Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Ashley McMullen

You're listening to The Nocturnists: Black Voices in Healthcare. I'm Ashley McMullen.

Three months ago, on May 25, 2020, George Floyd, a Black man, was killed by police in Minnesota, who kneeled on his neck until he took his very last breath. Today's episode is our last. So we wanted to take this moment to celebrate that, even in the midst of so much death, somewhere life is just beginning. There's unspeakable anxiety that comes with bringing forth Black life into a world that still sees Black lives as expendable, but also a universal love, beauty and sense of hope. This week, you'll hear stories that moved us about the excitements and fears of pregnancy, the mysteries of labor and childbirth, and the indescribable joy of hearing a baby's first cry. Here is “Episode Nine: Birth."

Almaz Dessie

I found out I was pregnant with my first child on the same day I found out George Floyd was murdered by police in Minneapolis. That was just such a strange day, because I was so happy and so surprised because I've been trying to get pregnant for awhile and didn't expect to get pregnant in the middle of a pandemic. And, and then I watched the video. And it was hard to be happy, or hard to reconcile those two realities.

I work in the emergency room and I felt scared. The whole beginning few weeks just was surrounded by fear for me. There's so little known about COVID in pregnancy, and the world just seemed like it was falling apart at this moment that I was–my world was just starting. But I really thought I was having a girl. I just knew I was having a girl. So, few weeks later I got that NIPT, the blood test. And I was on the Long Island Railroad with my husband, and we were coming back from a short beach trip. And I got a call from the nurse, put her on speakerphone. It was kind of hard to hear because we were on the Long Island Railroad. She tells me all my tests came back normal, no trisomies. Then she said, ""You know what you're having?" I said, "I'm having a girl." And she said, "Uhhh, hold on one second." I guess she went to go check, because I sounded so sure as if I already knew. And she said, "Um, it doesn't look like you're having a girl, you're having a boy." And my heart sank. I felt really disappointed that I wouldn't have this female bond with my child that I have, like, with my mother and my sister and my nieces. And I had no brothers. I had an absentee dad. So, the only way I really understand family is with women.

And growing up, we share clothes. We cook together, we walked around naked, really learned to love my body in that way. So when the nurse told me I was having a boy, that's the first thing I thought about, actually, was how am I going to, like, have a naked house with my kid? I feel like I'm just gonna lose that idea of what family is. Or, I guess, that idea of what family is has to change.

And then we got off the phone with the nurse and my husband just, like, how do you feel? He was pretty neutral about it. But I felt kind of scared to be pregnant right now and to be having a boy, a boy of color is just…. I'm mixed. I identify as a Black woman and I'm mixed, and my husband is white. And I suddenly had this thought of, “Really, I don't know what this kid is gonna look like. Will he look Black? Will he look Dominican? Is he gonna pass for white?”

You know, just not knowing how the world will see him and how, I mean, really you are thinking about is how police will see him, and how he'll see himself in me. And how he'll identify, because being Black is just such an important part of who I am. It's such an important part of who I am. And I can't imagine not sharing that with my child.

And I started to cry and cry to my husband, my white husband, who's a really good man, but he just cannot understand. Yeah, he just can't. It's not his fault, but he can't understand, you know, what it means to be a Black woman in America in 2020, in the middle of all of this and be pregnant with a boy. A mystery boy. Will he be safe? And I am kind of wishing he's one way or another, hoping that he looks Black, but that feels like such a strange thing to say. And that feels wrong one way or another to want him to be one thing, because he's, he's already who he is, or he's already who he's going to be. So, yeah, this boy chose me to be his mom, whoever he is.

Marshall Fleurant

So, I was having a discussion with my father, my pop. And not too sure how we got into this conversation. But, he was talking about how when he was born, back in those days, everybody was born in the house. I mean, all of his siblings was born at the house. My family from Haiti, and not everyone had easy access to the hospital, or whatever. You would hire a nurse to come to the house to help deliver the baby.

Fast forward about seventy years. So now, you know, I'm a physician. When my son was born in the hospital, I had it all planned out. I mean, I had the ipad out and we were playing, like, smooth r&b, because I really wanted my son to be in peace. Like, I wanted my son to be born in absolute love, like welcome to this world, like welcome to life. Like, that's the kind of environment that I wanted him to be in.

The funny thing about that particular day is that we came in the hospital, like, dressed up. Like, my wife came into the hospital, like, in a nice dress. I'm, like, I'm in a button-up shirt because it was, like, Valentine's Day. We were, like, out on a date. You know, like a, maybe, babymoon date, kind of thing. And she goes into labor so we got to go to the hospital. So first of all, we coming in dressed up. Now we got to get in the hospital clothes. I had the baby pack set up with the music, the ipad. We playing all those nicest, smoothest jams, like, you could think of, like nice smooth r&b. I done kicked everybody out the room. Like, if you weren't part of the medical team, get out. Like, that's, that was–I just wanted it to be me, my wife, and some, some kind of medical capability to be in the room. Didn't even let my moms in there. Didn't even let my inlaws in there, her best friend, nobody. Just us.

So during the birth, it's not really great to, like, go in there with a internist’s mind, cuz he's getting, like, tachicardic. And then, I know there was some changes in blood pressure, and a little emotional roller coaster of having your first son born. I don't even remember cutting the cord. But I do remember just grabbing it. Like, I was holding my son so long. I was just so happy that my wife, like, felt some kind of way. Like, "Can I get my son back please?” Like, “I just delivered him." And I'm, like, keep holding on to him. I, finally, I give my son back to my wife. And she immediately just got to work, like skin to skin, like breastfeeding. Like, she's, like, OB–she knew exactly what to do. Like, it was so natural. And then, we take him, we weigh him, and he was just, like, straight up, like–I felt like he was like a mirror image, like, this boy looked exactly like me. I don't know, it was just such a beautiful, beautiful birth. On top of that, it was Valentine's Day. So, the love was just definitely there. He came into some jubilation, I'm telling you.

So, fast forward a couple years now, this year has been kind of rough. You know, George Floyd, like, we upset. All the protests going on, and my wife is working on her shift. And during one of her shifts, while all of this was happening, she delivers a family, a Black family. And they had this setup, like, just like we had it. Like, they had the music setup, they were playing some r&b. Black man, Black woman, they delivered, like, a beautiful baby boy. And it was, like, she said it was, like, just like how we do it. And she literally cried after that delivery. Like, you know, I'm pretty sure she does this all the time. So when you see, you know, I guess she lost some composure or something like that. She was just crying because at the time she was just feeling so tired with everything going on, and, and it was just a beautiful thing to see. It gave her so much hope to see that love being continued in another family, in another generation, in the same way that we did it. You know, thank God for that kind of love continuing.

Whitney Wellenstein

As an OB/GYN on labor and delivery, your ability to touch becomes your most valuable tool. We use technology, we use bloodwork, labs, ultrasounds, things like that. But the real art of it comes down to your ability to touch, and feel, and make a clinical assessment based on that. I think that's very unique in the medical field.

I remember when I first started residency, I thought that the cervical exam, specifically the dilation, was the end-all be-all. I would practice and perfect my exam. One finger was one centimeter, two fingers stacked on top of each other was two. Two fingers adjacent was three. Two fingers spread just a little bit was four. Spread a little bit more to where I will feel it in the ligaments of my hand, it's five centimeters. Spread a little bit more to where I was feeling down towards my wrist is six centimeters. So on and so forth.

“What does the cervix feel like,” one of our midwives would always ask us. "Is it ready?" And what she meant was, “How forgiving is it? How stretchy is it?” She taught us that there's a difference between 90% effaced and tight, and 80% effaced and pliable. Where is the baby's head sitting? What way is it facing? And I remember I would have to close my eyes as I would check the dilation, the effacement, the station. What does a cervix feel like? The feeling, that fetal head that is soft with shifting bones. And trying to navigate those just right to feel that sagittal suture, and then follow it anteriorly sometimes, sometimes posteriorly, till you feel the next suture. How many are there? How many bones are coming together here? What shape is this making? What does this fontanel look like? And then place that into the baby's space, into the pelvis, and come up with the direction that they're facing. I would have to contort my head, my neck, I'd have to turn and flip my head in the same position of the baby's head so that I made sure I understood exactly where all the parts were.

That was a tough thing to learn right away. It was tough at the end, honestly, because those perfectly palpable sutures….Once that baby comes down into a pelvis and you can get that caput, all you could feel was this knot. Then you'd have to reach up even higher into their pelvis to try to find anything that resembled a suture. Those are the tough ones. They'd ask what the contractions feel like. Are they strong? Are they weak? You can tell how frequently they're coming by the external monitor. You can give a pressure measurement with the intrauterine pressure catheter, but they taught us to just leave your hand there after you perform the exam and feel a contraction. Does the head move? Do you feel it coming down against your fingers? That's a good one. The nurses taught us how to palpate contractions from the belly. They taught us to put the pads of your fingers just a little above the patient's belly button, find the fundus. That's the contractile portion. And if it feels like the tip of your nose, it could use a little work. But if it feels like your forehead, those are the strong ones.

One of my NICU nurses enter every delivery with us. They'll give us the eye if it was looking like they needed to take the baby off of the mom's chest so we needed to cut the cord quickly. And I remember she taught us that if we were ever unsure, we can feel the umbilical cord, which is kinky and curly and gelatinous. And if you palpate the baby's heart rate through the umbilical cord, feel that pulsating between your fingertips, you could get a good idea if it was above 100 or below 100. And that's how we knew if the baby was in a good place or not. And then afterwards, when the uterus was tired, distended, bleeding, you can just feel the bogginess, we say the atony, it kind of feels like a soaked sponge. But with some time, sometimes some medication, and you feel it start to firm up, it can become almost rock-like. It's so satisfying. because then you know it's gonna be okay.

Sylvia Owusu-Ansah

Such a beautiful process to help bring a child into this earth! It's one of the most beautiful things that a human can be a part of, or witness. Although my experience for my second child's birth wasn't as beautiful as I imagined it to be. See, I'm an African American physician. I gave birth in a hospital in which I didn't feel nurtured, and I didn't feel loved by the healthcare staff. They thought I was extremely anxious. It was encouraged that I take some anxiety medicine. I was not anxious. Every time I asked for help in the way of where I was in a lot of pain, and when I asked for pain medicine, I was looked down upon.

On the day of discharge, I had the most scary event ever. My husband brought me my favorite chicken wings as we were getting ready to go, and I couldn't taste them. And at first I thought it was in my mind again, they've been telling me that there was something wrong with me, that I've been anxious the whole time that I had been hospitalized after giving birth. And then my face started to droop and I had no control. The left side of my face just gave way. And my speech started to slur. And I was scared for my life. And knowing all the medical things that I know, the first thing I thought of was, “I'm having a stroke, oh my gosh, I'm having a stroke.” I asked my husband, who was standing right in front of me, who's a paramedic, if he saw something different, because I definitely felt something different. He said, "Yeah, your face kind of looks funny on the left side," and he, too, thought stroke. So I call in the nurses, who again begrudgingly came in because, again, they thought I was just this anxious patient. And the nurse kind of looked at me and said "Yeah, I see. Your eye looks a little bit swollen but I'm not really seeing anything else."

The eye looking a little bit swollen is known as ptosis, meaning my eyelid had dropped from lack of nerve innervation, not that my eye was swollen. The attending doctor came in and said that, "Oh, it's just an allergic reaction." And my brain almost exploded through to the ceiling. I'm a physician, you don't have an allergic reaction on the left side of your face, on one side of your face where you're slurring, and you can't taste anything.

We continue to go back and forth. I didn't feel comfortable being discharged, I thought I should be worked up some more. You would think that with the medical knowledge base that I have, that my physician would be more willing to be understanding and concerned about my own concerns about my body, which I know better than anyone. She said it was allergic reaction, should just take some Benadryl and go home. If it worsens, I should come back to the emergency department. But they were pretty much done with me. So I went home scared.

Fortunately for me, I have resources, and I called my best friend who is a neurologist. And, thanks to technology and FaceTime, she said to FaceTime her immediately because she could tell that my voice just didn't sound right. And she had me do a couple of things that you would do to kind of test for your nerves to see whether you're having a stroke or other types of nerve damage. She alleviated my fears that it wasn't a stroke that I was having, thank the living god. I was actually having what's called Bell's palsy, which is a facial nerve palsy, which happens quite often in pregnancy, after pregnancy, when the body is pretty much very inflamed, and sometimes the nerves get inflamed and don't work as well.

So the seventh nerve of my face, which controls two thirds of your taste and muscle movement and eye blinking and winking, was inflamed and not working well. And there was a solution to that, but that solution would take time. So I'd need to take some steroids right away, which my best friend helped to prescribe for me. And just take time. It would take probably maybe six months or so to get back to normal. I'd have to do facial exercises.

And so I called back the physician and let her know how I, what was going on, how I felt. But I truly felt, deep down inside, that the way that I was treated was because of who I was. It didn't matter that I was a physician. It didn't matter that I was well-educated. And instead of being able to really enjoy my baby that first twenty-four to seventy-two hours of going home, I was scared for my life. And I feel like the system had failed me. And I feel like the system had failed me because I was an African American female whom nobody was willing to listen to and take seriously.

Lawren Wooten

The story of my birth was always one of my favorite stories to ask my mom to tell me. She was twenty-eight at the time and pregnant for the first time. And around five months gestation, she developed pre-eclampsia and gestational diabetes and had to be admitted to the hospital. Something happened for her to need (?), she couldn't really remember. But for, like, two months, she had to lay on a hospital bed, in the dark, with her head angled to the floor. Unfortunately, despite all of the treatments that they tried, she developed eclampsia and started having seizures. And they had to do an emergency C-section at twenty-seven weeks. After surgery, she continued to bleed. They went back in to try and stop it. They stopped it temporarily. She started bleeding again. She went into DIC. And ultimately, they had to do a hysterectomy.

And the way she tells it, it's like she didn't actually meet me until a week or so later, when she woke up from a coma. As a kid, I'd stare at her while she told me the story, my mouth agape, that my mother was a literal superhero who had survived this crazy, crazy situation, experience, and almost died giving birth to me. I really realized just how close she actually came to dying, and how dramatic all of that must have been. And just, like, how common it is for Black women to die in childbirth.

Kimberly Manning

So, when I first moved to Atlanta, Georgia, I was really excited when I heard that one of my medical school classmates, Tracy, had opened up a solo OB/GYN practice here in Atlanta. I got pregnant. And so I called Tracy up and said, "Hey, you know, who are you going to refer me to for my prenatal care? Because, you know, I'm pregnant." And she was like, "What? What do you mean who am I gonna refer you to? You my patient!"

That pregnancy, with my first child, was pretty uneventful. Things mostly went fine. Her office was super close to Grady Hospital. So, you know, me being her friend, she let me just come out willy-nilly for my appointments, last minute, worked me in. It was great.

One day, I woke up in the morning, I was getting ready to go to work. And I really didn't feel my normally very active baby moving. I was probably about thirty weeks pregnant at that point. And so, because, you know, there's really no barriers between us talking to each other, I shot Tracy a text message and said, "Hey, um, your little fella is being lazy this morning." And so she calls me, and I tell her that, you know, I really don't feel that much movement this morning.

At this point, I'm in my car driving to work. And she said, "You know, if you see a McDonald's pull in a McDonald's and get an orange drink. It's loaded with sugar. And I promise you, it'll wake that little fella right up," which is what she always called the baby. And so, I bought a large orange drink and guzzled it all the way to the bottom of the cup. And by this point, you know, I was off the phone and just waiting to see if I could feel anything. And probably about thirty or forty minutes after I was in my office, Tracy called me back and said, "Hey, what's my little fella doing?" And I said, "You know, I think he's still asleep." And she could hear a little bit of worry in my voice at this point. So she said, "I tell you what, who's in your office with you?" And I said, "Nobody." So she said, "Just go ahead and get on the floor and lay on your back. He won't like that. And trust me, he'll start to move." So I did as I was told. I hung up the phone and I just sort of laid on my back. And I lay there probably ten minutes, fifteen, and–nothing. I poke my finger in my side–nothing.

This was a crazy day, because I was scheduled to give a lecture to the residents for primary care grand rounds. And Tracy called me, and at this point I'm very worried. And she said, "What do you want me to do? You want me to come get you? I can meet you at the office." And, you know, this was a Wednesday, her office was closed on Wednesdays. And I said "No, you know, let me just give my lecture. And, you know, I'll call you after that." And she said, "Okay." So I gave a lecture. And the whole time I have, like, a slide advancer in one hand, and under my coat, in the little slot on the side, I have my finger that I'm just poking repeatedly in the side of my belly, hoping that it's gonna make my baby move. And I didn't feel anything.

I didn't even take questions, I just said I had to go. And I kind of tore out of there and took the steps out of the auditorium two by two, just trying to get out of there, because I couldn't feel my baby moving for several hours. And I stepped outside and I just felt the sun on my face. And I was just shaking. And before I could even do anything, I felt my phone vibrating in my pocket and I looked at it and it was Tracy and she was like, "Hey, how you doing?" And she could hear my voice, that I wasn't good. And she said, "Look straight ahead. I'm here." And I looked and I saw her car parked in front of Grady Hospital. And I walked over to her car and she said, "Get in. We're gonna go take a look."

And I just leaned over in the front seat and I just cried and cried. And then I felt a hand on my back. And I looked over my shoulder, and it was my best friend from medical school, our other classmate, Lisa. She was there too. And Tracy drove over to her office. And when I got there, my husband was standing at the door, and my mom was even there. She unlocked the office and it was dark. And we came inside and all of us kind of crowded into this little room. And you know, it was just so quiet, you could, like, hear a pin drop. I still remember the sound of the ultrasound machine and the little, like, whirring sound that it started to make as it kind of woke up, and the squirting sound of the jelly on my abdomen.

My husband was holding my hand and my best friend was rubbing my head. My mom was rubbing my foot. And Tracy was sitting next to me on a little stool, with this ultrasound probe on my abdomen. And she looked at me and said, "Let's take a look." And I remember that probe gliding across my abdomen. And then all of a sudden, (IMITATING ULTRASOUND HEARTBEAT)–the best sound I'd ever heard in my life.

You know, I always say that women need women to survive. I'm just forever grateful for Tracy. She was more than my OB. She was like my angel. She was, she was just exactly what I needed in that moment. She would deliver that son, and she would deliver my other son too. She was decisive. She was present. She was my friend. (ULTRASOUND HEARTBEAT)

Erica Farrand

I was a second-year internal medicine resident, overnight in the Cardiac Intensive Care Unit, and also the code leader. I had rounded on all my patients, I had checked in with my attending, and I was settling into my call room, about to get a nice stretch of sleep. It was a little before three o'clock in the morning when my pager went off. Now I was terrified that I would miss a page, and so I had it set to the loudest possible ring and vibrate. And so it really was an assault on the senses when it went off. I grabbed this seizing pager, slide on my clogs, hoist the code bag onto my back and take off, running.

It was paging us to the lobby, which at three o'clock in the morning, there are few, if any, visitors. But I get to the lobby and there is no one there. I mean nobody. It is completely empty. And I remember turning around in circles a few times when I spied a group of doctors and nurses running around a cab outside. I go through the revolving doors and there are my colleagues. And there is a lot of commotion and activity, and I spot this man, one of the few not in scrubs, middle-aged, leaning against the hood of the cab.

And so, I approach. "Sir, I'm one of the doctors here. Can you tell me what's going on?" And he turns to me, like, wide eyed, trying to make sense of the last few minutes as he retells the story to me. He's two hours into his shift when a young couple hails his cab, a young guy and a very pregnant woman, and ask him to take them to their hospital, where their OB is. The hospital they toured, where they feel comfortable, where their baby is going to be born.

He agreed, and they take off across town. But as the moans from the backseat grow louder and more frequent they get turned around, and end up at the entrance to the adult hospital, which, unfortunately, is a block and a half away from the emergency room, and, more importantly, up a block and a half away from labor and delivery. The couple gets out as the woman is yelling, "The baby's coming, the baby's coming!" She lays down on the backseat and gives birth. Now the security guard in the lobby was unsure what to do, but he knew if he called a code that a bunch of providers would be there within minutes. And that's what he did.

So hearing all of this, my panic and alarm rises, and I slide into the front seat of the cab and peer over into the back. There is a young woman, her head up against the window, a floral quilted bag on the floor of the backseat, which I imagined contained, impeccably packed, her hospital items. On the other end of the bench seat is a surgical intern, who had already clamped the umbilical cord and was getting ready to cut it. And over her shoulder, Dad, who was pale, almost green, and anxiously looking at his wife and the baby–this very new baby, who was laying on Mom's chest, very new, and also very quiet. Now at this point, I had done one month of an OB/GYN rotation as a medical student. And so what I knew about labor and delivery was equal parts that one month of training, and medical TV drama. I honestly wasn't sure what needed to happen but I went with it, because what else was I going to do?

"Has anyone heard that baby cry?" The three people in the backseat turned to me. "No, no, the baby hasn't cried." "Okay, well then, give me that baby," I said. They passed the baby to me and I, honestly, I didn't know what to do. But I just started rubbing, rubbing its back and chest. And when, still, the baby was quiet, I asked for a suction bulb and I suctioned their tiny little nose and tiny little mouth. "Is my baby a boy or girl?" Dad was now standing next to me. "I don't know, Sir. We'll figure that out just as soon as we can." "Okay," he said, "Do you know what the time of birth was?" "I don't, Sir, but we will get all of that information as soon as possible." It was clear that he was desperately trying to fill his role in their birth plan. And we had gone wildly off script. I rubbed harder, I suctioned a little more.

And then that baby cried. And it was beautiful. It was incredible. Someone found a blanket and we wrapped this now pink, wriggling, crying baby up and placed them back on Mom's chest just as our OB and pediatric colleagues arrived. And we all sort of gratefully faded into the background as they took over. I eventually made it back up to my call room and thought, what a crazy, beautiful night. (BABY CRYING)

(MUSIC)

Ashley McMullen

This has been The Nocturnists: Black Voices in Healthcare. I want to thank our core team executive producer Kimberly Manning, The Nocturnists founder Emily Silverman, podcast producer Adelaide Papazoglou, sound engineer Jon Oliver, and medical student Rafaela Posner.

Thanks also to executive producer Ali Block and program manager Rebecca Groves, and Communications Manager Corey Becker. Our illustrations are by Ashley Floréal and our theme song is by Janaé E.

Black Voices in Healthcare is made possible by the California Medical Association, the California Health Care Foundation, and people like you, who've donated through our website and patreon page. Thank you for supporting our work and storytelling. If you'd like to add your voice to our project, visit our website at thenocturnists.com We'll be back next week.

Until then, remember: Black lives matter, Black health matters, and Black stories matter.