Black Maternal Health: I Want to Be Heard!

Charnele Brintley, MSPH

Every year in the United States, hundreds of people die during pregnancy or in the year after, but Black women are three times more likely to die from a pregnancy-related cause than White women. In a 2020 report from The Commonwealth Fund, data shows that a Black mother with a college education is at 60 percent greater risk for a maternal death than a white or Hispanic woman with less than a high school education.

Additionally, more than 80% of pregnancy-related deaths in the U.S. are preventable. Data from the PINC AI? Healthcare Database (PHD), determined that out of over 860,000 deliveries, over 4,000 Black birthing people experienced severe maternal morbidity (SMM) in 2022 (306 SMMs per 10,000 deliveries), which is 71 percent higher than White birthing people. And the research doesn’t stop there.

While the data highlights the disproportionate impact on Black mothers, birthing people and their families, there is also data that support the why behind it. If you listen to Black women’s stories, one common theme emerges: there is research around physician’s implicit bias that Black patients have greater pain tolerance, thicker skin, and feel less pain than White patients.

For example, American tennis player Serena Williams began to lose feeling in her legs after giving birth. She explains that her pain increased, but the staff didn’t seem overly concerned, so she insisted on getting tests to see if blood clots had formed while she was off her regular medication. The tests revealed that immediate surgery was necessary to keep the clots from reaching her lungs. Serena Williams explains that "being heard and appropriately treated was the difference between life or death for me."

Another example: Kira Johnson lost her life from a hemorrhage during a routine c-section. In an interview, her husband explains that he requested a CT scan at 4pm, but an hour later there were still no orders for a scan. By 9 p.m., Johnson pulled a nurse aside to ask why they never took her to the scan. "The woman looked him right in the eyes and said, 'Sir, your wife just isn't a priority right now.’”

Now imagine being a 32-year-old middle class Black woman, Master’s Degree, works in maternal health care. This person is 39 weeks pregnant at time of delivery with a second child, and is very aware of these statistics and stories, but has the tools to confidently communicate concerns, if needed. This person calls the labor and delivery service line (as instructed) when contractions are less than 15 minutes apart. Upon arrival (in tears) they inform the nursing staff that within 30 minutes, contractions are now 1-2 minutes apart. Not feeling heard, the nurse wheels them nonchalantly into the triage room. With a perceived lack of urgency from the staff, their husband runs downstairs quickly to move the car, so it’s not towed, because it’s parked illegally just to get quickly into the hospital. After waiting for about 5 mins, a nurse enters the room and then asks for a urine sample. In the bathroom alone, in mist of giving a urine sample this person begins delivering their daughter.

What if I told you that person was me?! What did I do wrong? I did everything they told me to do. Why wasn’t anyone listening to me? Is my baby ok? How did this happen? Did I just deliver my baby in the triage bathroom? On top of that, imagine how my husband felt returning to a bathroom and hallway covered in blood, but his wife was no longer in the room. At my 6-week follow up appointment, I asked my provider what went wrong, and she said that the staff told her that I didn’t seem like I was in that much pain.

Black women are communicating to healthcare staff, and regardless of education or economic status, we are still not being heard. This is why so many people have created organizations and platforms to focus, address, and advocate for improving outcomes for Black mothers and babies. One I would like to highlight is Black Mamas Matter Alliance who founded Black Maternal Health Week which is held each year from April 11 - 17. This week is dedicated to raising awareness and inspire action on Black maternal health.

We still have a lot of work to do in the maternal health space, especially regarding Black maternal health, but it’s not impossible. With more than 80% of pregnancy-related deaths in the U.S. being preventable, lets change the narrative!

As a Black woman, we just want to be heard, listened to, and respected! One of the scariest experiences in a woman’s life is giving birth, but even more as a Black woman. We tell people how important it is to always have their elevator pitch ready, but let’s take that same concept into healthcare. I challenge all healthcare nurses, providers and support staff to always have their “Hear Her“ checklist ready. Have you validated the patients concerns? Have you answered the patient’s questions? Have you made the patient feel safe? Can you repeat back to the patient what they just told you?

At the individual, group, and organizational level it’s imperative to continue education around health equity, implicit and explicit bias, shared decision making, respectful maternity care, and understanding how to Strengthening Black Maternal Health.

To learn more about Premier’s efforts to improve maternal health, please contact Sue Gullo, Principal at Premier, Inc. who leads the Perinatal Improvement Collaborative. Each and every one of us can make a difference. Let’s start today!

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Note:? The author of this article is a Premier consultant. The views expressed are her own and do not represent Premier’s positions or opinions.