A recent Tip of the Week reported on research showing that more money and more education generally protects women from bad birth outcomes — except if you’re Black. Compared to the richest white mothers, the richest Black mothers and their babies are twice as likely to die from childbirth.

Here’s a follow-up story in the New York Times, Unwanted Epidurals, Untreated Pain: Black Women Tell Their Birth Stories, that offers a personal version of negative experiences that Black moms suffered while navigating the healthcare system.

How does the trouble start? “Long before women become pregnant,” researchers told the Times. “It happens across health care settings, with research showing that even if medical staff is empathetic overall, just one such interaction can have a big effect. It continues through childbirth, when discrimination, unconscious or not, affects Black mothers’ hospital care.

“These long-term issues of disparities in maternal outcomes can’t be boiled down to class,” said Tyan Parker Dominguez, who studies race and birth outcomes at the University of Southern California School of Social Work. “Racism doesn’t operate along economic lines, because even when you control for that, it’s still a factor.”