In October 2020, Cheyenne Scarlett arrived at an emergency room with a directive from a radiologist: go immediately, or you could bleed out and die. The diagnosis was an ectopic pregnancy—a life-threatening condition where a fertilized egg implants outside the uterus. Despite presenting the necessary paperwork and imaging, Scarlett was met with skepticism. A triage nurse told her she “looked fine,” and an ER doctor told her, “I’m not buying what you’re selling.”
The delay in care proved costly. By the time Scarlett was admitted the following day, medication was no longer an option. She required emergency surgery and lost a Fallopian tube. For Scarlett, this was not merely a medical complication, but a stark illustration of the racial disparities in maternal health that persist within the Canadian healthcare system—a system where the lived experiences of Black women often clash with the clinical gaze of their providers.
Scarlett, a certified doula, professor of early childhood education at Seneca Polytechnic, and co-founder of the Black Birth Project, has dedicated her career to bridging this gap. Her work focuses on the systemic dismissal of racialized women during childbirth and the critical, often ignored, need for race-based health data to drive policy change in Canada.
The invisible spectrum of birth trauma
While medical professionals often categorize birth trauma through a lens of clinical outcomes, Scarlett argues that the definition must expand to include the emotional and psychological toll of the experience. Physical trauma—such as sepsis, ruptured uteri, or severe vaginal tears—is documented in charts, but emotional trauma is often erased.
According to Scarlett, emotional trauma manifests as the way a provider speaks to a mother, the treatment of her spouse, or the feeling of being dismissed. “If they dismissed you or made you feel silly or unimportant, all of those things count,” she says. This dismissal is not felt equally across all demographics. Data indicates that 37 per cent of women from visible minorities describe their delivery as “challenging or distressing,” compared to 34 per cent of all mothers.
To better understand the scope of these experiences, the following table outlines the two primary dimensions of birth trauma identified in Scarlett’s advocacy work:
| Physical Trauma | Emotional/Systemic Trauma |
|---|---|
| Birth injuries (e.g., broken tailbone) | Dismissal of pain or anxiety |
| Medical malpractice/wrong medication | Disrespectful communication from staff |
| Sepsis or uterine rupture | Ignoring patient requests for privacy |
| Severe vaginal tearing | Stereotyping based on race or status |
The danger of the ‘data gap’
One of the most significant hurdles in improving maternal outcomes for Black women in Canada is the absence of comprehensive, race-based health data. Without official statistics, the systemic nature of the problem is often framed as a series of isolated anecdotes rather than a public health crisis.
This lack of visibility contrasts sharply with the United States and the United Kingdom. In the U.S., the Centers for Disease Control and Prevention (CDC) tracks pregnancy-related deaths with racial specificity, revealing that Black women are three to four times more likely to die from pregnancy-related causes than white women. Crucially, these disparities persist regardless of socioeconomic status; the most educated Black women in the U.S. Often face higher mortality risks than white women without a high school diploma.
In Canada, Scarlett notes that the absence of similar data makes it difficult to force systemic accountability. “I’m telling you about a problem I know to exist because I’ve experienced it,” she says. This data void obscures how racism permeates every level of care, from the denial of epidurals to the assumption that Black women cannot afford private hospital rooms, regardless of their insurance status under the Ontario Health Insurance Plan (OHIP).
Stereotypes versus reality in the delivery room
The persistence of racial disparities in maternal health is often fueled by deeply ingrained stereotypes. Scarlett points to a pervasive narrative that Black mothers are uneducated or have unstable family structures—assumptions that influence how providers listen to them. However, her own 2020 study of Black women who gave birth across Canada challenged these tropes.
Scarlett found that many of the women she interviewed held advanced degrees, including PhDs and law degrees, and were married. Despite their professional status and education, they reported receiving the same negative treatment and dismissal as those who fit the negative stereotypes. This suggests that the bias is not based on a patient’s actual socioeconomic standing, but on the provider’s perception of their race.
These challenges are further compounded for those who are trans, non-binary, or in queer relationships, adding layers of complexity to an already fraught navigation of the healthcare system.
Strategies for patient advocacy
While Scarlett emphasizes that the burden of change lies with the system, she encourages patients to employ specific strategies to protect themselves during the birthing process. The primary tool for this is a comprehensive birth plan that includes an emergency plan.
Rather than treating a birth plan as a simple checklist, Scarlett views it as an educational tool. She suggests that advocacy in the moment can look like asking for space to process information. “Advocacy might also look like asking, ‘Hey, can I have five minutes to consider this choice you’re giving me right now?’ or ‘What are my options?'” she says.
By shifting the dynamic from passive reception to active questioning, patients can sometimes force a higher level of engagement from their providers, though Scarlett maintains that this is a temporary shield against a system that requires a fundamental overhaul.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Please consult a licensed healthcare provider for medical concerns regarding pregnancy or childbirth.
The path forward involves a concerted push for the Canadian government and provincial health authorities to implement mandatory race-based data collection. Only by quantifying the disparity can the medical community move toward evidence-based interventions to eliminate obstetric violence and maternal mortality. The next critical step for advocates remains the integration of these data standards into national health reporting frameworks.
Do you have experience with maternal health advocacy or thoughts on the need for better health data? Share your perspective in the comments below.
