By Kylie Marsh for the Charlotte Post, with support from the Pulitzer Center on Crisis Reporting.
Broadcast version by Shanteya Hudson for North Carolina News Service reporting for the Charlotte Post-Public News Service Collaboration.

Amirah McCree planned to deliver her second child, Yara, at a hospital in Pineville. She immediately felt rushed by the all-white nursing staff.

Because delivery required an induction, McCree, a Charlotte paralegal, did her research. She knew she did not want to take pain medication, because it would make labor harder and faster. She was able to convince the nurses to go with a different induction method, but "they still felt it wasn't going fast enough."

There is growing awareness of the medical racism Black women like McCree have faced during pregnancy.

"[The nurse] literally said, 'we're here to have a baby,'" McCree said. "It scared me a little...even though I tried to advocate for myself, it still went nowhere. It was really scary because you're in a hospital bed and you can't say, 'I don't like this, I want to leave.'"

The nurses then asked McCree's family to leave the delivery room.

"When they left, it was just me, the nurses and the midwife," McCree said. The nurse then informed McCree that she'd check her cervix, and proceeded to perform an amniotomy, which is manually breaking the amniotic membrane.

"I know what a cervix check feels like. She went further," McCree said. "She swiped my fluid, and when I tried to stop her, the nurses held my hands. It was completely traumatic."

McCree never returned to the hospital, and has trouble recollecting what followed due to blocking out the memory.

In the U.S., Black women are far more likely than white women to report that health care providers scolded, threatened, or shouted at them during childbirth, research shows.

In April, the Charlotte-based nonprofit Care Ring hosted a panel discussion during Black Maternal Health Week, a national initiative geared toward tackling the high rates of death for Black mothers and their babies. There, healthcare professionals Jonisha Brown and Keyona Oni shared their stories about receiving sub-par medical care.

A 2016 survey of medical students and residents found that half held false beliefs about biological differences between Black and white people, including that Black people feel less pain. That belief is just one factor that can cause bias and lead to inaccurate treatment recommendations or clear medical neglect in patients of color.

"We recognize that there is a trust breach that has occurred in healthcare. That trust breach is present, that there is implicit bias, and certain things we took as dogma," said Noellee Clarke MD, a OB-GYN at Novant Health who is Black. "During my residency, they'd talk about the number one risk factor for preterm labor and preterm delivery, and by de facto, it was Black maternal risk.

"It was no more risk factors. The only other would have been prior history of what the condition is, but back then it was, there's a race-based system."

Implicit bias is just one piece of the larger Black maternal and infant mortality puzzle. In addition to lifelong trauma and generational distrust of the medical community, a history of neglect and malpractice are significantly more deadly for women of color.

According to the federal Centers for Disease Control and Prevention, the maternal mortality rate for non-Hispanic Black women in 2021 was 69.9 deaths per 100,000 live births, 2.6 times the rate for white women.

Rates for Black women were significantly higher than rates for their white and Hispanic peers. The increases from 2020 to 2021 for all race and Hispanic-origin groups were significant.

In North Carolina, the maternal death rate is higher than the U.S. average. In 2021, the state's maternal mortality rate was 44 deaths per 100,000 births, according to CDC data compiled and analyzed by the investigative news organization MuckRock.

North Carolina's Maternal Mortality Review Committee's report on North Carolina reported that more than 85% of those deaths were preventable, and discrimination was the leading probable contributing factor in nearly 70% of cases.

Bias and discrimination went beyond race or ethnicity, and included weight, geography, substance use, history of incarceration, and other factors.

Panelists at Care Ring's Black Maternal Health Conference in Charlotte addressed issues relating to maternal and infant mortality in addition to implicit bias, like lack of access, poor policy, and the threat of reduced funding for programs aimed at certain demographics.

Other issues that can contribute to maternal mortality are connected to housing insecurity and intimate partner violence. Clarke explained Novant's three-tiered strategy geared toward increasing ease of access for expecting mothers.

The strategy focuses on social determinants of health, personable care and early prenatal care.

"The reality is we don't live in a vacuum," she said. "As patients and as human beings, we each interact with the world, and each patient's world looks different."

Social determinants of health include access to transportation, nutritious food, safe housing, education and community support.

In 2023, Novant reported that each month, an average of 3,000 patients screen positive for food insecurity at Novant Health medical group clinics, with 400 to 600 patients not having food on a given day.

Novant has set up partnerships to address inequities, like referring patients to the nonprofit food bank Nourish Up and providing free transportation with a community health worker to and from the food bank. It includes new and expecting mothers.

Clarke compares trying to change social determinants of health to boiling the ocean.

"It's on us as healthcare workers to help make these outcomes better for our patients," she said. "We have the ability to have influence and we can directly make a difference for our patients."

Earlier access to care is crucial, especially in a country where access to family planning care is becoming increasingly hard to find. Clarke says that's why it's important to get care as early as possible.

"We need to be more aware of our pregnant population," she said.

McCree's experience at Novant Health Ballantyne Medical Center is the opposite of Pineville.

McCree's mother and grandmother faced life-threatening complications with their third birth. Their experiences were on her mind since her son, Noah, would be her third.

"It's really scary as a mother of color to go into institutions where you know there is a prior history of being discriminated against," she said.


"It was like everyone was passing the baton. There was never a lapse," McCree said.

Nurses tried a bulb induction, where a balloon is filled with fluid to stretch the cervix to a safe diameter before the mother can push. However, the baby still wasn't coming. Having been traumatized from her previous experience, McCree refused to let Swiyyah perform an amniotomy.

While the nurses and McCree were weighing a switch to Pitocin, a pain medication that causes faster and harder contractions, Noah was born.

McCree is part of a Facebook group for Black mothers in Charlotte, where people frequently ask for recommendations on Black doctors.

"That comes from a sense of fear that if you don't have someone who looks like you, the likelihood of you being treated normal - not special, just normal - might not be given," she said.

While there are public-private partnerships meant to address historic harms to Black moms, it is still significant. As long as it exists, it will continue to sow distrust.

"I think it's hard to ask how do you remove fear from places that have created the fear," McCree said. "I think that'd be a better question for the people that created the fear in the first place."


Kylie Marsh wrote this article for the Charlotte Post.


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Holiday travel is in full swing and for many, so is the stress. The American Heart Association of Missouri has health tips for anyone with heart disease or other chronic health conditions.

Medical professionals emphasized holiday travel requires planning. They suggested starting with a checklist: Consult your doctor, stock up on medications and prepare any medical equipment.

Dr. Georges Chahoud, cardiologist with SSM Health and board president for the American Heart Association-Metro St. Louis, offered advice for travelers with pacemakers and similar devices.

"If they are traveling, especially on an airplane, they have to make sure that they have enough time because they have to go through a special security check, since they have those devices," Chahoud explained. "It's recommended that they don't go through the metal detector; they can be 'wanded.'"

The American Heart Association also noted flights over four hours increase blood clot risk, so wearing compression socks is recommended. Research shows 6% to 7% of travelers deal with some kind of illness during or after their trips.

In a Heart Association survey, 69% of respondents said they struggle with eating healthily during the holiday season.

Chahoud, who is regional director of the Heart Failure Clinical program at SSM Health-St. Louis and Southern Illinois, and director of Cardiology Services at SSM Health-St. Joseph Hospital in Lake St. Louis, emphasized the problem can be exacerbated if you are traveling.

"They may indulge more in alcohol use, which can induce some heart problems, especially with irregular heart rhythm and A-fib," Chahoud pointed out. "Diet is quite important for patients with heart failure, especially as it pertains to those patients that don't watch the salt in their food."

He stressed the importance of seeking immediate medical attention if you experience symptoms of heart issues, such as chest pain or shortness of breath. Check for medical facilities available at your destination and know your health insurance coverage.

Maryland is facing a significant shortage of behavioral health professionals and a new report from the Maryland Health Care Commission offered some suggestions to fix the problem.

All but two counties in Maryland are labeled as a partial or complete mental health shortage area. Years of underinvestment and high rates of burnout for behavioral health specialists has caught up with the state. The report found a 50% shortage in the number of professionals needed to adequately care for Maryland's population.

Tiara Fennell, assistant clinical professor and clinic director of the Center for Healthy Families at the University of Maryland-College Park, said behavioral health professionals have long been undervalued, which can lead to burnout. The COVID-19 pandemic, she added, is also partly to blame.

"A lot of it has nothing to do with their intent or their desire to help people," Fennell explained. "It's because of their desire to want to be able to take care of themselves. One of the major things that is a deterrent is people not getting paid enough."

The report showed 45% of behavioral health professionals currently working in Maryland are expected to either retire, leave the state or exit the profession in the next five years.

To tackle the shortage, the Maryland General Assembly passed a Behavioral Health Workforce Investment Fund in 2023 and commissioned a report on how to spend the money. The report recommended focusing on investments in behavioral health. It suggested implementing more "earn while you learn" programs, with paid apprenticeships, fellowships and stipends to lessen the costs of college. More flexible schedules and mentorship programs were also recommended to address the nonfinancial issues of burnout.

Fennell pointed out many behavioral health internships are unpaid and she believes efforts to increase pay and reduce work loads for these professionals will boost recruitment and retention.

"That would make a huge difference getting people interested in this type of work," Fennell contended. "Also, maintaining that workforce -- and having people want to be there long-term, and spend the majority of their employment history -- however long that will be, working in this space."

The Behavioral Health Workforce Investment Fund will allocate more than $148 million over the next five years.


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The excitement of the holiday season is celebrated with family get-togethers. But for Alzheimer's patients, large groups can produce fear and confusion. The disease causes brain cell deterioration and the ability to rapidly process information diminishes daily.

Macie P. Smith, a licensed social worker and gerontologist, advised paying attention to nonverbal cues when a patient appears agitated.

"If you're going to have a small, intimate gathering, I also recommend doing name tags," Smith suggested. "Go ahead and put the person's name and the relationship to the person on the shirt, so that way they won't have to guess and wonder and try to figure out who this person is. It just helps with the ease of engagement."

Reminiscing over the family photo album is a traditional holiday favorite. Despite the best intentions, Smith explained, asking an Alzheimer's patient to identify a relative can be frustrating. The questions cause them to use brain cells that are severely impacted and could produce combativeness and aggression. She recommended singing or playing music as better choices.

The Alzheimer's Association Illinois chapter reported 311,000 caregivers cook meals, assist with basic hygiene and monitor medication intake. The needs of patients are unpredictable, leaving them with sporadic break times.

Additional stress from gift shopping and work obligations underlines the importance for a caregiver to routinely nurture their physical and mental well-being. Smith advised using a calendar for scheduling enjoyable activities.

"I've asked caregivers, 'So, what do you like to do?' They don't know, or they don't remember, because they have been so engulfed with caring for someone else and depleting everything that they've had, they've lost a sense of self," Smith observed.

For unmanageable situations, Smith recommends contacting a professional respite care service through your local department on aging. The agencies offer vouchers to pay a certified person to sit with your loved one. Another choice is asking for help from a church member, trusted neighbor or a Medicare or Medicaid-funded adult day service.


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