“We want to introduce topics that are heavy, but in a way that feels inviting”: Interview with The Black OBGYN Project
Interview transcript edited and shortened for clarity
The Black OBGYN Project is a platform that aims to educate its followers on the health inequities that affect Black women in the field of obstetrics and gynecology. What started as a space for Black ObGyn interns and residents to converse and share their experiences has now evolved into an informative page that delves into the history of health inequities, amplifies Black voices, and raises awareness of issues widely prevalent today.
To learn more about the process of creating the Black OBGYN Project and its current developments, Eraced spoke with Rachel Bervell, co-founder of the social media project, to discuss health disparities including Black infertility, pregnancy complications, and medical racism.
RACHEL: The Black OBGYN project is my Instagram page that I started with one of my best friends from medical school. So before you become a physician you have to go through four years, or more, of training and residency. During that time we were interviewing for [OBGYN] residency programs in the fall of 2018, and we noticed that every time we were at these interviews we were often the only Black or brown faces — or one of the few Black or brown faces — in the cohort that was interviewing that day.
And I remember my friend and I, her name is Dr. Tamandra Morgan, spoke with each other and [said], ‘Wouldn’t it be cool if we made a network where all of the Black residents we were meeting or future residents we [would meet] could have this place to chat.’ So [we] would go to an interview and if [we] saw someone [we thought] might be Black, which in and of itself comes across a little problematic in hindsight, … we would be like, ‘Hey, we have this Instagram, it’s for Black [residents], would you like to join?’ And by the end of the interview cycle, we had over 100 Black women who had joined this group.
And then we were trying to figure out ways we could continue our relationships with each other because it was so great to see that everyone had [been from] all around the country. [We thought about] how [we could] still keep that connection together since there are so few Black physicians in the workforce.
Originally we thought we would make an Instagram that would be like a diary of our day-to-day experiences when we were training, but it became really hard to figure out how to put an Instagram account in the hands of 100 people. And then residency started, [so] we took a step back and said, ‘For now why don’t we just put a bunch of stuff on the [Instagram] stories because the stories would be more of a place for conversation.’
We really want people to learn alongside us because there’s a lot about medicine that we are not taught in medical school that I think is important for us to reconcile and consider, especially if we want to have healthier, fairer, and [more] equitable societies. We really have to acknowledge the past before we move forward. It’s our passion project … it’s a hobby. We don’t consider it to be a job because it’s been so fun, and we’re super humbled by the response and the following.
ERACED, SUHANI: In terms of the longevity of the many followers you received this past summer and straying away from performative activism, what sorts of long-term changes do you want to see happen?
R: This past spring with [the deaths of] George Floyd, Ahmaud Arbery, [and] Breonna Taylor, there was this new societal appreciation of trying to understand diversity, equity, inclusion, [and] anti-racism. We had 200 followers who were super committed in April and then fast forward one month later, we went to one thousand. By the end of summer, we had five thousand. And now we have almost twelve thousand. People, number one want to hear from providers who happen to be Black because we are so few.
Number two, we have tried to make the Instagram a community where you can talk. All of a sudden, people are using [social media] for educational purposes. It’s important for us to have these [important] conversations, not just for this summer or this year given everything going on in the climate, but really day in and day out.
Obviously I’m still a resident and I’m going to be busy, and I know that there will be a timestamp on it in the future. But I’m hoping that for the time that I do have this page, that we are able to make sure that we have constant dialogue and that everyone is learning alongside us. Thankfully [all of our followers are] interested to see what we’re posting about or to be encouraged. I hope they stay along with us while we’re learning with all this information in history about health and medicine.
S: Can you describe where this institutionalized pattern of Black women having such a high mortality rate for pregnancy-related complications stems from?
R: We need to take a really big step back when it comes to understanding racial inequities in general, and its relationship with medicine and look back at the basis of slavery, for example. Even before then, understanding how medicine has racialized Black bodies, and how Black bodies at the same time were used as subjects in understanding how to provide better healthcare. The founding of gynecology in and of itself was based on Black bodies. The names of Anarcha, Betsey, and Lucy belong to young women who Dr. Marian Simms, [the] considered father of gynecology, used as subjects to figure out how to solve and cure obstetrical fistulas. He did so without anesthetics, and he did surgeries on Anarcha — a 19 year-old virgin, over 25 times.
This idea [came forward] in the beginning of medicine’s history, that Black women are capable of enduring great pains and that Black women’s bodies are disposable enough to be put through experimentation. And recently, things like Tuskegee, we learned about syphilis and now have great treatments for it but purposely learned about it through infecting people. That’s seen over and over again in history in different ways.
Then fast forward all the way to today, there’s a paper in 2016 where they surveyed medical students, a [majority of them], thought that Black patients had thicker skin compared to their white patients, which is not true. Maybe a Black patient may seem more stoic because of the history and the perception when you’re giving them a shot, but it doesn’t mean that they have thicker skin.
But all of that contributes to how we consider different patients of different races and ethnicities when they’re in front of us as a doctor. We have a system in place that really hasn’t reconciled with that history or identified that a lot of what we’re doing in medicine is based on problematic presumptions. It contributes to those disparities.
ERACED, NOOR: Could you talk about Black midwifery, as it’s a big topic covered on your Instagram, and how its perception evolved over time?
R: One reason why we focused so much on midwifery care, doula care, and other aspects of cares is because every specialty has its roots in something else. OBGYN is rooted in midwifery practices and that has expanded itself. And the second reason why we focus on it so much is because there are very adverse outcomes when it comes to Black women, maternal health, and infant health.
One of the solutions that has been proposed to us over and over again has been adding midwifery care or emphasizing these other types of care, so Black women can have better outcomes. Midwives’ influence has really been impacted by Black women, as they were often the people that were delivering babies of not just the enslaved women but also the slavemaster’s wives.
They often would take care of these women in their postpartum period, too. Up until the 1900s, up to 50% of all deliveries were attended to by a midwife. And then came the 1920s and the 1930s, when the field of OBGYN was really picking up in its professionalism with board licenses, the American Medical Association, and the Flexner report. Medicine is no longer [being] seen as a charlatan thing as it used to be in the 1800s and is now a legitimate field of practice.
But at the same time this [seemed to create] competition with midwives delivering out in the community in rural areas and often in ways that were deemed unsanitary to these physicians. So unfortunately, from delivering 50% of all babies in the United States [at their peak], licensing bodies [began marginalizing midwives]. [By] the ’70s, [they accounted for] only 1% of deliveries.
It’s important to talk about this history because there is this whole field that was taking care of people considered disadvantaged, disenfranchised, and who were minorities in their community. They were the ones that were taking care of these folks, but unfortunately there was this demonization by the field, and they were no longer seen with respect.
Today, research has shown that midwifery can actually improve birth outcomes because midwives often focus on low risk pregnancies and pregnancies that don’t necessarily need to have interventions. Midwives are still clinicians; they practice alongside OBGYN’s and family medicine doctors. They’re still delivering in the hospital — they just aren’t always going to propose or push for interventions. But if that’s necessary they will refer [patients] to their [doctor] colleagues to make sure that’s done.
I think it’s really important to talk about inclusion in medicine and everyone that has played a role in the field. Midwifery is no exception.
N: Another [issue] you talk about on your Instagram is fertility and issues related to fertility. Could you talk about the stereotype of Black women “being fertile” and how Black women are disproportionately affected by fertility complications?
R: Fertility is a big umbrella term so there’s a lot of different definitions within it. It could mean the ability to get pregnant, the ability to stay pregnant, and the ability to deliver properly. Regardless, people don’t talk about these sorts of conversations. I’ve never heard someone say, “Let me tell you about my miscarriage” because it’s hard. If it wasn’t for Chrissy Teigen, for example, I wouldn’t know if we would even be thinking about losing a baby in pregnancy so openly and candidly. We want to introduce topics that are heavy, but in a way that feels inviting.
When it comes to the stereotype of Black women being very promiscuous and this idea that they can get pregnant easily, it is based off of stereotypes and racist thoughts. [The assumption has been that their behavior or] certain features like big breasts or a big bum contribute[s] to or might be affiliated with their ability to get pregnant more easily. All the way from slavery times, this perception that Black women were there to have babies was apparent. That’s what an enslaved person was there for — to [birth] babies [who would] work. That idea remains throughout today, and it still permeates society.
On the flip side, birth and fertility issues happen to impact Black patients at a higher rate. I think that’s predominantly because fertility can also be associated with a lot of other chronic health conditions, [such as] endometriosis and fibroids. All of those things can impact fertility. So if anything is in the way of a patient getting pregnant or holding onto a baby, they will not get pregnant.
It feels shameful to talk about it. Michelle Obama had two or three miscarriages before she had Sasha and Malia … Cardi B had postpartum depression. Beyonce had preeclampsia. These are Black women in society who are celebrities and they don’t talk about it. People don’t talk about their health issues because they think it’s embarrassing.
At the same time, some health issues don’t just feel embarrassing — they feel shameful because [they] should be something you can do [naturally]. Having a baby, that feels like something we should be able to do. That’s one reason why [The Black OBGYN Project] focused on it because it is so layered and taboo, but we wanted to break down those stereotypes and let [our followers] know that if this is something they’re going through or a friend is going through, even if they’re not Black, it’s okay to talk about it.
Last updated 11/18/20
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