"Encourage this holistic approach to medicine"

You’ve spoken a lot about being a black woman navigating the healthcare space, being a mom, about childbirth, about mental health, so w hen did you decide you wanted to be an influencer?

K: I started taking this really seriously when I was pregnant with my second child. Being pregnant in a pandemic is part of the reason why I became so vocal. Influencing gave me a space I could go to express myself and connect with people, who also were seeking that human contact, since we were all locked in our houses.

D: So I initially found you on the black maternal mental health instagram page, where you talk about this experience of being a mom and a woman who has been through childbirth at the intersection of your racial identity. What were those experiences like and why were they so important to you?

K: So, wow, going back to when I was 19 and pregnant with my first son, my childbirth experience was traumatic. I was 19 and my doctors bullied me into all these things that I didn’t want to do. I was induced and they ended up breaking my water for me. Through that my son had developed some meconium and his heartbeat started going crazy and I spiked a fever. All of this ended up in a 26 hour labor. It was so painful and I was extremely disoriented. And at the end of it all, I had to have an emergency C-section.

What sticks out for me about all of this was that there was actually a black doctor in the room when I was giving birth. I had explicitly told my team that I did not want an epidural. That was just something I didn’t care to do. I was okay with any other medication, but I didn’t want the epidural. And this doctor stands by my bedside, as I’m stating my needs and says, “What are you trying to prove?” Like, what are you saying to me? Why are you being so aggressive right now? What are you trying to prove, really?

But eventually, I gave in to it. I felt like I had to. And they put the epidural in crooked so I felt everything on the left side of my body. They then had to go in and do a spinal block— It’s just not what I had expected for my first birth at nineteen.

D: Of course not.

K: For my second pregnancy, I was a little older and I started to take more matters into my hands. I began doing a lot of research about VBAC (vaginal birth after C-Section) and well, I wouldn’t say my doctors were supportive, but they were fine enough with it that they said I could ahead. So we planned for a natural birth, and as the pregnancy progressed, I found out that they had scheduled me for a C-section at 38 weeks.

I was told that my baby could be fine ‘til 42 weeks. They said I was not high risk at all. My husband was travelling at the time and so I was in a space where I was just made to consent to the C-section, I felt like I had to. To be fair, the surgery was not traumatic at all. My doctor was great, everything was fine. But after the procedure— I mean that surgery was the hardest thing I have ever had to recover from. My scar would not heal. I was so miserable. I was taking care of my other kid. I wasn’t living in my own home. I was just so uncomfortable.

D: Oh yeah, discomfort is big in hindering the healing process. And I feel like that’s not something medicine looks into. Do you have spousal support, do you have a safe and homely place to recover… Those are questions that don’t often get asked.

K: Yeah! And cut to 2019; I find out that I’m pregnant with my third baby.  And my hospital has a very strict policy about not accepting a vaginal birth after two C-sections. So I had relented to the fact that I would be having another surgery. I liked my doctor, so I convinced myself that it was fine. But somewhere into the beginning of my third trimester, I started reaching out to some Facebook groups to ask if anyone would just let me do a vaginal delivery after my other two childbirth experiences. I didn’t care if I had to drive hours and hours to get there. I just wanted to know if someone could help me fulfill my wish of delivering vaginally. I finally found an amazing doctor who was willing to accept me as a VBA2C. I always say, even today, that he was my savior. He gave me my redemptive birth experience that helped me get over the trauma of my first two births. After all this, my biggest thing that I always tell people is that you need to learn how to advocate for yourself. In any aspect of your health, advocate for yourself. If your doctor says something that doesn’t sit right with you, ask questions, say no, tell them you want to know more.

D: It’s your body and it’s your right to ask questions.

K: Exactly! And with my last baby, I would’ve been fine with the C-section if it needed to happen. But it was really important for me to know that my healthcare team and my husband did everything they could to give me the delivery I wanted. I didn’t want any regret or the unwanted pushing of healthcare onto me.

D: And is that why a vaginal delivery was so important to you? Was it to be free of medicalization in childbirth or was it something else?

K: I think so. In birth, there are a lot of doubts about women. I wanted to prove to them and myself that despite what everyone said I could do it.  And now that I have, I can advocate for other women who have had these traumatic experiences of doctors telling them they need surprise C-sections and say “Hey! That doesn’t have to be your narrative forever. That doesn't have to be your end.”

D: Birth is one of those things that is so intimate to your body. You are creating this whole other person. You deserve to have it be as close to your expectations as possible. I think it takes a special kind of person to convert all that pain to uplift others in the same situation. But I’m curious, why do you think these doctors are “turning?” All these professionals that say they’re okay with vaginal birth and then are suddenly not. Why is this happening?

K: I don’t know if it’s happening to certain groups more than others, but I feel like doctors just kind of say what they need to say to reel you in as a patient and then eventually they go with what is more convenient for them. With each of my kids, if my due date was close to a holiday or nearing a week that my doctor would want to be on leave, I noticed I was getting induced or called in for a C-section well before those times. I’ve been reading a lot about this phenomenon. More expecting moms getting induced weeks before major holidays, C-section rates going up prior to important weekends. And it really makes me wonder.

D: And when that conversation does happen, where your doctor says to you “Yup! You’re having a C-section,” did you ask why? What is going on? Why are we doing this when you said we didn't have to?

K: It was brought up to me very on the sly. The nurse, as I’m checking out and the doctor has already left the room, says “Hey! They’re going to want to schedule your C-section.” I was more thrown off than anything. At that point, I wasn’t vocal enough to express to them that that's not what I wanted to do. And I kind of just let it happen. I feel like they put me in a situation wherein no matter what option I chose, I was not going to be happy about it. And I was very upset with myself about not speaking up. But I struggle with a lot of anxiety, especially about saying things for myself. So to look at a person of authority, like my doctor, and say “no I don't want to do that,” was paralyzing.

D: Right, but your doctor is part of your healthcare team! They shouldn’t be this figure you don't feel comfortable talking to. And making you feel safe enough to open up to them about your healthcare… the onus is not on you. 

K: Mhm. Yeah 

D: And I think we would be remiss if we spoke about this topic and didn’t discuss the very consequential interview that came out a few years ago where Serena Williams talks about her childbirth experience. She tells us as a black woman, that no matter no high you reach, no matter how influential and rich you are, you can still expect to be unheard and disrespected by the people that promise to heal and take care of you. I wanted to know your perspective on that. The intersection of race and medicine in childbirth… 

K: Absolutely! Medicine doesn’t listen to women, period— black women specifically. With my second baby, I got an awful, awful spinal headache after. And I had noticed this with my last baby, so I was able to recognize it. By my second day, I couldn’t walk 200 feet down the hallway to the NICU where my baby was, I was in so much pain. So, I decided to speak up and I told the anesthesiologist that I thought I had a spinal fluid leak. That it felt like last time. That I knew what this was. He looked at me, said that I was dehydrated, and that less than 5% of people got what I knew I had. He didn’t put me on a blood patch, but rather gave me five, five bags of IV fluids and I, obviously, did not improve. I did not feel any better. And this is after 14 hours of labor.

D: Oh wow!

K: And I just have to wonder, if I was a white woman in that situation would I have been listened to? Would my words have mattered more?

D: Imagine if you were a white man!

K: They might’ve bent down and kissed my toes. I mean, before that experience, I knew the whole black woman childbirth thing was real, but I didn't expect to experience it. Especially, in this massive hospital, with the biggest cancer surgery center in the region, and all this other fancy stuff in it. And honestly, if I didn’t have the final birthing experience that I did, I don't think I would have been able to survive and overcome this whole spinal headache issue: the sudden inductions, emergency C-sections, or my son’s nine day NICU stay. If I hadn't eventually advocated for myself and made things happen, where would I have been mentally? 

So my word for this year is just advocate!

D: And in that same vein, another thing you talk about on your platform is mental health. You speak very frankly about your anxiety. You’ve posted pictures of you feeling down on your bed, just very honestly having a bad day. How does mental health and your struggle with it impact the act of being a patient or being the mother of a patient in our healthcare system as we know it today?

 
K: Two words. Very frustrating. I was actually in a mental health hospital last October. That was a very big part of my healthcare experience. When I was in there, they told me that I wasn’t really in a condition where I needed to see a psychiatrist– that I could just have my regular doctor prescribe me medications to keep my condition under control. But when I went into their office, my primary care physician told me that he couldn’t do it. That he couldn’t give me one of the most common SSRI’s out there. Like, what do you mean you can’t? I eventually had to get in to see behavioral health, which took me another month and a half of waiting, and then another therapist appointment which took a whole extra month. 

D: So hold on— you’re saying mental health is not under the jurisdiction of your primary care doctor? Your first line, preventative care. mental health is not covered under that? Is mental health not primary? Is it something that only belongs to specialists?

K: Exactly! And it blows my mind. Recently, I went in to tell the provider that I thought a certain medication they were giving me wasn’t working and all they wanted to do in response was keep upping and upping my dose. I kept telling them, “It. Is. Not. Working.” But in the process, I learned that a lot of doctors are actually afraid to prescribe a variety of medications because of patients who are known to pill shop. People who manipulate providers into getting the pill they ultimately want for an addiction. But this goes back to our connection with our doctors. If you had bothered to take a look at my charts, you would see that I have never been on a ton of antidepressants before and I haven't been skipping around doctors. I have anxiety and I want to get help for it. I’m not abusing SSRIs! But in medicine, we’ve forgotten about this human connection and made it so technical that— I mean, people are people! 

D: And at the end of the day, if a patient like yourself wants to figure out what is best for her there should be a space to have those conversations. I’m getting that there is a need for providers to have some basic training in— well, humanity, to identify who is genuine and who maybe isn’t. And so in that direction, if you had to say something, an open letter to future doctors and medical professionals, given everything you have experienced as a patient, what would you want to say?

K: Just be open! Be personable. Be an ear to listen and fill in the gaps for someone who might not even know those gaps exist. If people have questions, be willing to look outside yourself, and outside of the things you may have learned in medical school. 

D: And if I had to open the floor to all forms of medicine. Your run-of-the-mill care, so not just childbirth, but the annuals, the pediatrician visits, the pap smears, the checkups. Do you think given all your identities, these facets of healthcare look different for you than they do for some other groups of people?

K: I think because I look a lot younger than I am, I’m not taken as seriously. You can tell that there is an air of the doctor knowing more than you. I’ve had pediatricians dismiss me about my own daughter. I’ve had them tell me that there is nothing I could do with her eczema except give her cortisone. “Nothing?” I’d ask them, “Do you think she has asthma?” and they’d say “No. She’s not wheezing right now.” But I know that she is as soon as we get home! And I’m telling you that and you’re not listening to me! And I feel like you’re looking at me like I don't know what I’m talking about! Why? Because I’m younger than some of the other parents out there? Or is it something else...

D: And where do you feel like that’s coming from? Is it just that one doctor?

K: I think it’s a general “I know more than you thing!” and a complex of “whatever you’re describing doesn’t check all my little medical boxes,” so, I’m sorry. But shouldn’t being in medicine involve a love of the puzzle?

D: The love for things outside the inventory checklist.

K: Yeah! You should get a rush from helping people put the complicated pieces together. You can’t just listen to my story and think “yeah no it doesn't make sense off the top of my head, so I’m going to let it slide.”  I don't want to use the word laziness…

D: But complacency? And comfort with where you are…

K: Exactly.

D: Well, thank you so much, Kaesha, for taking the time to sit down with me and open up about these issues. Being a patient in the 21st century healthcare system is not easy and your unique experiences help us see a whole new side of what it’s like navigating this territory. Is there anything that you would like to say that we should put out in this narrative medicine piece?

K: Just to, as a professional, encourage— be an advocate for your patients, but also encourage them to be an advocate for themselves. In all places of medicine. Childbirth, mental health. Encourage holistic well-being. In the mental health hospital, we worked on a lot of mindset things, and I loved that. You can’t just treat the problem, you need to go to the very source of a person and treat all the underlying issues. So yeah, encourage this holistic approach to medicine.