Shanaz Ikonne on Racial Disparities in Healthcare

This post is a part of our ongoing Guest Speaker series, where we delve into various topics and experiences that have significantly impacted the lives of mothers. Upon first meeting Shanaz, we were captivated by her candidness, profound insight, and her inspiring work. We invited her to share her story on our blog, hoping that our readers might recognize their own experiences within her narrative and feel empowered by her journey.

Can you tell the story of your birth and how that experience inspired you to support BIPOC women in a community setting? 

I am eager to share my birth story as it has profoundly impacted my personal and professional understanding of perinatal and postpartum care for women of color. In 2019, I was pregnant with my first child, and while I had some basic knowledge of perinatal care, I was unaware of the racial disparities that exist within the maternal health care system. At the suggestion of friends, I hired a doula of color and attended childbirth classes. However, it wasn't until a week before my delivery that I became aware of the issue.

During general follow-up appointments, my doctor was irritable and dismissive of having a doula present at the birth. My doula brought up the microaggressions she observed in the appointment and we discussed how to address it. During my last routine OB/GYN appointment my doctor was alarmed by my elevated blood pressure and insisted that I go to the hospital immediately to have my baby. I was not in labor and did not have my birth bag with me, and I did not get a chance to notify my husband until the doctor left for her next patient. Feeling rushed and lacking informed consent, I tearfully called my husband and doula and went to the hospital for further testing. My doctor ultimately confirmed that I had preeclampsia and insisted that I be induced to prevent harm to my baby. Despite having no prior indication of high blood pressure or preeclampsia, I agreed to the induction out of fear and frustration with my doctor.

I spent the night in the labor and delivery room, where I felt trapped and unable to move without the assistance of nursing staff. I didn't eat lunch that day because I was supposed to go home after work and rest for a week until the baby arrived. I mentioned several times I was hungry and they gave me a single saltine cracker while they admitted me. My husband advocated for me and brought food. The labor and delivery nurse saw what happened and told my husband he could leave snacks in the nurse break room refrigerator. The labor and delivery nurse was so kind and I'll always remember her. The next morning, I was administered Pitocin, which sent me into rapid labor. After receiving an epidural, I gave birth to my child and was moved to the postpartum recovery unit. However, I soon realized that the level of care I was receiving was inadequate.

The postpartum nursing staff denied me pain medication and basic supplies such as postpartum underwear and pad replacements. After bleeding through my postpartum underwear I requested additional supplies and was denied. I was told by the postpartum nurse that “I needed to wash them in the sink and hang them dry.” They also refused my husband's request to order food, leaving him to run out and purchase food on his own. When my milk came in, I experienced painful breastfeeding and requested lactation support, but I was told to push through the pain. The nurse even made an insensitive comment about scrubbing my nipples with sandpaper. There were many overt aggressions, sarcastic and rude comments throughout my stay.

This experience was traumatic and overwhelming, and I sought outpatient lactation support to help me with breastfeeding outside the hospital. My husband and I filed a complaint and requested a meeting, but we were dismissed without any resolution. The experience made me realize that women of color often face discrimination, met with silence, and inadequate care during childbirth. After this experience, I felt compelled to support them with mental health therapy in a community setting.

Since then, I have become a passionate advocate for equitable care and services for BIPOC women during pregnancy and postpartum. My own birth experience has inspired me to work towards creating a more supportive, trauma informed, and inclusive environment for women of color. I specialize in supporting women from all walks of life, and focus on resolving issues related to: trauma wounding (generational or family of origin), anxiety and stress in addition to supporting women with life challenges related to identity, self worth and careers, IVF challenges, equitable births, and matrescence. My niche and passion is supporting perinatal and postpartum women and men because there is a lack of care, empathy and understanding to serving BIPOC communities.I fully believe in supporting paternal mental health as well because of the stigmas men face around seeking mental health care, support, and parenting.

What type of emotional, physical, and medical support did you require from your healthcare providers during that time?

Personally, I needed my healthcare providers to show compassion, empathy, and understanding while assisting me in adjusting my birth plan. Instead of a fear-based approach, I would have appreciated a trauma-informed, inclusive approach to care that provided me with the necessary support, time and resources to make the best choice. Unfortunately, I did not feel that I received such support, and I was left feeling like my healthcare providers were solely focused on giving me directions without addressing my emotional needs or providing sufficient postpartum supplies and support.

What advice would you give to healthcare providers of birthing people in the hospital setting to inform their care for others, especially with BIPOC patients?

Drawing from my personal experience and that of my BIPOC friends, I strongly advise healthcare providers to consider the following when caring for birthing people, especially those from BIPOC communities:

• Studies have shown that Black, Indigenous, and People of Color (BIPOC) experience higher rates of maternal and infant mortality and morbidity compared to white patients. Data also shows mortality rates are the highest in Black women who are three times more likely to die from a pregnancy-related cause than White women. My advice is for healthcare providers to increase awareness of these disparities and take steps to address them, including educating themselves and their colleagues on the issue and actively working to mitigate any racial and cultural biases they may hold. Also becoming an ally and building trust in the BIPOC community around active ways they are addressing it with more transparency will allow for changes that are necessary for positive equitable outcomes. We need more white allyship to make critical systemic changes in the birthing systems.

• Practice cultural humility: Healthcare providers must approach their patients with an attitude of cultural humility, respect and inclusive approaches, which involves acknowledging that they may not fully understand a patient's culture or experiences and being open to learning from them. My spouse is Nigerian-American and I’m South Asian- American. My postpartum nurses were not culturally responsive or respectful in how they communicated with their dismissive tone and language. There were times when my husband asked questions and was ignored/stereotyped as not being a present father when in fact he kept asking for skin to skin and time to bond with the newborn. Providers should also avoid making assumptions about a patient and their partner's beliefs or values based on their race or ethnicity including making appropriate check-ins about the patient’s pain levels, comfort and ways they can support them in this transition from delivery to postpartum recovery for both parents/caregivers.

• Build trust and rapport with patients: Building trust and rapport with patients is vital and non-negotiable in all healthcare settings, but particularly with BIPOC patients who may have a history of mistreatment or discrimination in healthcare. Providers can build trust by listening to their patients, being respectful of their concerns, and demonstrating a willingness to work collaboratively with them. This didn’t happen and the lack of trust can prevent patients from seeking further care of treatment or appropriate follow up visits.

• Advocate for systemic change: Healthcare providers can also play a role in advocating for systemic change to address the root causes of racial disparities in maternal and infant health outcomes. This may involve working with consultants and experts like myself that can help train and provide support in implementing new policies and procedures of equitable reproductive care, engaging in policy advocacy, or participating in efforts to diversify the healthcare workforce (hiring more staff of color) because patients need to see and experience diversity in their providers, and going through mandatory trauma-informed coursework in medical school, fellowships and hospitals.

By following these guidelines, healthcare providers can better serve their patients and promote positive and equitable outcomes for all birthing people, especially those from BIPOC communities and change the outcomes for all. To learn more about Shanaz Ikonne's therapy services and consulting please visit www. shanazikonne.com or email hello@shanazikonne.com.