It’s Black Maternal Health Week. Here’s everything you should know to protect yourself and those you love.
In 2018, Rachell Dumas cried tears of joy after seeing a positive pregnancy test. She was excited and immediately began planning for her new life. However, after experiencing heavy bleeding nearly 15 weeks into the pregnancy, Dumas sought immediate care from her OB-GYN. She knew something was wrong. Nonetheless, her doctor, after doing a routine checkup, told her that she would likely go on to have the baby without any issues.
What happened shortly after Dumas’ visit was the first of nine heartbreaking losses over a span of five years. Repeated visits to the emergency room and switching healthcare providers, Dumas noticed a constant throughout each of her experiences: medical gaslighting.
“When I lost twins in 2020, I was repeatedly sent home despite having 10 out of 10 on the pain scale. There was vomiting, bleeding…and I even delivered the fetus into the toilet,” she recalls. “It was demoralizing being in so much pain…knowing something was wrong and still feeling unheard by professionals that I’m supposed to trust,” she adds.
After her third miscarriage, Dumas, now 33, refused to give up and continued to seek answers. When she finally switched to another OB-GYN, she was officially diagnosed with cervical insufficiency.
What is Cervical Insufficiency?
Cervical insufficiency, also referred to as an incompetent cervix, is a condition that occurs typically in the second trimester (typically between 14-24 weeks) when the cervical canal prematurely dilates and effaces, often leading to miscarriage or preterm birth. Treatment depends on how far along the birther is in addition to the patient’s individualized history. Weekly doses of the hormone progesterone, cervical cerclage, and in some cases, a transabdominal cerclage are offered. Doctors may also prescribe bed rest or abstinence from activities (like sex or vigorous exercise) that could increase the likelihood of early dilation.
According to the Centers for Disease Control (CDC), the preterm birth rate for Black women in the United States is 14.7%, higher than the national average of 10.4%. Consequently, infants born to Black mothers with cervical insufficiency also have a significantly higher rate for neonatal (NICU) care.
In addition to systemic barriers that Black mothers already face, cervical insufficiency is quite difficult to diagnose.
“For some, cervical insufficiency is painless, and this makes it hard to detect. In addition, there is also an absence of labor symptoms, such as uterine contractions, which can result in unexpected miscarriages or premature births,” explains Faith Ohuoba, MD an expert in women’s health, Clinical Associate Professor at the University of Houston, and the first Black OB-GYN and Department Chair at Memorial Hermann Northeast in Texas.
“It is especially difficult to diagnose in first time moms, where there is no prior pregnancy history to reference, and because cervical insufficiency can present with vague and non-specific symptoms, such as pelvic pressure, vaginal discharge, vaginal bleeding or light spotting. The symptoms can be light and attributed to other conditions,” she continues.
Ohuoba also notes that shortcomings in proper care can also lead to delayed or missed diagnoses.
“When doctors do make the call, it is based on a diagnosis that falls into one or more of three categories: a physical exam, which features building membranes through the cervix and dilated thinning of the cervix; an ultrasound exam showing a shorter cervical length and a ‘funneling’ appearance; and finally, medical history, which includes understanding if prior cervical procedures were performed and if congenital or malformed gynecological conditions were present at birth, and as previously mentioned, early births or pregnancy losses,” emphasizes Ohuoba.
How to Advocate for Yourself
Although incompetent cervix is difficult to diagnose, there are ways to advocate for optimal treatment.
That’s what Morgan Chance, a 37-year-old Oregon-based entrepreneur, had to do when she discovered after two miscarriages that something else could be wrong.
“After my first two miscarriages, I didn’t feel comfortable with my doctor at first, until she gave me a referral to a doctor in another state who recommended placing a cervical cerclage. Although both times, the cervical cerclage did not prevent preterm labor, at the very least I did feel heard,” she explains.
Bayo Winchell-Curry, MD, a board-certified family physician and healthcare equity advocate, suggests finding healthcare providers whom you feel comfortable sharing your journey with.
“As a doctor who has also had a miscarriage, I encourage my patients to seek care from doctors who are empathetic, good listeners, and aren’t quick to dismiss your concerns,” says Winchell-Curry.
Shalini Shah, a reproductive wellness practitioner, perinatal educator, and lactation consultant (IBCLC) at Millie agrees.
“It’s important to recognize that the healthcare system doesn’t always make it easy for Black birthing people to get the care they deserve. While it’s crucial to advocate for oneself, it’s also essential that healthcare providers are proactive and responsive and working to ensure equitable care. If you’re not getting the answers or support you need, don’t hesitate to speak up and keep asking questions,” urges Shah.
Chance also understands that making informed decisions with your healthcare providers after experiencing cervical insufficiency is a critical form of self-care.
“You never know just how strong you are until that’s literally all you can be. But depression is real and it will consume you,” she says. “My husband and I have decided that moving forward with a surrogate is the best and healthiest route for our journey…and we are excited for the next installment.”
As for Dumas, she and her partner decided with her tenth pregnancy to fly out of state well into the second trimester for implementation of a trans abdominal cerclage. The risky procedure proved beneficial and resulted in the birth of a healthy, full-term baby.
The Importance (and Urgency) of Sharing Our Stories
One additional reason for misdiagnosis and missed diagnoses include lack of awareness.
“Both patient and healthcare providers may have a limited knowledge of some of the symptomatology of cervical insufficiency – particularly in populations where it is infrequently diagnosed,” says Kecia Gaither, MD, MPH, MS, MBA, FACOG, double board-certified OB-GYN and in maternal fetal medicine, Director of Perinatal Services/Maternal Fetal Medicine at NYC Health and Hospitals/Lincoln in the Bronx.
Just as more education is needed, particularly in underserved areas, so are more mainstream narratives of Black women who’ve been diagnosed with cervical insufficiency.
“From a cultural standpoint, a lot of us have been told to keep our personal business to ourselves. However, we know the numbers. We know that we need policy change. We know that we need to come together in community to save our Black mothers and infants. We can no longer afford to be silent,” states Erica Freeman, doula, author, and visionary founder of Sisters in Loss.
Freeman’s mantra and mission with her work in media is to “replace silence with storytelling,” which she has done for the past seven years through her podcast that shines a light on Black women navigating infertility and pregnancy loss.
Like the women on Freeman’s podcast, Dumas and Chance feel honored to share their stories in the hopes that it will help other Black women feel comfort or gain a sense of direction in their journeys.
“That’s why I love Black women. Our grief is cyclical, but we always come back to our why. No matter what it takes to do that, and how it looks, everyone is not a mom by means of giving birth, but looking at the ways that we come into it has been such purpose-driven work,” says Freeman, whose debut book Never Healing Alone: a Guide for Black Women Around Pregnancy and Infant Loss, centers the narratives of real women as they navigate infertility, pregnancy loss, and conditions like cervical insufficiency.
“That’s where we are now as a country. We can’t stay in sorrow because we have the ability to hold that space for grief and hope for healing,” Freeman says. “That’s the beauty of what Black womanhood and Black motherhood represents.”
