We open on a seemingly idyllic scene of a Black mother giving birth naturally in a hospital — her husband beaming beside her as their newborn infant takes her first breath of oxygen, the music swells...but something is terribly wrong. The mother cannot move her arm. After some tests are run, it’s discovered that the mother has a lump in her thyroid. It’s stage 3 cancer. She must immediately begin intravenous radioactive treatment which will mean separation from her new baby (whom she’s named Pearl) and her husband for the next 4-5 months. So begins the April 20, 2021 episode of NBC’s procedural medical drama, New Amsterdam, which examines the inequities in child labor for women of color through the stories of three different Black women with three unique birthing experiences at the titular hospital.
According to its hub on the University of California San Francisco website, the SACRED Birth Study was designed to validate the first and only Patient Reported Experience Measure of OBstetric racism©, also known as the PREM-OB Scale™, developed in 2019 with funding from California Health Care Foundation and owned by Dr. Karen A. Scott, MD, MPH, FACOG. The PREM-OB Scale™ examines obstetric racism, as defined for, by, and with Black mothers and Black birthing people, during hospitalization for labor, birth, and postpartum in six theorized patient identified quality of care domains: Safety, Autonomy, Communication, Racism, Empathy, and Dignity.
The site further states that the information gained from the PREM-OB Scale™ will help hospitals, health plans, scientists, funders, and the public better understand how obstetric racism and other forms of neglect and mistreatment affect the ways that hospitals provide care, services, and support to Black mothers and birthing people during labor, birth, and postpartum. Although the study officially ended on January 31, 2021, it was indirectly given new life and a new platform during the New Amsterdam episode.The episode was titled “Catch” and was written by staff writer Erika Green Swafford (@swptatopie on Twitter), who is also a Black woman, and was directed by Shiri Appleby. Swafford also served as a consulting producer on the episode.
Dr. Scott was tapped by Hollywood, Health & Society to serve as an expert for Swafford on writing “Catch.” Hollywood, Health & Society is a free resource to television and screen writers, connecting them with resources and experts on a variety of health and social topics. Hollywood, Health & Society also presented an open conversation on the issues surrounding Black maternal health on May 6 called “The Black Birth Experience: Challenges, Joys and Justice,” for which Swafford was a panelist.
“Thank you so much for another opportunity to support the amazing work @HollywoodHealth. Thank you @robertacruger for introducing me to @swptatopie. Congratulations in advance to the brilliant Erika and all the talent at New Amsterdam. I plan to watch tonight and apply @SACRED_PREM_OB to the stories,” Dr. Scott tweeted ahead of the episode’s airing. She went on to tweet during the episode.
After the opening, a young Black woman, Ydalis Fournette (actress Tiffany Mann), comes into the hospital because of an abrasion on her head, but is immediately assumed to be pregnant because of her size. Bloodwork shows that she actually is pregnant, despite the fact that she adamantly claims to be a virgin.
A prominent birthing justice attorney, Evelyn Davis (actress Victoire Charles), is in another room preparing for a VBAC birth and shares the terrible experience she had during the birth of her first child. At that time she was forced to have a C-section and felt like she did not have autonomy of her own body. Now, she wants to give birth on her own terms. Dr. Max Goodwin (series lead Ryan Eggold), a white male, says to her, “Unfortunately, that’s true, Black and Latina mothers tend to have less successful VBACs.” To which Davis replies, “And lower birth weight babies, more complications postpartum, higher maternal deaths. None of which has anything to do with our beautiful skin, just how we’re treated in it.” Dr. Goodwin assures her that they want her to have a successful birth, but if she doesn’t progress naturally soon (she’s only 5 cm dilated at that point), the only recourse is a C-section.
Meanwhile, Nia — the mom from the opening — is mourning the fact that she has “hardly seen Pearl at all. Barely got to hold her.” She asks if she can see her baby, feed her, bond with her, before they take her for treatment. Dr. Helen Sharpe (series regular
Freema Agyeman), who is Black, assures her that they can in a few more hours. Nia had planned to breastfeed, and now mourns the loss of an opportunity to do so. Empathizing with her, Dr. Sharpe makes it possible for Nia to have time to bond with and try to breastfeed her baby.
To this storyline, Swafford tweeted, “What you're seeing is Dr. Sharpe be a Doula for Nia. Imagine you're exhausted physically and mentally while giving birth. How do you also advocate for yourself? Get thee a Doula. sistamidwifedirectory.com @NBCNewAmsterdam @FreemaOfficial”
Later, Ydalis is in labor and the doctor asks the psych consultant, Dr. Frome (series regular Tyler Labine), to look at her file. He says her mind is having a hard time accepting that she’s pregnant (cryptic pregnancy). He’s informed that they’re getting a court order to perform a C-section. He argues that, “just taking unilateral action could be further traumatizing, so maybe before we get the courts involved, you and I can assess what triggered this.”
The female doctor replies, “With what time? That baby is coming out one way or another whether she wants to believe it or not.” Dr. Frome answers, “What I’m saying is, you and I need to proceed with care.” She replies, “Dr. Frome, that woman never received any prenatal care. None.” The divide is: one is advocating for the health of the baby, while the other is advocating for the health and well-being of the mother.
Evelyn Davis, the attorney, checks herself out of the hospital. Dr. Goodwin pleads with her to stay, then with her husband. The husband says, “Dr. Goodwin, have you ever loved a Black woman? I’ve heard lots of numbers today, how they’ll keep my wife safe, how they’ll help ensure my child is born safely, but I really haven’t seen my wife in your numbers. There’s nothing worse than being told how to be grateful.” Then, Evelyn begins bleeding.
To this scene, Dr. Scott tweeted, “‘Have you ever loved a Black woman!!’ @NBCNewAmsterdam @swptatopie Yes, this is the QI benchmark!” She then quoted one of her published works from Feminish Anthropology, titled, The Rise of Black Feminist Intellectual Thought and Political Activism in Perinatal Quality Improvement: A Righteous Rage about Racism, Resistance, Resilience, and Rigor: “‘Maintaining fidelity to cultural rigor requires a level of nuanced knowledge about and infinite radical love and care for Black women and people.”
On the show, Evelyn is back in the hospital room and they try to administer a C-section against her wishes. Dr. Goodwin, finally listening, tells the other hospital staff to stop and listen to the patient. They argue that her VBAC score is only 28 percent. He asks, if she wasn’t Black, would it be higher? They say that it likely would be. So he tells them to change it. They ask how. He says, “Make her white.” Later, he comments, “If her VBAC score can be changed just by switching her race, then maybe the VBAC calculator is a racist tool.”
Dr. Frome brings in a Black midwife to help deliver Ydalis’ baby. Once the baby is born, however, and she is confronted with the reality of a crying, breathing, tangible and tiny human, Ydalis experiences an emotional breakdown. We find out that at the beginning of the pandemic, she took shelter with her step brother who repeatedly raped her after he lost his job and times got tough. This traumatic experience led to her cryptic pregnancy.
“Nearly 1 in 3 women experience physical or sexual violence,” Dr. Scott tweeted in reference to Ydalis’ storyline. “Not every pregnancy is the result of consent. That’s why applying trauma-informed care during service provision, especially during birth, is essential. Thank u for lifting up our humanity @swptatopie @NBCNewAmsterdam.”
As the episode reaches its final act, it ties up neatly into hopeful endings for each woman. Evelyn ends up giving birth to her baby naturally. It goes well. Ydalis’s baby appears to go to the care of a happy, adoptive Black couple, and Nia’s baby finally latches — after an initially difficult time trying to breastfeed — right as she’s heading to treatment.
The impact of the groundbreaking episode — in particular on women who share relatable birthing experiences — was expressed in a message Dr. Scott tweeted from Stephanie Baker, PhD, MS, PT: “It’s just crazy because I had my own trauma during birth and to see that reflected so accurately, but then to see how it could have been different too...it’s just a lot to take in. And makes me hopeful.”
For more information on the SACRED Birth Study, please visit: sacredbirth.ucsf.edu. New Amsterdam airs on Tuesday nights on NBC. Check your local listings for details.