She gave birth to her daughter at home in April due to "concerns about negative birth outcomes for black women in America."

By Claire Gillespie
August 14, 2020
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Actress and new mom Jodie Turner-Smith has shared her home birth experience, revealing that it gave her “what every single woman deserves to have: full agency in determining my birth support.”

Turner-Smith, 33, who is married to actor Joshua Jackson, gave birth to a daughter in April, only weeks after the COVID-19 outbreak was declared a pandemic. But the virus wasn’t the reason for the couple’s home birth choice. The Queen & Slim star told British Vogue that the couple “had already decided on a home birth because of concerns about negative birth outcomes for black women in America.” 

Turner-Smith and Jackson spent four days together while the mom-to-be was in labor. “We never imagined that in the coming weeks, hospitals around the country would begin restricting who could be present in the birthing rooms, forcing mothers to deliver without the support person or people of their choice,” she told the magazine

Her concerns about poorer birth outcomes are not unfounded. According to a Centers for Disease Control and Prevention (CDC) report published in September 2019, Black, American Indian, and Alaska Native (AI/AN) women are two to three times more likely to die from pregnancy-related causes than white women. For Turner-Smith, this points to one thing: “systemic racism," she told British Vogue.

This maternal death disparity increases with age. The CDC research also found that the pregnancy-related mortality ratio, or PRMR (pregnancy-related deaths per 100,000 live births) for Black and AI/AN women older than 30 was four to five times higher than it was for white women. Significant disparities exist even in states with the lowest PRMRs and among women with higher levels of education. 

The outcomes for Black women aren’t just significantly worse in terms of death rates. A study published in the American Journal of Obstetrics and Gynecology in 2014 found that Black women are three times more likely to have fibroids (benign tumors that grow in the uterus and can cause postpartum hemorrhaging) than white women. Researchers have also found that Black women display signs of preeclampsia earlier in pregnancy than white women. 

Hospitals that primarily serve Black patients also provide lower quality maternity care and have higher rates of maternal complications than other hospitals. According to another study published in the American Journal of Obstetrics and Gynecology in 2014, they also perform worse on 12 of 15 birth outcomes, including elective deliveries, non-elective cesarean births, and maternal mortality.

“Black women are experiencing significantly worse outcomes in pregnancy and childbirth,” Candice Fraser, MD, an ob-gyn at Juno Medical in New York, tells Health. “As a Black woman and a Black physician that cares for Black women, this is of great concern to me.” 

Dr. Fraser believes that multiple factors contribute to the different outcomes, some of which are still unknown. “Currently, there are a few factors that are known and can be addressed,” she says. “Systemic racism and implicit bias are factors that are deeply rooted in the history of our country and play a significant role in the maternal mortality rate. Black women are often not taken as seriously as their non-Black counterparts, and this has led to poor outcomes.”

Preventative care and preconception counseling is another problem area. “This is not encouraged as much as it should be,” Dr. Fraser says. “As Black people, we are at a higher risk for high blood pressure, diabetes, and heart disease, which can result in significant pregnancy complications. However, these are commonly only diagnosed in pregnancy, missing the opportunity to optimize health prior to pregnancy.”

Turner-Smith’s decision to have a home birth comes as no surprise to Dr. Fraser. “Black people have a significant distrust of the medical community due to systemic racism,” she explains. “Historically, Black women have had medical procedures and experimentation performed without consent and this has fostered a lack of trust in physicians. There have been studies showing that medical providers believe that Black people feel less pain, and Black women are often taken less seriously when they report pain and other symptoms. These factors have contributed to maternal death in hospitals, so it’s not difficult to understand why women would be reluctant to go to hospitals and seek to give birth at home instead.” 

Of course, there are other reasons for choosing a home birth—to avoid unnecessary intervention, to have more support persons or children present, or to have a water birth, which is usually not readily available in hospitals. Home birthing is a growing trend, according to a 2019 paper in the journal Birth. Researchers wrote that home births in the US increased 77% from 2004 to 2017, though the vast majority of babies are born in hospitals.

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