I was in good hands.


I found a black obstetrician with admitting privileges at my chosen hospital to manage my care and for good measure also hired a doula. It was she who I chose to call first when I awakened from an afternoon nap a few days before my due date with an overwhelming feeling that something was wrong. As I put my hand to my belly, expecting to feel the firm warmth of my baby, my touch was met with a cool soft void. My heart rate quickened and skipped a beat as I felt the warm flush of panic begin to envelop me. I took a deep breath and reminded myself that I had to keep calm. As I arose from bed to get dressed, I went through a mental checklist of the things that needed to be done-get in the shower, grab the hospital bag, call the husband, call the sitter, call the doctor, and watch the time for kick counts. As I headed to the shower, I pressed my fingers against my enormous belly, searching for my baby. I found her completely balled up on my left side. I gave her a bit of a shove, then a little jiggle-nothing. Once in the shower, I knew for sure that she would get moving once the warm water came down; she always moved a bit in the shower. Again, there was no movement. As I drove myself to the hospital, I called my doula to tell her I was heading in. We met up with my husband on the labor and delivery unit. A few minutes after arriving on the unit, I finally felt a movement.


During the fetal nonstress test the baby moved not quite as much as expected, but enough so that the resident and student assigned to my care scored my test as normal. I was quickly discharged and advised to follow up with my obstetrician in the morning. So I was surprised when I got as far as the hospital parking lot and received a call from my obstetrician requesting that I return to the unit. Although she wasn't on the unit at the time, she was not comfortable with the decreased movement on the nonstress test and wanted to induce.


During my induction, I responded poorly to the medications and experienced a significant drop in blood pressure. Further, cord compression was discovered in multiple positions that caused substantial drops in heart rate for the baby-probably also the cause of the decreased movement experienced earlier. In the end, I avoided a cesarean section and delivered a healthy baby girl. I'm not sure if I would have had the same outcome at a different hospital or with a different, less cautious provider, but I'm thankful things worked out the way they did.