Why maternal death?
Unless it’s your work, you’re pregnant or know someone who is, maternal death is not a topic of casual conversation– especially in developed countries. Maternal death is when a woman dies during pregnancy or a month after giving birth from conditions related to pregnancy and child birth. With the advancement in medicine, medical and other technologies, we assume giving birth is “routine.”
Approximately eight years ago, a close family member died from post-partum complications, exactly one month after giving birth to her first and only child. The circumstances surrounding her death mirrors the ones described later in this post. It was déjà vu when I heard Shalon Irving’s story on public radio; her story reignited buried mistrusts, so I researched the subject at the Centers for Disease Control and prevention (CDC) website and what I found was sobering.
According to the CDC, the U.S. has a higher percentage of maternal deaths when compared to other developed countries, and Black women in the U.S. are three times more likely to die during and after child birth than their white and Hispanic counterparts. Explanations for this disparity include Black women’s genetic predisposition to certain health conditions; long term stress; poor quality care; lack of access to early prenatal care; poverty and low-level education etc. Even though poverty and low-level education might play a role, it must be noted that Black women who suffered this fate came from varied socio-economic and educational backgrounds.
The Shalon Irving story, which aired on Public Radio (All Things Considered –December 7, 2017) “Lost Mothers: Maternal Mortality in the U.S.” Black Mothers Keep Dying After Giving Birth. Shalon Irving’s Story Explains Why, details one Black mother’s fight for her life. According to this report, all Shalon’s accolades (high level education, platinum health insurance, high ranking position at the CDC, affluent upper middle-class status) did not prevent her from becoming a part of this dire statistic. The focus of Shalon’s work at the CDC was to eliminate inequities and ensure better health outcomes for all. Isn’t it ironic that a woman with such advantage, working for the agency that sets and dictates healthcare standards, died three weeks after giving birth to her own baby from complications of high blood pressure? Granted Shalon went into pregnancy with some chronic health conditions (clotting disorder/on blood thinners, history of uterine fibroid surgery, controlled high blood pressure and overweight), the actual events surrounding her death are questionable. This young woman sought assistance from healthcare providers shortly after discharge; each time she was evaluated and sent home with instructions to monitor her condition and follow up with primary care provider or seek emergency treatment if condition worsens. Her final attempt to seek care received similar response – tests were normal, so she was sent home with a script for high blood pressure medication. Shalon was told that there’s nothing they can do – she must give it more time. Unfortunately, Shalon did not have much of this most precious of commodities left; she filled her script, ate out with her mother, went home, and collapsed shortly thereafter. She died on her way to the hospital from complications of high blood pressure.
Now juxtapose with Serena Williams’ experience as written in the January 10, 2018 issue of VOGUE Magazine; also, a very prominent Black woman, elite athlete and millionaire, went into pregnancy with a known clotting disorder. Serena stopped taking her blood thinners because of an emergency C-section delivery. One day after C-section, Serena started experiencing shortness of breath and suspected pulmonary embolisms (blood clots in her lungs) due to not taking her blood thinner. Serena recounted getting out of bed and walking to the nurses’ station to request a CT scan and intravenous heparin (blood thinner); however, the nurse told her that the pain medication was making her confused. Serena insisted on a CT scan and IV heparin immediately, despite the nurse’s dismissal. Next thing, a doctor was performing a Doppler on her legs but according to Serena, “I was like, a Doppler? I told you I need a CT scan and Heparin drip.” Worthy of mention, the Doppler was normal, however, the CT scan showed several small blood clots in her lungs and, she was started on heparin drip immediately. Serena explained, “I was like, listen to Dr. Williams!” Serena had two more surgeries; to repair a re-opened abdominal wound, and to insert a filter into a major vein to prevent more clots from breaking away and getting into her lungs. Thankfully, Serena lived to tell her story!
Finally, Patrisse Cullors (Co-founder of Black Lives Matter and author) also described her birth experience in the February 01, 2018 issue of Essence magazine. Patrisse’ original plan to have her baby with nurse midwives fell through because of a necessary C-section. According to Patrisse, everything went downhill after her arrival at the hospital. The surgeon did not bother to explain the procedure or what to expect, and when she asked, the reply was “what do you want to know?” After the surgery Patrisse described what was a gross under treatment of her pain. Both Patrisse and her mother’s pleas for help were ignored. Patrisse stated that she did not achieve adequate pain control for the entire duration of her hospital stay. Patrisse went home, only to return to the ED with respiratory symptoms and was diagnosed with pneumonia. Patrisse later learned that the pneumonia was a result of a violation of proper C-section protocols.
Without a doubt, Serena knew her risks, happened to be at the right place, at the right time, recognized her symptoms quickly and insisted on the kind of care she needed, notwithstanding dismissive attitudes from healthcare providers. Likewise, Shalon knew her risks, recognized her symptoms and sought care at the right place and at the right time, however, she was dismissed by healthcare providers. Patrisse demanded the care she needed but was also dismissed by healthcare providers. Should Shalon have insisted and refused to leave on that fateful day when all the tests were normal, but she knew something was wrong? Should Patrisse have raised the roof of the hospital when she was being under treated for pain? We hear only about those cases that pertain to the affluent, well placed, or where the situation is so egregious that it can’t be ignored; what about the thousands of cases that we never hear about? We cannot Monday morning quarterback these issues; we can learn, increase awareness, appreciate the nuances of being Black in America and become proactive in changing the culture.
I’d be remiss if I fail to mention that providers’ attitudes play a major role in such poor maternal health outcomes for Black women. In as much as there are laws to prevent maternal mortality, it’s up to states to implement the policies and regulations. Providers need sensitivity and bias trainings to increase their awareness about these issues and to ensure that meticulous and compassionate care is delivered to Black women before, during and after pregnancy. This is not primarily a knowledge deficit issue on the part of healthcare providers; if it was, maternal death rate would have been equally distributed across populations. Providers have the skills and tools necessary to address pregnancy, child birth and post-partum complications; they just need to value all lives equally and provide quality and compassionate care to everyone, regardless of who they are or what they look like. I’ll explore healthcare providers attitudes further in my next post.
It’s been proven that change begins with awareness; the more informed we are, the better we can advocate for ourselves and our loved ones. Black women, pregnant or not must endeavor to learn about their risk factors and be their own best healthcare advocates, albeit numerous existing barriers. Knowledge is power; if you know your body and are educated about your risks, you can partner in your own health care and demand care that is right for you. Black women can and should be a part of the solution. We can become healthcare providers and encourage our children to do the same, to diversify the healthcare workforce. We can also become very vocal about our experiences at all levels. Until we’re able to move the healthcare community toward equal and quality treatment for all, my advice – channel your inner Serena…know your body, know your health risks, advocate for yourself and your family, share your story-Stay Woke!