In August of 2020, in Lexington, Kentucky, Serena Williams was doing what she is best known for—playing tennis. It was one of the early matches in the 2020 Top Seed Open. This winner of twenty-three Grand Slam titles was unexpectedly distracted during her match. In the midst of a play, she heard a single cough from the stands. Her daughter’s cough. At the time, her daughter Alexis Olympia Ohanian Jr, 2, was watching her mom while sitting in the stands with her dad, Alexis Ohanian. The father-daughter duo was snacking on grapes while watching Williams on the court, when Olympia coughed. In interviews following the match, Williams shared that while she was on the court, she immediately knew that the sound came from her daughter. Her mind wandered from the court, and she began to remember how grapes can be a choking hazard for toddlers. She hoped her husband was making sure that Olympia was chewing before she swallowed. While Olympia’s cough might have momentarily distracted Serena, it didn’t affect her game play. She was able to regain her focus. In that match, she beat Bernarda Pera in order to go on to play her equally famous big sister Venus. 

The story went viral. Maybe it was because Olympia is absolutely adorable. Maybe it was because other working moms understood the balance of attending to the need of their children while also being a success in their field. Maybe it was because it was a humanizing story of a top tier athlete. She was not only a magnificent tennis player; she was also a concerned mother. The professional and the personal intersected in public for her. And yet, she went on to dominate on the court. 

For people who have only ever seen Williams dominate as a powerhouse on the tennis court, this lean toward domesticity may be unexpected. Serena Williams and her husband, the co-founder of Reddit seem to have found a balance. They appear to have crafted a life that allows them to support each other as partners, in their professional endeavors but also within their home.

When deciding what to name her daughter, Williams told Haskell that she began looking up the word “strong” in various languages. While her first name, Alexis, is the same as her father, Williams and Ohanian, decided to call their daughter by her middle name: Olympia. She was determined to raise Olympia to be strong. Williams wanted her daughter to grow up feeling empowered, she would do everything and anything she could to remove obstacles in her path.

Williams is a feminist who named her daughter the Greek word for “strong”, who works towards equal opportunities for women, women of color. She has access to the best health care in the nation, but she could not escape the risks associated with giving birth as a Black woman. 

A 2019 press release, from the Centers for Disease Control (CDC), titled “Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths”, began with the gut wrenchingly clear line: “Black, American Indian, and Alaska Native (AI/AN) women are two to three times more likely to die from pregnancy-related causes than white women.” Naysayers, and those who may be slow to accept the painful reality that we are not living in a post-racial society (as some alluded to with the election of former President Barack Obama) may claim that this is a side effect of disparities within socioeconomic status (SES) or education level. That is a flawed argument because within the United States, SES and level of completed education are inextricable from race. Additionally, the CDC seeming to have anticipated such a counterargument, went on to explain how the pregnancy related mortality rate for a Black woman with a bachelor’s degree was still 5.2 times higher than the pregnancy related mortality rate of her white counterparts. Both being pregnant and delivering your child are categorically more dangerous if you are a non-white woman, and it is especially dangerous if you are Black. 

Serena Williams, with all of her power, education, money, and industriousness, was not exempt from this statistic. In a harrowing story of self-advocacy, Serena Williams recounted to Haskell how she saved herself from a near-death experience immediately following the birth of her daughter. 

Alexis Olympia Ohanian, Jr was born on September 1, 2017. She was born by emergency caesarean section; the surgery went smoothly and both baby and mother were healthy. The small Williams-Ohanian family had grown to three, and they were all happily resting together. According to Williams, “that was an amazing feeling, and then everything went bad.”.

Williams had a history of having pulmonary embolisms. A pulmonary embolism happens when a blood clot begins in a large vein in the body, known as deep vein thrombosis, and travels all the way through the heart, and eventually to the lungs. There, the blood clot gets in the way of the normal exchange of oxygen and carbon dioxide. Williams had successfully been managing the condition with an anticoagulant regimen, but had to stop taking her medication because of the caesarean section. 

Caesarean delivery, also known as a C-section, is a common way of delivering the baby through incisions in the abdomen and uterus. Some caesareans are planned, and some are considered “emergency C-sections” when they are done unexpectedly following complications from a vaginal delivery. Some complications that could make an emergency caesarean delivery necessary are if the baby is in an unusual position, the umbilical cord slips through the cervix before the baby, either the mother or the baby have a medical concern, or potentially because the mother has had a prior caesarean. While some doctors approve of a vaginal birth after a caesarean (VBAC), depending on the incision and other factors, the doctor may recommend a patient to have a caesarean delivery if they have had one in the past. 

As with most medical practices, caesarean deliveries are not without controversy. Some women want to plan to deliver their children via caesarean delivery because they are comforted by the structure of a planned and scheduled delivery. However, more and more medical professionals discourage this practice due to the possible medical complications of the caesarian on present, or future, deliveries. In 2019, The Atlantic published an article, “Why the C-Section Rate Is So High”, posing that doctors may be financially incentivized to perform more C-sections than are medically necessary. According to the World Health Organization, approximately ten to fifteen percent of deliveries need to be done via caesarian. That is a significantly lower percentage than the average percentage of caesarians done each year in the United States. 

On September 2nd, the day after her successful and necessary caesarean, with her newborn nearby, Williams began to feel out of breath. She knew she was once again battling a blood clot. The industrious self-advocate that she is, she told her nurse that she needed a “CT scan with contrast and IV heparin (a blood thinner) right away.” Initially, Williams received pushback from her medical support staff. It felt to Williams as if they didn’t believe her. The staff told her that she may be confused as a result of the heavy prescription painkillers she was taking. They followed an alternate plan of care: they started with an ultrasound. After what Serena described to Haskell as “too long”, they gave her the CT scan she knew she had needed; soon after she was prescribed the exact IV drip she had originally requested. 

Serena had doctors who (eventually) believed her. The outcome of that day was a healthy woman, a healthy baby, and eventually a slew of Instagram pictures of the two of them in matching princess dresses. 

Just one year earlier in 2016, the Department of Psychology at the University of Virginia in Charlottesville published the article: “Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites.” This article is frequently cited to back up the widely understood claim: Black Americans systematically receive substandard medical treatment, specifically when compared to white Americans. 

The 2016 study went on to prove that the systemic racism ultimately was tied to false beliefs, held by both white laypeople and white medical students alike. Some of the false beliefs were: “Blacks’ skin is thicker than whites’”, “Blacks’ nerve endings are less sensitive than whites’”, and “Black couples are significantly more fertile than white couples”. These statements sound as if they are out of a Reconstruction or Jim Crow Era pamphlet. They reek of ignorance. And yet, a number of highly educated medical students believed these statements to be true. These false beliefs lead to significant racial disparities in their pain assessments and treatment recommendations. 

The study was able to operate under the understanding that Black Americans receive substandard care, because that is already a well-documented atrocity of American history. And much of that documentation can trace its origins back to what is now known as “The Heckler Report”. The Heckler Report, or “The Report of the Secretary's Task Force on Black and Minority Health”, was published in August of 1985 after the Secretary of the Department of Health and Human Services, Margaret Heckler, launched an investigation into the disparities in life expectancy between white Americans and non-white Americans. When Heckler was first presented with the data showing the disparities in life expectancy for non-white Americans, she called it an “affront to our ideals and to the genius of American medicine.”  

Ultimately, the Heckler report became both a launchpad and an anchor. It gave government institutions and academic institutions alike the data needed to support the undeniable truth that healthcare was not equitable. Once that truth was proven undeniable, those same government and academic institutions were able to get to work righting some of those wrongs. 

It is clear that in the thirty-one years between the Heckler Report and the 2016 study from the University of Virginia, the wrongs were not righted. Disparities remain, and they have continued to the present day. 

In 2018, a tweet with a short clip of Dr. Neel Shah, a Harvard Medical School professor, went viral. In this clip Dr. Shah states clearly that “[Doctors] believe black women less when they express concerns about the symptoms they’re having, particularly around pain.” The tweet ended up with more than fifteen thousand retweets, and what followed was a litany of wrongs committed against Black women by doctors, hospitals, and nurses alike. It is not that just one woman related to this story, or that one friend shared an anecdote. Over fifteen thousand people saw that statistic, and saw themselves in it. It wasn’t data for them, it was healthcare. 

While I was already familiar with the disproportionately negative outcomes for Black women in healthcare, I was motivated to learn more after talking to Melissa. She had seen my post asking to hear from women about their adventures, and misadventures, in healthcare and sent me a message. We scheduled a time to talk the following week.

When I was talking to Melissa, while doing my customary laps around Irving Square Park, it was Serena Williams who kept popping up in conversation. Melissa had, on occasion, used Williams as an anecdote to prove how the inadequate treatment of Black women in healthcare affected women of all socio-economic statuses. It was Melissa who reminded me that even Williams’s fame and notoriety were not enough to keep her safe. 

Melissa is bi-racial: Black and white. Her husband is Mexican-Korean; together they have five-year-old twins. When describing her children, Melissa told me “I’ve got a daughter who has more my darker skin. I’ve got a son who looks like he could be Caucasian and obviously how they interact with the world, and even the health care community, is going to differ.” 

Melissa was adopted when she was young and grew up, in the Texas Rio Grande Valley, with two white parents who she describes as being a bit older than her friends’ parents. Her parents came from a generation where they felt that they could trust their doctors unconditionally. If their doctor prescribed them a medicine or a treatment, they took it. They taught Melissa to do the same. They told her: “Your doctor is correct; you don’t ask questions.” So, when Melissa was an eighteen-year-old growing up in the Rio Grande Valley, she unquestioningly took the birth control that her gynecologist prescribed to help treat her heavy periods. 

Melissa was a very active and healthy eighteen-year-old when she started birth control, she took birth control because she wanted to find a way to lessen her heavy periods. It was a little while later when at an appointment with her primary care provider that the doctor noticed she had high blood pressure. She never questioned the link between the birth control she had been prescribed and the sudden onset of high blood pressure. Instead, when the doctor recommended that she begin taking blood pressure medication, she said okay. Melissa then paid sixty dollars a month, every month for the next eight years: 2000 to 2008. By the end of that eight years, she had paid about $5,760. 

It was not until years later, that Melissa realized that her birth control might be causing more problems than it was solving. It was 2008, and Melissa’s gynecologist asked her: “You're very healthy. You run every day. Why do you have high blood pressure? What other medications are you taking?" In Melissa’s telling, it only took the doctor two seconds to say that she needed to have a lower dose for her hormonal birth control. Melissa didn’t have high blood pressure because of a lack of exercise or a healthy diet. She didn’t have high blood pressure because of a hereditary factor. She had high blood pressure because of her birth control. 

High blood pressure, medically known as hypertension, is not always a side effect of hormonal birth control, even when taken for many years as Melissa did. But this was how Melissa’s body reacted to the prescription. Melissa was changed to a lower dose of hormonal birth control and her hypertension went away. 

Melissa did not need all those years of medication for her high blood pressure, she needed a doctor to look at her and question what could be the cause of her problems. The previous doctors had only tried to fix the symptoms rather than identify the root cause. 

It was then that Melissa began to question all the money she and her parents had spent over the years; she questioned all the times she had tried to lower her high blood pressure. It was then that Melissa realized she needed to start asking her doctors a lot more questions. Just because a doctor was kind, or well-intentioned, did not mean that they would unfailingly prescribe the plan of action that would best help Melissa. It could be true that a misalignment in their values could lead to an improper care plan. 

Melissa knew then that she would have to always go in prepared. As a biracial woman who identifies as Black, she would need to prove how seriously she deserved to be taken. She went in with questions, ones that proved she had done her homework and was going to be steering the ship when it came to her health and healthcare. 

Some women worry about being a “difficult patient”. Not Melissa. According to her, when you’re advocating for yourself, there’s no such thing. If you are unsure of something your doctor says, or maybe you’re unsure about a drug they prescribe, you need to ask. If you have a question, it is your responsibility to ask. If your friend, sister, partner, daughter, son, brother, or neighbor is uncomfortable, then you need to teach them how to speak up. 

By the time Melissa was explaining how we need to not only advocate for ourselves, but also teach those around us to be better advocates, I was moved by the way that Melissa so clearly cared for others. When she learned lessons of how to better advocate for herself, she passed on those lessons. She did this when she agreed to speak to me about her experience and the ways that it spoke to larger systemic strengths and weaknesses. But, at the same time, she also made sure that there would also be seats at the table for other women to do the same. While we were on the phone, Melissa made sure to ask if I was speaking to a sufficiently diverse cohort of women. It was important to her—as it is important to me—that I spoke to women of different ages, races, educational backgrounds, socioeconomic statues, religions, et cetera. Melissa wanted to make sure that the metaphorical megaphone was being passed to other individuals who also deserved to have their stories heard. 

Once Melissa was prescribed the lower dose of hormonal birth control, she continued to take it for five years, until 2013, when she was twenty-nine. She and her husband, who was in the military and had been deployed for three years, decided that they wanted to start their family. One month after he returned from his deployment, Melissa became pregnant with twins. 

Because her husband was in the military, all of Melissa’s prenatal care was done through the military healthcare system at Walter Reed’s new facility in Bethesda, Maryland. Despite being pregnant with twins and having a history of high blood pressure, Melissa was lucky to have a fairly easy pregnancy. She never had gestational diabetes or a reoccurrence of hypertension. She was able to carry her twins for the full term. But it was during delivery that, as Melissa put it, “things got dicey.”

Her daughter was born vaginally after only fifteen minutes of pushing. Her son was then born via an emergency Caesarean section. But as Melissa tells it, the drugs had stopped working. Throughout the entire Caesarean section, she remembers telling the physician that she could feel everything. He only responded that there was no way that was true. She repeated: “I can feel everything.” She was screaming. They called on a team of anesthesiologists to figure out what was going on. They tried a number of different anesthetic cocktails. Nothing worked. But they had to deliver her son. 

In the hours and days that followed, a number of nurses and doctors came by to apologize to Melissa for what she had gone through. She appreciated that. It wasn’t until years later that she began to think about how she fit into larger themes and narratives about what was happening across the country. She thought again of Serena Williams. When looking at the statistics and stories about maternal health, especially Black mothers, Melissa began to question why exactly was she not believed. Why was she told that she couldn’t possibly be in pain, when she felt every incision they made to deliver her son. Could it be because is Black?

Melissa explained that she can’t know for sure what role her race played in the ways in which her pain was not respectfully acknowledged. But she is a Black woman. And her pain was not believed. In spite of this, Melissa was still appreciative of the care that she received at Walter Reed, because it was there that her life was saved soon after her twins were born. 

Three days after Melissa and her twins were released to go home, they were back at Walter Reed for their routine checkups with their pediatrician. While talking with the pediatrician, Melissa mentioned that she was experiencing some new swelling. The pediatrician was worried; this was not a symptom she should be having in the immediate days postpartum. Walter Reed is a huge campus, so the pediatrician was able to send Melissa on a short walk to check in with a gynecologist in the Women’s Health Department. The moment the gynecologist saw Melissa, they told her to go straight to the ER. There, she was readmitted with postpartum preeclampsia, a deadly condition if left untreated. 

According to the Mayo Clinic, postpartum preeclampsia is a rare condition characterized by high blood pressure and excess protein in urine soon after childbirth. It is similar to preeclampsia that some women develop while pregnant before giving birth. While high blood pressure, diabetes, and obesity can make a patient more at risk of developing postpartum preeclampsia, it is not well understood what causes postpartum preeclampsia or preeclampsia during pregnancy. While if caught early, women with preeclampsia can experience a full recovery, if left untreated, women can experience seizures, other serious complications, and occasionally death. Most doctors treat postpartum preeclampsia with medicines to lower a patient’s high blood pressure and prevent future seizures. For seizure prevention, many doctors prescribe a magnesium sulfate treatment. 

If Melissa had waited even a short while longer, her doctor told her that she very likely would have suffered a stroke. After twenty-four hours and a magnesium regimen, Melissa was stable and returned home. Not all women who experience postpartum preeclampsia in the days after delivering their children fare as well as Melissa did. She felt lucky to have Walter Reed and their integrated care model. It is uncommon that an American woman would have a follow-up appointment with their gynecologist three days after being released from the hospital. And if they don’t see their doctor, they have a significantly decreased chance of catching a condition like preeclampsia. Melissa credits Walter Reed with catching her condition, and saving her when they did. 

Melissa understands her own story as an example of being an empowered self-advocate. She spoke up and asked questions when she realized there was swelling that she didn’t expect. She had learned that even when doctors appeared to have her best interests in mind, she still needed to question what she saw and actively advocate for what she thought was best. Her experience with birth control induced hypertension prepared her for her experience with post-partum preeclampsia. She didn’t wait around to see if it went away. 

In Melissa’s retelling, not all of the credit for her recovery can be attributed to her advocacy. She knows how lucky she is to have the military health care system. In her experience, they do an excellent job of caring for soldiers and their families. She knows others, not in the military healthcare system, who have not been as lucky.

Melissa is quick to tell me how her experience of care is not true for all women, she alluded to the fact that her sister has not always been as lucky as she has. In addition to her sister, she has a friend who was slapped while receiving her epidural. In the moment when she should have been presented with a way to alleviate her pain and welcome her child into the world, she was slapped. Dehumanized. Melissa went on to explain how the woman who was slapped had a Ph.D. How the woman is well known in certain D.C. circles. But there is no world in which it is okay for a medical practitioner to slap a patient. No lack of education or social clout makes this acceptable. But by that same measure, it seems that no education or social clout could protect her either. 

While horrifying, it should not be surprising that Black women, and other women of color, are disadvantaged in the world of pregnancy and giving birth. A history of American gynecological studies would be incomplete without an acknowledgement of the ways in which modern gynecology evolved through dehumanizing testing of enslaved women. 

Giving birth is a dangerous business. There is an overwhelming multitude of ways in which a woman’s health can be at risk during childbirth, but some complications are more common than others. One fairly common complication, from a vaginal birth, is a vesico-vaginal fistula—a small hole that occurs between the bladder and the vagina. If left untreated, this tear leads to nearly perpetual discomfort and uncontrollable urination. The doctor responsible for both the surgical procedure that cures a vesico-vaginal fistula, as well as the invention of the vaginal speculum, was Dr. James Marion Sims. Before Dr. Sims, there were treatments for a vesico-vaginal fistula, but not cures. 

In Alabama, between 1845 and 1849, Dr. Sims operated again, and again, and again on three enslaved women: Lucy, Anarcha, and Betsey. These operations were painful, reoccurring, and inhumane. In one account, Lucy was forced to kneel, on her hands and knees, on a table, while Dr. Sims operated on her—without anesthesia—for over an hour. In his own autobiography, written thirty-nine years after the gruesome operations, Dr. Sims recounts that “Lucy’s agony was extreme, I thought she was going to die.” There is no account of remorse on the his part.

At the Smithsonian’s National Museum of African American History and Culture, you could easily miss the small waist-high glass box that holds the gynecological surgical instruments that Sims used to torture and experiment. I almost did. Against a pale beige linen background, four items stand in relief: a speculum, a needle holder, a needle, and two circles of silver wire. As I walked by this particular display, I thought at first, that the silver wire was a pair of earrings; an item worn to adorn rather than torture. But, when I stopped, and looked closely, there is no mistaking the horror that these tools witnessed. On the red placard, just to the left of the box, in large beige capital letters is the title “Enslavement.” Under this unmistakable title, the paragraph, which enumerates the horrors that Lucy, Betsey, and Anarcha faced, begins with “Slave owner Dr. J. Marion Sims…”. There is a clear intentionality here. While Dr. Sims found a way to progress modern gynecological practices, his “discoveries” do not outshine the horrors he inflicted. He is first, and foremost, a slave owner.

Fifty years after the torture of Lucy, Betsey, and Anarcha, in the 1890s, a larger-than-life statue of Dr. Sims was erected in Bryant Park in New York City. It stood there for thirty years until, as a result of subway construction, the statue was removed. The statue was not hidden for long; in 1934 it was installed across from the New York Academy of Medicine in Central Park. And there it stood—uninterrupted and seemingly unquestioned—until April 17, 2018. 

In 2017, community leaders and elected officials called on the New York City Department of Parks & Recreation, as well as the mayor of New York City, to remove the statue of Dr. Sims. On April 17, 2018, the statue of Dr. Sims was removed from its pedestal in Central Park and moved to act as a headstone for Dr. Sims’s grave in Brooklyn’s Greenwood Cemetery. It is an imperfect solution, but it is removed. He is no longer lauded without question across from the New York Academy of Medicine. It took nearly one hundred and thirty years for New York City to remove the statue. Anarcha alone received over thirty torturous surgeries from Dr. Sims. That is over four years of public commemoration for each of her surgeries.