Dying to Have a Baby

A Close Call

I am number nine out of ten children. To say we, numbers nine and ten, are close is an understatement. My sister and I share everything, including a love for helping others. She is a pediatric physical therapist, and I am a registered nurse. When she called and said she was going to the emergency room for a severe headache and elevated blood pressure, I panicked.

Why would a nurse panic?

I have seen too many things go wrong, especially for Black birthing mothers.

Her newborn was barely a month old, and I knew what she was experiencing was abnormal. I later learned that, in the United States, the rates for high blood pressure (hypertensive crisis), during the postpartum period have steadily increased. If left undiagnosed and untreated, this condition can lead to heart attack, kidney disease, stroke, or death.

Pregnancy-induced hypertension is a serious and often silent killer. According to the Centers for Disease Control and Prevention (CDC), hypertensive disorders of pregnancy account for nearly 10% of all maternal deaths within 42 days after having a baby.

Her emergency room visit was particularly concerning to me. She was given one dose of an antihypertensive drug and told to “calm herself” and rest at home, despite having some of the common risk factors for pregnancy-induced hypertension i.e. advanced maternal age and history of eclampsia.

The doctor further explained that she should make an appointment with her primary care doctor for a follow up. He assured her that having a new baby was stressful and, if she got some rest, she would be fine. He said she was “in great shape” (Yes, she’s always been skinny and I’ve always been jealous) and not to worry.

My sister called me as she and her husband were heading home. Her blood pressure at discharge was 150/100. I told them to turn around and go back to the hospital.

Since they were almost home, a different hospital was actually closer. She was admitted for observation and remained in the hospital for two days because they had trouble regulating her blood pressure. The obstetric team there was familiar with pregnancy-induced hypertension and proper treatment. Other Black birthing persons have not been so lucky.

Each year in the United States, hundreds of women die during and up to one year after childbirth. Thousands more have unexpected outcomes post pregnancy with serious short- and long-term health consequences. Black and Indigenous women are most affected, dying at two to three times the rate of their White counterparts. Every maternal loss is tragic, especially because most reported maternal deaths were considered preventable.

Exploring the Data

The thought that any birthing person could die in the United States of America, one of the richest countries in the world, is unconscionable. Right? ?Also, the fact that the numbers are not getting any better, as medical advancements continue, is equally atrocious.

In 2020, the average maternal mortality rate in all high-income countries was 12 deaths per 100,000 live births. In the U.S., that number was nearly 24. New research indicates the U.S. rate continues to climb annually. Again, minority populations are usually the most impacted.

Since my sister’s brush with calamity, I have been exploring the Black maternal health crisis, delving into causal factors and viable interventions (Oh, if you are wondering, both my wonderful sister and beautiful niece are doing well.)

There is a considerable amount of research on the subject of causation as well as tried and true remedies i.e. centering pregnancy groups, doulas, and midwifery. Despite these efforts, the death rate has stagnated for most populations and rising for others, especially for Black women. Of note, the disparity exists regardless of insurance status, income, or social status. One study concluded maternal mortality rates were just as high among the highest-income Black women as among the lowest-income White women.

“We must first ask, ‘How do systems, policies, and social structures combine to create the conditions for poor health (outcomes)?’ Marian MacDorman PhD, the director of the Center for Antiracism Research for Health Equity at the University of Minnesota said in a recent interview.

A study she and her colleagues led found that late maternal deaths—those occurring between six weeks and one year postpartum—were 3.5 times more likely among Black women than White women. Postpartum cardiomyopathy (problems with your heart muscle that can make it harder for one’s heart to pump) was the leading cause of late maternal death among all races, with Black women having a six times higher risk than White women.

The prominence of cardiovascular conditions for Black birthing persons, “highlights the importance of increased vigilance to improve early diagnosis and treatment of these complications,” MacDorman explained.

Coauthor of the study, Maria Thoma, PhD of the University of Maryland School of Public Health explained that “the elevated risk of maternal mortality for Black women, from multiple causes, reflects the impact of structural racism on health and health care in the United States.

“Further research into the experiences of people of color can inform efforts to improve health care systems and, thus, improve the birthing experience for all. We need new models of care before, during, and after birth to address these inequities,” said Dr. Thoma.

Exploring Patient Experience

After reading many studies containing alarming data related to the death rate for Black mothers, I decided to do further research on the Black birthing experience. The stories were equally shocking.

In 2021, the U.S. House Oversight and Reform Committee held a hearing on racism in Black maternal health care. The complete session can be viewed HERE. Among the witnesses were the families of Black mothers who had died giving birth. Congresswoman Cori Bush gave an impassioned speech recounting her own traumatic pregnancy experiences as a Black woman. “Every day, Black women die because the system denies our humanity,” Bush said.

Research supports the claim. A recent report, published in the CDC’s Morbidity and Mortality Weekly Report, noted that Black, Hispanic, and multiracial mothers reported higher rates of negative experiences compared with white and Asian individuals.

“The general sentiment of this survey highlighted that we as physicians and health care professionals need to listen to our patients and ensure that we are providing respectful and equitable care, regardless of the setting we are practicing in,” said Jennifer Buckley, M.D., FAAFP, a member of the Academy’s Commission on Health of the Public and Science and family medicine/obstetrics director in the Department of Family Medicine at the Warren Alpert Medical School of Brown University in Providence, R.I.

A study in California, Listening to Black Mothers in California, underscored many social and economic issues affecting pregnant and parenting Black women, including their experiences with racism and discrimination within the healthcare system.

What’s Next

While I am concluding this article, I am continuing the exploration. I want to talk to experts and interview activists. I want to know what states, institutions, and individual programs are having the best outcomes. I want to share this knowledge with all of you, my supporting and caring colleagues. I am requesting that you consider the magnitude of what is being discussed and act on it accordingly.

Coming Soon

I am happy to share my recent interview with Dr. Dana-Ain Davis, Ph.D.? Dr. Davis is a Professor of Urban Studies and Anthropology. She is the director of the Center for the Study of Women and Society at the CUNY Graduate Center.

In the last decade, Dr. Davis has focused her attention on reproduction, race, and the technologies that assist in reproduction. She has written several articles addressing issues of reproduction and racism including, “The Politics of Reproduction: The Troubling Case of Nadya Suleman”; “Obstetric Racism: The Racial Politics of Pregnancy, Labor, and Birthing”; and “The Bone Collectors.” She is the author, co-author, or co-editor of five books, the most recent being Reproductive Injustice: Racism, Pregnancy, and Premature Birth. See you next time!

Joann Wortham, RN, DNP, JD is the author of the Amazon bestselling book EDI is the New Black: Lead the Market with Diverse Teams. She has presented on both national and international stages on healthcare equity, workplace diversity, and inclusive culture subject matter. Her most recent work includes an up-and-coming maternal health, feature documentary entitled, Notice of Intent: Peril of the Black Womb (2024).

Disclaimer: This article was prepared by the author, Joann Wortham, in her personal capacity. The knowledge/opinions/views/thoughts expressed are the author's own and do not reflect the view of any associated or related organization/employer/client. As applicable, all rights are reserved.