Consider Annette, who was in her mid-thirties when she became pregnant with her first and only child—her now five-year-old daughter. Annette earned her law degree from an elite university and worked as a lawyer for a nonprofit in the Bay Area. She described herself as multiracial; however, “if I have to check one box, I check ‘black.’” I talked to Annette about her pregnancy over Zoom during the worst of the pandemic in 2020as her little girl popped in and out of frame throughout the conversation.
Annette told me that when she was in her sixth month of pregnancy, her heart sometimes beat irregularly. The irregularity would last for hours at a time. Occasionally, her heart raced for so long and with such unevenness that she went to an emergency room for help, but the irregularity always went away when she was being observed. Annette always reported her symptoms to her midwives at the prenatal care appointments that followed her emergency room visits, and her midwives always dismissed the possibility that the symptoms were a sign of a more serious condition: “They all said, ‘Your body does weird things when you’re pregnant. Or maybe it’s stress.’ But no tests, no nothing.”
When Annette finally went into labor—after several more trips to the emergency room—the heartbeat irregularity returned. Because she was already in the hospital, her providers decided to perform an electrocardiogram, which revealed a pregnancy-triggered heart condition. Because of the condition, Annette had to deliver her baby in the cardiac intensive care unit(ICU). Her labor and childbirth were nightmarish.
Nearly everything went wrong. The physician who attempted the Foley bulb induction was a fairly unskilled resident, and the procedure was “excruciating” as a result: “They had a resident doing all of these things. It felt to me that they were saying, ‘Resident, this is a great way for you to get practice. This is a great opportunity for you to get your hands on a really once-in-a-lifetime thing.’ They made that choice instead of saying to themselves, ‘Wow, this is probably the most physically traumatic day of this woman’s life. Let’s just have the actual [attending physician] insert the Foley bulb.’ No. They didn’t consider my experience of the whole thing. Instead, they had this fucking resident who’s like, ‘Ahhhh, I can’t . . .’”
Then when it was time to push, Annette suffered a third-degree vaginal tear, which her providers, again, allowed a resident to suture: “They had the resident do it! And he was doing it wrong! And so, [the attending physician]had to come in and be like, ‘Oh, no, no, no, no!’” Finally, when Annette was in the recovery room, resting after the birth of her daughter, her heart began to beat irregularly again, making it necessary for her to go back to the cardiac ICU—without her daughter: “And it’s seared off in the most awful way in my brain— the sound of her crying when they took her out of my arms.”
Five years later, Annette still became visibly angry when she talked about her experiences during her pregnancy. By the end of our conversation, her face was flush and her voice quivering:
It’s upsetting. I mean, I didn’t die. My daughter didn’t die. I’m well aware that it could have been so much worse. But for me, it comes back to this question. . . . I don’t know. . . . If I was some pretty, rich, thin, white lady having my heart race, would my midwives have been like, “Oh, we’ve got to get you into the— . . . .”? You know what I mean? As opposed to, “Oh, I think it’s just stress,” when it was a fucking heart condition that could kill me or cause my daughter to die if it’s not managed. No one paid attention the whole time that I was paging the doctor quite literally saying, “I think I’m dying.”
Annette’s class privilege— her juris doctor degree from a top law school, her status as a civil rights attorney— did not guarantee her a positive experience with reproductive healthcare. During her routine prenatal care appointments, her midwives did not insist on figuring out why a racing heart had sent her to the emergency room on multiple occasions. During her labor and delivery, Annette’s doctors did not think about what it must have feltlike to her to be diagnosed with a potentially fatal condition on the day that she was to give birth to her first child.
Now, of course, it is not clear that Annette’s black race explains why they had such traumatic experiences. People of all races in the United States have terrible encounters with healthcare institutions. Further, scores of women of all races report disempowering experiences with obstetricians and gynecologists. Black people do not have a monopoly on receiving poor healthcare in this country. But we would be naïve if we did not ask the question: What role did Annette’s race play in causing her providers to dismiss her symptoms of a potentially fatal heart condition? If Annette had, in fact, been a “pretty, rich, thin, white lady,” would she have managed to avoid a hellish childbirth experience?
We do not know. We cannot prove that but Annette’s black race, their providers would have given them excellent healthcare. But this lack of proof is always true. Although we may have damning statistics describing the higher rates of injury and death that black people suffer in hospitals and healthcare facilities, we do not know in any individual case whether the person’s black race caused them, in particular, to suffer an injury or death. This is a reality that makes racism both deniable to racism skeptics and elusive to many who are confident that racism persists in countless ways in the post– civil rights era. (As Annette said, “You’ll never know, right? Unless they show up in white hoods to the appointment, you don’t entirely know—which is one of the mind- fucks about it.”) Nevertheless, many of the class-privileged black women who spoke with me for this book were confident that even though they enjoyed some degree of affluence, their black race mattered—or had the potential to matter—as they navigated healthcare systems in the pursuit of a healthy pregnancy, childbirth, and newborn. Many of the class-privileged black women that I interviewed were confident that their race placed them at a distinct disadvantage— despite their advanced degrees from competitive universities, high-status jobs, and amassed wealth. As a result, they adopted strategies for diminishing the effects of that felt disadvantage and for avoiding what Dána-Ain Davis calls “obstetric racism”— the fact that racism “materialize[s] during Black women’s medical encounters” involving reproductive healthcare and “threat[ens]maternal life and neonatal outcomes.”
Excerpt from the book Expecting Inequity: How the Maternal Health Care Crisis Affects Even the Wealthiest Black Americans by Khiara M. Bridges copyright © 2026 MIT Press. Reproduced by permission.
