The Grisly Origins of Gynecology: How Colonialism Still Haunts the U.S Healthcare System
Gynecology is the branch of medicine that has to do with diseases and conditions that affect women and girls as well as their reproductive health. Like many branches of medicine, gynecology advanced through the exploitation of an oppressed group. As Dr. Deirdre Cooper Owens documents in her book, ”Medical Bondage: Race, Gender, and the Origins of American Gynecology” enslaved black women were used as guinea pigs to test experimental procedures.
J. Marion Sims was a 19th century physician who was heralded as the father of gynecology. He is credited for creating the speculum and the self-retaining sigmoid catheter. A common birth complication in the mid-1800s was the vesicovaginal fistula. A vesicovaginal fistula occurs when a breach forms between the vagina and the bladder. Women with this condition often suffer from urinary incontinence. This condition often made life unbearable for women, with them having to deal with chronic pain as well as stigma. Sims conducted experimental surgical procedures on enslaved black women in Alabama to repair vesicovaginal fistulae. He experimented using different materials to suture the fistulae. Anesthesiology was not used during this time, so the women were often in agony during these surgeries, some even died. Once these experimental surgeries were perfected on enslaved black women, they were made available to white women.
The gruesome beginnings of American gynecology continue to reverberate to this day. According to the CDC, black women are 2–3 times more likely to die from a pregnancy related complication compared to white women. Black women also have higher rates of severe maternal morbidity compared to white women. These statistics make it clear that something must be done to safeguard the lives of expecting black women and their newborns.
The question is “what can be done to protect pregnant black women and their children?” It is necessary to acknowledge that the field of medicine has been inherently racist. For centuries in the U.S, those who provided medical care widely believed that black Americans did not feel pain. This was due to racist preconceptions that black people were biologically different from whites, that they possessed thicker skin and that their blood coagulated faster. Evidence that these racist ideas persist in the field of medicine in the present exists in the fact that black Americans are less likely to receive treatment for pain compared to their white counterparts. OBGYNs must be responsive to the needs and concerns of black pregnant women. If they say they are in pain, they must be believed and be given treatment. Physicians must be made aware that being a pregnant black woman in and of itself is a risk factor for birth complications. Medical school curricula should include medical humanities courses that cover the history of gynecology. Books like “Medical Apartheid: The Dark History of Medical Experimentation on Black Americans From Colonial Times to the Present” should be required reading. Most medical professionals have good intentions, they are not explicitly racist, but they may harbor subconscious biases. Medical school students should undergo introspection and examine whether they may have these biases.
While the institution of medicine plays a large part in the poor outcomes experienced by pregnant black women, it is certainly not the only cause. First of all, it is important to understand that the biggest risk factor for birth complications is stress. Living in America can be incredibly stressful for black women. They face the double burden of facing discrimination for being both black and a woman. Racism permeates every aspect of American life. Whether it is interpersonal racism, such as microaggressions faced in everyday life or structural racism, such as black people being more likely to be stopped by police or having to live in poor, underdeveloped neighborhoods due to housing discrimination, it is clear black Americans are stressed due to racism, and this is not good for pregnant women. Racism is as American as apple pie and it is not going anywhere any time soon, so what can be done?
First, black pregnant women should seek out the care of doulas. A doula is a “…trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible.” Studies have shown that the use of doulas leads to improved birth outcomes.
In addition, new and innovative paradigms of prenatal care, such as Centering Pregnancy, should be made available to black pregnant women. Traditional prenatal care typically consists of one on one meetings between pregnant mothers and their physicians. These interactions often have a parent-child dynamic, with the physician doing all of the talking. The cumulative time of these doctor visits is typically around two hours over ten visits. Centering Pregnancy offers a more effective model for prenatal care. Under this model, pregnant women meet in groups of 8–10 along with a medical professional. The women meet ten times for approximately two hours each visit, meaning women will have 10X more time with their health care provider compared with traditional prenatal care. The meetings begin with the mothers taking and recording their own vital statistics. The group then covers topics such as nutrition, breastfeeding, stress management, and more. By having the women take and record their own weight and blood pressure, the women build self-efficacy. Meeting in groups allows the women an opportunity to socialize and form connections. Studies have shown that the Centering Pregnancy model leads to improved birth outcomes and reduces racial disparities in preterm birth.
The significant maternal mortality and morbidity experienced by African American women is a public health crisis. Medical school curricula should be reformed to shine a spotlight on this serious issue. Pregnant black women should have access to doulas and alternative models of prenatal care, such as Centering Pregnancy. Although these interventions may go some way in mitigating the birth complications black women face, how to deal with the greater societal issue of racism remains to be seen.