When I was a girl, my Bajan grandmother insisted that my older sister and I recite Psalm 23 every night before bed. I didn’t yet know what death was, but I knew that there was something sinister and brave about repeating the words “Yea, though I walk through the valley of the shadow of death, I will fear no evil.” I learned that Christians were foot soldiers in an army helmed by an almighty God, and that their faith would shield them from danger. Fearlessness wasn’t a bad idea to instill in two black girls growing up in 1980s Brooklyn, where the threat of violence was palpable, a lump you felt in your throat every time you passed the police or a group of guys who could quickly turn from admirers into assaulters.

My parents emigrated to the United States from Barbados and Antigua in the late 1970s. They were determined to cloak their children in an armor of education, etiquette, and religion—to protect us from a world that, in the words of Audre Lorde, “we were never meant to survive.” I was ten when Gavin Cato, a seven-year-old black boy born in Guyana, was hit and killed by a Hasidic Jewish driver in Crown Heights, two miles from our home. I was old enough to know that the rebellion that followed was connected to the suspicion that characterized relations between the Hasidic Jews and West Indians who lived alongside one another in that corner of Brooklyn. The riots interrupted the regular rhythms of my life. White reporters came to Sunday services at our all-black Episcopal church; adults’ voices lowered to a whisper when we entered the room. For the first time, I understood that there was something hated and precarious about being a black child in America.

Psalm 23 came back to me when I became pregnant last summer, at the age of thirty-eight. I’d long stopped repeating it before bed, but I hadn’t forgotten it. Five years after my granny’s passing, I’d realized what faith was for: it was meant to be a balm in times when certainty was out of reach. I’d been praying for a baby for years, though the intensity of my wish to be a mother waxed and waned. My desire was mostly a secret. I had friends who talked about basal body temperatures and dieted to prepare for pregnancy, but that approach felt uncomfortable to me—too ostentatious and too confident. I knew women who had struggled to conceive and others who had lost babies. Assuming that you could get pregnant at my age and that your child would survive seemed like laughing in the face of God.

I met the man who would become my husband in the winter of 2017. By that summer, we’d married, and within eighteen months, we had begun trying to conceive. We told almost no one what we were up to. Last June, I started texting a friend for weight-loss secrets, convinced that my jeans were tight because I had been eating too much cafeteria food at my new job. String by string, all my waist beads popped off, then my breasts ached, and I was often nauseous. My husband pointed out the obvious, but I was in denial until I took a pregnancy test that came back positive. Over the Fourth of July weekend, we told our families that we were expecting.

Having a black child in America has always been an act of faith. In the antebellum South, one in every two children born to an enslaved woman was stillborn or died within a year. If they lived, the babies were often sold away from their mothers. Black women in the Jim Crow era feared that their children would be sexually assaulted or lynched, and that the crimes would go unreported, unsolved, and unpunished. Still today, we worry that our children will not survive. The gap between infant mortality rates for black and white babies is wider now than it was during slavery. And the lives that follow hold many dangers. Images of black mothers mourning their murdered sons and daughters—from Mamie Till to Kadiatou Diallo to Samaria Rice and Tamika Palmer—are achingly familiar. George Floyd’s pleas for his mother in his final moments drove home what we already knew: despite our best efforts and fiercest love, we may not be able to keep our children safe.

But our children are not the only ones in danger. As I began seriously considering having a child, I started to read more about the risks that pregnancy poses to black women in the United States. American women are more likely to die in childbirth than women in the rest of the developed world, and black women are three to four times more likely to die than white women, regardless of income or education. In New York City, black women are nearly twelve times as likely as white women to die during childbirth or in the postpartum months. We have higher rates of infertility, fibroids, preeclampsia and postpartum health problems. I read testimonies from Beyoncé, Serena Williams, Tatyana Ali, and Allyson Felix, all of whom had traumatic birth experiences, including preeclampsia, pulmonary embolisms, and emergency C-sections. If a doctor doubted Serena Williams when she recognized the symptoms of blood clots, which she had experienced before, how would a black woman without the protection of celebrity fare?

And I was no one’s ideal patient. My medical chart was littered with problems, including Graves’ disease, thyroid nodules, and an increased risk of thyroid cancer. I had been diagnosed with uterine fibroids in 2014, and an MRI in February 2019 showed multiple leiomyomas. The obstetrician-gynecologist I consulted warned me that I could experience pain and other complications if I got pregnant, if I was able to get pregnant at all. I had also been diagnosed with bipolar disorder. My recovery from a particularly bad episode in 2018 included a two-week stay on the psychiatric ward at Mount Sinai Hospital in Manhattan. I knew that the risk of relapse for people with bipolar disorder is considerable during pregnancy and the postpartum period; I had read the grim data about postpartum psychosis and suicidal ideation. My psychiatrist, a black woman whom I credit with aiding my recovery, was alarmed when I told her that I was pregnant. She quickly cycled me off divalproex sodium, a medication proven to cause birth defects, and thankfully none of my symptoms returned.

On top of my very real risk factors, the statistics on black maternal mortality amplified my anxiety and distress. Well-meaning friends shared anecdotes and offered unsolicited advice. One friend told me about the death of a mutual acquaintance’s baby. Another told me about her friend’s miscarriage. A third, concerned about how the stress I was under was affecting the baby, predicted that I would have a preterm birth. A fourth insisted that I ask my doctor for a steroid shot to strengthen the baby’s lungs in case he came early. I tried my best to shield myself from their fears and projections, but I felt overwhelmed. I held my breath, waiting for the worst to happen.

During my pregnancy, I worked as a staff writer at a philanthropic foundation that provides grants to social science researchers, including several studying the benefits of paid family leave policies. I felt lucky to get the job just as a visiting professorship I’d had at Queens College was ending. But the human resources department said I was ineligible for the foundation’s own three-month paid childcare leave because I hadn’t been an employee long enough, despite having also worked there for more than a year in my twenties. Instead, I had to hope that the baby would wait to be born until I qualified, after twenty-six weeks of full-time employment, for New York State Paid Family Leave, which would pay 60 percent of my salary for ten weeks. I whispered January 29 like a mantra. I told the baby to hold on, and had a few friends pray on it, too.

Meanwhile, I planned for my delivery. I dreamed of a home birth with a midwife. My stepmother’s great-grandmother, known as Cousin Lou, had been a midwife who rode on horseback through the Jamaican countryside at all hours of the night to deliver babies. She accepted payment in whatever form families had—soap, fabric, food—and sometimes worked for free. But a home birth was out of the question because of my age and other risk factors. Even if it had been an option, I learned that these days less than 2 percent of the nation’s fifteen thousand licensed midwives are African-American. Until the mid-twentieth century, most black women gave birth at home with the aid of black midwives, but that tradition was stigmatized and erased as black people gained access to hospitals and midwives who lacked formal training were barred from the profession. The low number of black midwives today makes it hard for black women to receive culturally responsive care in their own communities, a privilege that many white women take for granted.

It took me a month after my positive pregnancy test to find an ob-gyn. I wanted to work with a black woman. Research supports what I already knew from experience—that African Americans being cared for by black doctors are more satisfied with their treatment; they have better health outcomes and longer life expectancies. My primary care physician, psychiatrist, dentist, and dermatologist are all black women, but I couldn’t find a black female ob-gyn who would take me on as a patient. According to the Association of American Medical Colleges, about 5 percent of physicians in the United States are black, including about 11 percent of the nation’s ob-gyns.

I ended up back at Mount Sinai, the site of my acute psychiatric care the year before. I settled into a comfortable rapport with a white female doctor, a maternal-fetal medicine specialist. My husband came with me to my first appointment, on August 1, 2019. We were stunned to find that I was already twelve weeks along and carrying not one but two fetuses. A blood test and ultrasound later confirmed that they were identical twin boys. I was overjoyed. I spent much of the next month on the phone with family members, trying to figure out where these twins had come from.

The trouble began two weeks later, when I went in for a follow-up appointment with another doctor in the same practice. One of the fetuses I was carrying was smaller than the other due to a rare disorder known as twin-twin transfusion syndrome, in which twins unevenly share blood. I asked the doctor whether I should come back in a few days to check on the struggling fetus. She replied that it didn’t matter—he would probably die anyway. I was stunned by her callousness. I went home and prayed for a sign to tell me what was happening, but I felt nothing. When I returned to the hospital the following week, the heart of the smaller fetus had stopped beating.

My grief was intense and complicated. This summer, I spoke with Dorothy Roberts, a legal scholar of race and reproduction and a mother of four, and she reminded me that “there is still a very prominent belief that there is something wrong with black women’s bodies, and every poor outcome is because of us.” We shouldn’t be having babies, the thinking goes, because our wombs are “harmful and defective.” Even though I knew better, I found it hard not to blame myself for the loss of my second son.

Our doctor warned us that the surviving twin might also have suffered brain damage and could have developmental delays. She reminded us that terminating the pregnancy was an option. New York State requires doctors to inform patients with pregnancy complications of their right to an abortion, but I still bristled, thinking of the history of forced sterilization among black women in the United States.

My husband and I knew that we would see the pregnancy through. But I was unsure how to process the strange fact of carrying one living and one dead fetus. My beloved niece kept referring to Auntie’s twins long after the co-twin had passed; I found myself both wanting to tell her to stop and happy that the idea lived on with her.

I asked the doctor what it would be like to deliver the deceased co-twin. She described the fetus as a “pressed rose” that would come out along with the placenta. I thought of the white rosebush in my late granny’s garden in Barbados, and the rosebushes outside our house in the Bronx that always reminded me of her. I thought of Our Lady of Guadalupe, the patron saint of Mexico, who is revered as a protector of pregnant women, infants, and the unborn. In devotional images, she often stands with the sun behind her and the moon at her feet, encircled by a wreath of red and pink roses.

The doctor said that if I made it to the six-month mark without further problems, I’d likely carry the surviving fetus to term. Midway through my sixth month, I had a dream that a surgeon was removing my uterus. I woke up moaning and hyperventilating, convinced that all that was left of the baby was a bloody sheet. As my due date neared, I worried less about qualifying for paid family leave and more about making it out of the delivery room alive.

My doctor wanted to schedule an induction. I heard her concerns about avoiding a stillbirth, the risk of which increases significantly after thirty-nine weeks for women over forty. Still, I wanted to aim for an unmedicated childbirth. When I was twelve, I had a seizure that left me afraid of sleeping alone and inspired a lasting need to remain in control and aware of my surroundings. During a hospital stay after I was diagnosed with bipolar disorder, I was sedated with psychiatric meds and was unconscious for several hours. I woke up groggy and afraid in an unfamiliar hospital room. For weeks afterward, I was unable to write my name clearly and developed a stutter whenever I was nervous or overly tired. I vowed I would never again take medications that compromised my sense of autonomy.

At my thirty-eight-week appointment, my blood pressure tested above the acceptable range, meaning that I could have preeclampsia, a condition that can result in seizures that are life-threatening for both mother and baby. Preeclampsia is 60 percent more prevalent in black women and more likely to affect women above thirty-five. My doctor wanted me to go to the labor-and-delivery floor for monitoring. I knew that she was trying to ensure that I didn’t become another statistic, but I resented what felt like her efforts to control me. I declined further monitoring that day, agreeing only to come back for my appointment the following week.

Over the weekend, my husband cleaned, painted, and organized the baby’s bedroom and tried to keep me calm. I spoke with my doula, Nicole Jean Baptiste of Sésé Doula Services in the Bronx, about my birth plan. Nicole’s services were a gift from an ob-gyn friend of mine who told me that continuous support from doulas during childbirth is associated with decreased caesarean section rates and less frequent use of epidural anesthesia. Years ago, in Boston, my friend had helped deliver the baby of a black woman who died from complications after she left the hospital. She wanted to ensure the same thing didn’t happen to me.

When I returned to the hospital the following Monday for a blood-pressure screening, my reading was high again. I agreed to the induction. I knew that I’d never forgive myself if my stubbornness led me to lose the baby or endanger my health. I was relieved to be introduced to a black female doctor who would be part of my care team.

The day before the induction, the black ob-gyn discussed possible plans with me. She suggested I take the drug misoprostol to induce contractions. I hesitated. I’d just read about Tatia Oden French, a thirty-two-year-old black woman from Oakland, California, who developed an amniotic fluid embolism (AFE) after being given misoprostol; both she and her daughter died after she gave birth via C-section. French, a psychologist who had written her dissertation on traumatic brain injuries among black women who had suffered domestic violence, questioned the use of misoprostol, but ultimately gave in after a nurse reportedly asked her, “You don’t want to go home with a dead baby, do you?” There is no proven link between misoprostol and AFE, and the drug is widely used to induce labor, but my distrust of the medical establishment was so thorough that I refused to take it. One of racism’s subtlest legacies is to make it harder for black people to know when our fears are rational.

The induction was scheduled for early evening on February 4. I tried to stay calm, but inside I prepared for a fight. I knew that my medical chart, which lists my bipolar diagnosis, was readily available to every nurse and doctor who interacted with me. So, in addition to the routine threat of being labeled a stereotypical angry black woman, I worried that I would be dismissed as a “crazy” person. But I told myself I would rather be seen as belligerent than be dead.

I wasn’t wheeled down to the labor-and-delivery floor until around three o’clock the next morning. From the beginning, I was at odds with the hospital staff. After having to wait nearly twelve hours, now I was being rushed. A Foley balloon was inserted in my cervix to encourage dilation. When I told the resident who inserted it that she was hurting me, she said that if I couldn’t handle that pain, I wouldn’t be able to make it through my labor without medication. I had to repeat over and over again that I didn’t want an epidural—I was terrified of being unable to move.

Three and a half hours into my labor, the resident offered to break my water, which I knew would intensify my contractions to such an extent that I might be in too much pain to refuse the epidural. When I asked why she was in such a hurry, she admitted that she wanted to complete the task before her shift ended. I was livid and asked her to leave my room. Later that morning, I sparred with the nurse, who pressured me to increase my intake of Pitocin—a synthetic hormone that causes contractions—every hour to keep my labor going at a healthy clip. My doula, Nicole, later noticed that, despite my request that the nurse stop upping the Pitocin, she had increased the dose when we weren’t looking.^*

My sister, Shari, arrived around nine o’clock that morning, and my husband went home to rest. Shari and I did squats, led by Nicole, to encourage the baby down the birth canal. We listened to Mahalia Jackson and Kendrick Lamar. As the day wore on, the doctors and nurses stopped coming to my room regularly. I couldn’t help but wonder whether it was because they didn’t want to hear my mouth. I lumbered around, dragging my IV behind me, because standing was more comfortable than sitting or lying down. At around 2:45 pm, the black ob-gyn came to check on me because she could see on the monitors outside my room that I was pushing; she warned me to stop before I tore myself. I insisted that the baby was coming soon and begged her not to leave. She assured me that the baby was still a ways away and promised she’d be back in twenty minutes.

Twenty minutes later, she was nowhere in sight. I swayed between Nicole and my sister, and asked them if they were ready to catch a baby. Shari ran to the nurse’s station to tell them that the baby was coming. The staff promised her they would page the doctor, but they seemed unconcerned and made no move to come check on me. When Shari returned to the room, Nicole told me to reach down and see if I could feel the baby’s head. I could. Shari went to the doorway and started yelling for help, but the baby couldn’t wait any longer. After one push, my son was born into Nicole’s hands.

I wept as I held my son to my chest and fed him for the first time. I marveled at his full head of hair and impossibly bright brown eyes. He put one tiny finger to his chin like an infant philosopher. I was shocked to finally touch him, as I had never really allowed myself to believe that things would turn out okay. I was at Mount Sinai, one of the leading hospitals in the country, and I had just delivered a baby without a doctor or nurse present. I was both enraged and comforted that, after the battles over admission and induction and medication, I’d had something akin to a home birth, with my healthy baby boy born into the loving arms of the family I’d created to receive him.

I remember asking Shari to search the placenta for the little pressed rose the doctor had promised me. I worried that if I saw it myself, I would never be able to forget it, and the happy occasion of my son’s birth would be imprinted with sorrow. My sister held my hand and told me that the co-twin looked as if he were asleep. Nicole stroked my hair and reminded me that I would always be a mother of two.

These past few months, I’ve often wondered why I’m still here in the United States. I’ve always imagined what my life would have been like if my parents had never emigrated, or if I were to move back to the Caribbean, which I also consider home. Five years ago, I applied for and received Antiguan and Barbudan citizenship. But I haven’t left. As much as I think about living elsewhere, for better or worse, I’ve thrown in my lot with black people in America.

This spring, while I cared for my newborn, at least three more black women in the United States died during or after giving birth. In April, Amber Rose Isaac, twenty-six years old, died at Montefiore Medical Center in the Bronx after delivering her son, Elias, via C-section. She had requested in-person doctor’s visits for several weeks before she was finally admitted to the hospital and diagnosed with HELLP syndrome, a complication of preeclampsia in which the red blood cells that carry oxygen to the body start to break down. Wogene Debele, an Ethiopian mother of four in Takoma Park, Maryland, died on the same day, before she was able to hold her son, Levi. Unique Clay, a postal worker and mother of three in Chicago, died of COVID-19 just days after being released from the hospital where she had given birth.

I am grateful to have a healthy baby, because I know it could have easily gone another way for him, or me, or both of us. I appreciate bedtime, diaper, and feeding routines, which help take the edge off the awful and infuriating news: the pandemic that has disproportionately affected black communities, the police killings of black people, and the brutal response to the attendant rebellions in cities across America. The night before New York City was put under curfew, my husband went out in the small hours of the morning to do laundry, a practice he’d started a few months before, to mitigate the risk of COVID-19 infection. I stayed awake, nursing the baby while sirens blared and helicopters flew low overhead, trying to will my husband back to us unharmed. I dreamed about another place we might live, where a mundane trip to the laundromat might not incite such anxiety and fear.

My faith lies in God and black women, as it always has. I know that we have the answers to this seemingly intractable problem. Scholars such as Deirdre Cooper Owens, Dána-Ain Davis, and Lynn Roberts are producing groundbreaking research on reproductive justice. National organizations like the Black Mamas Matter Alliance are pushing for legislative change that would transform maternal health care. And at the state and local level, black-led organizations are developing new models of culturally congruent care. Jamaa Birth Village in Ferguson, Missouri, and Ancient Song Doula Services in Brooklyn are providing childbirth education classes, parent support groups, and doula and midwifery care that centers on black women and their communities. Bx (Re)Birth and Progress is advocating for the construction of the first freestanding birth center in the Bronx, which has some of the worst health, economic, and education indicators in the United States.

To be a black mother in America is to know that your children never truly belong to you, that any number of forces or actors might take them from you at any moment. I pray that this will not always be the case. Since giving birth, I have been comforted by the image of the pregnant Virgen de Guadalupe—a woman with the sun at her back, the moon at her feet, surrounded by roses.