“I called the nurse so many times and I keep hearing her go to these other rooms that are pressing their buttons after me and I'm getting so frustrated because I can look around there's no Black staff, there's not even a brown person like everybody's white,” Castelli said. “I’m like nobody is seeing me. All these other ladies in these other rooms are white and why are they getting help? I'm sitting here, been telling them that I've been having trouble breathing for this amount of time and they're just so nonchalant about it, just whatever, just brushed me off.”

After that night, Castelli knew a hospital would not be the place she would be giving birth and took the security of her pregnancy into her own hands.

“Basically, I was like I refuse to birth at this place, “Castelli said. “I was like, I don't care if we have just the three of us and have an unassisted home birth somewhat like, you know, she would just be there helping us but I was like I'm not doing it at a hospital., we can’t do the birthing center, we have like little no options left.”

Texas has among the highest maternal mortality rates in the nation. Black mothers are now taking action to assure Black maternal mortality doesn’t become another unbeatable high percentage by addressing racism Black mothers face during pregnancy and educating expecting mothers on the importance of pre-pregnancy health care.

“In our country, people of color have been discriminated against, Black people in particular and so absolutely, that has a detrimental impact on health,” Ortique said. “But it's not as simple as saying, well, we need to find a provider that's not racist.”

The Texas Maternal Mortality and Morbidity Review Committee was formed in 2011, with Dr. Ortique being an original member of the committee. The committee recommends areas of improvement for better methods of practice for hospitals. Rather than enforcing, the committee highly encourages hospitals to follow the recommendations.

“We basically review the deaths of women that occur in our state during pregnancy and up to one year beyond,” Ortique said. “So, looking at maternal deaths, and attempting to identify causes, contributing factors whether or not they're preventable, and then to develop recommendations when they are found to be pregnancy-related, and preventable.”

The CDC states Texas is above the national average birth maternal morbidity rates, and Black women still experience higher birth mortality rates than others.

“The [Black women] have a two to three times higher risk of mortality,” Ortqiue said.

On Dec. 6, 2019, TMMMRC Subcommittee on Maternal Health Disparities found that “factors related to the provider and facility were the most frequently identified contributors to pregnancy-related deaths among Non-Hispanic Black women,” meaning the facilities and people Black women go to for help during pregnancy are also the ones having a hand in their death.

“We've developed a subcommittee to look at maternal health disparities and to help guide the review process to make sure that a health equity lens is being applied to the review process and to make sure that recommendations are developed that would address institutional and societal level drivers of maternal health inequities,” Ortique said.

“As far as health status of women going into pregnancies [can be] an issue, but we also know that women, well the Black population in general face more discrimination and in the healthcare system itself,” Raines-Milenkov said. “So, when we think about, like delays in recognizing health conditions or dangerous situations during birth, immediately following birth, that's when kind of discrimination comes into play.”

In 2020, four million Black households were single parent oriented. Having to go through pregnancy alone, not receiving proper health care till pregnancy, along with the Superwoman Schema Black women have, all contribute to a risker pregnancy.

Black women in society have the pre-assumed image of being strong, which they also adopt themselves, this is called the Superwoman Schema or the superwoman complex. This way of thinking and taking on more stress as a working woman, head of household and in a majority of other roles forces Black women to accept many levels of stress without addressing the emotional and health damages it does to them.

“There’s still this idea of Black women having so much the cumulative stress on their body, from being, like even in situations where [they’re] high achieving women, high incomes, but that doesn't protect you necessarily from a life of discrimination, and having to work really hard,” Raines-Milenkov said.

The Superwoman Schema causing Black women stress and medical issues, along with racism in hospitals is the reason why despite education or financial level, all Black women can experience the same health concerns during pregnancy.

“We know with Black women it doesn't matter, it’s not a poverty issue, it doesn't matter if you have insurance or not, you're still more likely to die,” Raines-Milenkov said.

Mothers stopping mortalities

Committed to having a homebirth, Castelli enlisted the help of BlackHomebirths Matter ATX, one of the many assistant birthing organizations in Texas. The organization is run by a group of BIPOC midwives in Austin who help minority women have safe home deliveries and give donations through a birthing fund, dedicated to decreasing out-of-pocket costs for expecting parents wanting a midwife and home birth.

“I was actually able to get 3000 out of the 4000 we needed from the birth fund which was super awesome,” Castelli said. “We found our midwife who was the other midwife who runs the birth fund, who was awesome, amazing and we started care at 31 weeks with her and started planning for this home birth.”

Throughout Texas, various organizations are blooming to cater to the needs of Black mothers due to the increased risk they encounter during pregnancy.

Erin Backus, Black MamasATX Grant Manager, joined the organization as an intern but was drawn to Black Mama ATX due to their cause and concern for helping mothers have comfortable pregnancies.  

“My sister, my best friend, were having kids around this time, and all this stuff that I was learning about you know, these outcomes, they were experiencing them,” Backus said. “Thank God they survived, but I just thought, you know, it sucks that they had to endure this.”

Since its founding, Black MamasATX has helped 130 mothers have successful pregnancies, organized the Show Up for Black Mothers which raises public awareness of racism Black mothers experience and invested in the work of multiple Black physicians, nurses, hospital administrators, doulas, midwives, and social workers to create an available healthcare network.

“We have employed doulas and pay for their training,” Backus said. “And so, these are Black women who live in Austin, who serve other Black pregnant women. They attended births, they attended prenatal visits, they give childbirth education and lactation support. They provide a lot of emotional support for our moms and also connect with resources for other needs they may have.”