Tamika Cross, MD, FACOG
As we celebrate women today in honor of International Women’s Day, it is vital to remain mindful of the extreme disparities’ women face in the U.S. This is especially true for Black women in the healthcare system. Black women’s experiences with racism and bias among healthcare providers and limited access to quality healthcare and medical insurance are well documented. Medical conditions disproportionately affecting Black women include high blood pressure, heart disease, hypertension, cancer, and maternal mortality.
According to the Centers for Disease Control, each year in the U.S., around 700 people die during pregnancy or the year after. An additional 50,000 people each year experience unexpected labor and delivery outcomes with serious short- or long-term health consequences. However, pregnancy-related mortality rates among Black women are over three times higher than for white women. One common cause for pregnancy complications is preeclampsia, a common condition that is more prevalent and can potentially pose a greater risk for Black expecting mothers. Such was the case for Tamika Cross, a Texas-based ob-gyn who found herself wrestling with the same condition that she has treated hundreds of her patients for.
Dr. Tamika Cross owns and operates Opulence Health and Wellness, a private practice in Pearland, Texas. Dr. Cross’ private practice is not a dime-a-dozen ob-gyn office that reeks of pap smears, anxiety, and cold seats in the waiting room. Opulence Health and Wellness provides patients full-scale health and aesthetics services ranging from routine gynecological services such as well-women exams and pregnancy care to non-invasive aesthetics treatments such as Botox, dermal fillers, and facials.
As a practitioner, Dr. Cross has become acutely familiar with the anxiety many women experience during pregnancy and the various pregnancy-related conditions that may arise and potentially complicate pregnancy, labor, and delivery. Especially, for Black women. But she would never have thought that the same issues she has patiently walked countless expectant mothers through would shape her pregnancy significantly.
Tamika Cross, MD FACOG
Forbes: How was the first part of your pregnancy?
Dr. Tamika Cross: I had hyperemesis during the beginning of my pregnancy. So, I experienced extreme nausea and vomiting. I actually had hyperemesis during my entire pregnancy – until I delivered my daughter. So, although I was not yet diagnosed with preeclampsia, I was really sick during the first half of my pregnancy and nauseous a lot.
Forbes: At what point in your pregnancy did you develop preeclampsia?
Dr. Tamika Cross: I was officially diagnosed at 34 weeks. I'm an OB. So, I saw the signs coming. Because I had hyperemesis, I was so sick that I initially lost weight during the first half of my pregnancy because I could not keep down what I ate. And then, suddenly, toward the end of my pregnancy, I gained around 20 pounds in a week. It was mostly fluid. My legs were swelling a lot, and my face looked fuller. You can have swelling during pregnancy, but it was rapid swelling. That was my first sign.
When my swelling began, they checked my lab for preeclampsia and my blood pressure. Both were fine but my blood pressure was starting to increase. My baseline blood pressure is normal, about 117 over 70. But now I was around 120 or 130 over 80. Although it wasn't abnormal yet, my blood pressure was abnormal for me. But the other labs checked out fine, and my blood pressure checked out okay – technically — based on the diagnosis guidelines for preeclampsia. But I was keeping an eye on it. When I went in for my prenatal appointment at 34 weeks, my blood pressure was 140 over 90, and my doctor sent the preeclampsia panel again, and it came back positive.
Forbes: What was the next course of action after you were diagnosed with preeclampsia?
Dr. Tamika Cross: My doctor told me I needed to regularly check my blood pressure – about two to three times a day. Which meant that I had to get a blood pressure cuff. I was also checking it while I was at work. I also had to log my blood pressure readings to help monitor my symptoms. I was on the lookout for all the typical symptoms like headaches, vision changes, pain in the upper right quadrant, and so forth. My doctor also wanted me to stop working or drastically cut back on my work schedule, which is very hard to do while running a practice alone.
The entire pregnancy, I was working. Coming into work super pregnant at 28 weeks. If someone comes in for delivery at one in the morning, I would get out of bed, vomit, deliver the baby, go back home, vomit, get back in bed, wake up, and do clinic all over again. So, I know what led to developing preeclampsia. I felt responsible for all my patients in my care, and I was not getting enough rest and could not really cut back on working. That conflict would be different if I were employed at a job where I could take PTO or go on disability. But that was not an option for me. Working way too much made it very difficult for me, which I think definitely led to my diagnosis because I couldn't scale back. But I also did not want to not be there for my patients, who were relying on me.
Tamika Cross, MD FACOG
Forbes: While you were experiencing these symptoms and still maintaining a rigorous work schedule, what, if any, fears did you experience?
Dr. Tamika Cross: I was terrified. I am an ob-gyn. I’ve seen many women of color who have preeclampsia and almost die from it. So, I was scared because I saw myself spiraling, and I couldn't do anything to fix it. I felt trapped. I opened a new clinic at 27 weeks pregnant, and the stress was unbelievable. I was really terrified for many different reasons. I was scared that my blood pressure would cause a stroke. I kept thinking, ‘I don't want to die.’ Obviously, I didn’t want anything to happen to my baby.
I didn’t want to start having seizures, and I was terrified because, at the time, I lived alone, and my family did not live in the area. If I am being completely transparent, I was terrified that somebody would find me dead in my house days later. That was my biggest fear. I have a huge village here in Texas of very supportive people, but because I was living alone, I was fearful that something would happen to me and that no one would be here to help me or call for help.
Forbes: Share your labor and delivery story.
I started trying to follow a lighter work schedule. I hired a nurse practitioner and felt like I was doing my due diligence, but I was still running my practice. My mom came to town to stay with me because she was terrified. One day, I had a long day at work, and when I got home, I felt really nauseous. But it wasn't the same kind of nausea from my hyperemesis. I was sitting on the floor doing stuff in my daughter’s nursery and thinking something was not right. So, I took my blood pressure, and it was in the 160s, over around 110. I retook my blood pressure about two or three more times because I was in complete denial.
Because I was at 35 weeks and had preeclampsia, which had become severe by then, I knew they would deliver me. I told my mother to pack a bag and let's go to the hospital. When we got to the hospital, my blood pressure was around 185 over 112, and it continued increasing. They admitted me, got me on medication, started me on magnesium, and then they started the induction process. That was when I started taking blood pressure medication because it is not recommended to start taking blood pressure medicine before preeclampsia becomes severe.
My delivery was not difficult at all. When my daughter was born, she weighed 4 lbs and 7 ounces. But she did not have to go to NICU. My medical team was prepared for her to go to the NICU because she was a preemie, which I was very emotional about. Thankfully, she came out crying and breathing on her own. Her Apgar scores were perfect for a full-term infant. Everyone was shocked that she did not have to go to the NICU.
After I delivered my daughter and went home, my blood pressure was back up again on Christmas Day. My doctor had to remind me to take it easy, which was hard because I was caring for a newborn. I wasn’t getting much sleep and I was either breastfeeding or pumping breast milk every two hours. But my doctor encouraged me to figure out an alternative, which was frustrating for me. My daughter is a preemie and I wanted to give her the best form of nutrition I could provide. I hated feeling like I had to choose between providing my baby with a healthier option and taking it easy for my own health. It was really difficult trying to find a balance.
Tamika Cross, MD FACOG
Forbes: How do you feel about the care that you received?
Dr. Tamika Cross: I received excellent care. I really liked my doctor. He was extremely attentive and supportive. But I realize my experience is far from the case for many Black women.
Forbes: Has this experience impacted your desire to have more children?
Dr. Tamika Cross: Actually, my experience has not impacted my desire to have more children, and I am blessed for that. I thought my experience would change how I felt about having more kids because the pregnancy was so difficult – between the hyperemesis and all the stress. But when I really think about it, a lot of the stuff that I went through in 2022 will not be recurring factors. For example, hopefully, I will not have to open a practice at 27 weeks pregnant again. So, I don’t anticipate experiencing some of the same stress that I experienced during this pregnancy which was a huge factor in some of my experiences.
At the end of the day, even though I was hysterically crying because I had to deliver early, the delivery went so easy. My doctor came in and he broke my water. The next thing I knew, I was seven centimeters dilated and delivered my daughter two hours later. I barely shed a tear during delivery because I experienced minimal tearing, and again, she didn’t have to go to the NICU. I felt like God really blessed me – to have such a beautiful ending to my pregnancy and to give birth to such a beautiful healthy baby. I was overjoyed and continue to feel immensely blessed.
Forbes: Why do you think preeclampsia disproportionately impacts Black women?
Dr. Tamika Cross: That's a good question. I think there are a lot of different reasons. I think, situationally, women of color are always taking care of everybody else. The pressure to be all things to everyone creates a certain stress level. Although some studies say that preeclampsia is not only caused by stress, we know stress can impact the onset of preeclampsia. So, I think when it comes to Black women taking care of their household, taking care of the kids, and sometimes even taking care of grandma — all while trying to take care of ourselves — it can be heavy and stressful. As an ob-gyn, I see this all the time. I always have to remind my patients that they have to take care of themselves and who will take care of their families if they aren't here.
When I opened my clinic, I wanted to cater to women. Especially, women of color. I wanted to create a space for them to take care of themselves, which is why I also added med spa services. So, I think the stress and pressure to care for other people is a significant factor. Misdiagnosing preeclampsia or not diagnosing the condition altogether is another factor. It’s not uncommon for Black and Latinx women to be blown off and dismissed by their medical providers – and the condition is caught when it’s too late and the patient is having a stroke or bleeding out.
Additionally, I think the majority of women do not understand how serious preeclampsia can become and then you look at someone like me – a Black ob-gyn diagnosed with preeclampsia that progressed into severe preeclampsia. I definitely think it’s multifactorial. But even when I look at myself. I understand fully how dangerous preeclampsia can become. Yet, I was so conflicted about taking time off and not caring for my patients that I added additional stress to myself. I really struggled with not being there for my patients, and I suppose that is how many other Black women feel about their loved ones.
