• Dr. Joy

What’s the Fuss?: Black Maternal Mortality




As if just being black was not hard enough, ProRepublica highlighted the story of a black woman who had everything going for herself but died tragically at 36-years-old just three weeks after giving birth. As a black woman, that article changed me. As an ObGyn, that article transformed me. I will never be the same because Shalon Irving could easily have been one of my friends or colleagues. That article renewed my commitment to the survival of black women and that is why I am writing this post. A little over a year later, superwoman Serena Williams lived to tell the details of the story of her postpartum pulmonary embolism or clot in her lungs. She had to advocate for herself to get the treatment for what she could feel was happening in her lungs. And while a lot of the hysteria around black maternal mortality has come from media hype, please know that the hype is real. Think of the women who are not famous enough to share how the doctors did not listen to them or the women who have transitioned to ancestry that a journalist has not picked up their story. Black women are 243% more likely to die than white women in the United States, but this post is committed to survival, your survival. Let’s discuss what makes this hot topic a real and true one and then at the end there are tips on how to survive before and after birth.


We Are More High Risk

Blacks giving birth are a high risk population because of some medical reasons and genetic reasons. When I say we are high risk do not take that as a negative, it is just a fact. If you could imagine if black America was its own country we would just have the statistics we have and would not be compared to white America so often. There are some basic facts that shape my approach to the black patient giving birth.


1. Black women have a higher preterm birth rate: ~17% of babies born to black mothers are born preterm.

2. Black women are more likely to have preeclampsia in pregnancy: In addition to this widely-known fact, it is important to also know that black women also have elevated rates of complications from preeclampsia like stroke, heart failure and pulmonary edema and this could contribute to elevated rates of mortality.

3. Black women are more likely to be obese: While we can talk about how our body type can be different, the main obesity that is concerning is central obesity or having most of your fatty tissue around your waist. In essence, when it comes to obesity, thick thighs save lives. However, increased rates of central obesity in our community are also due to African-Americans being half as likely as the general population in living within one mile of a chain supermarket. Living in food deserts makes us more likely to eat fast foods and unhealthy foods that contribute to obesity. That said, being obese does come with added risk factors for things like preeclampsia, diabetes in pregnancy and peripartum cardiomyopathy (heart failure in pregnancy).


These three things can contribute to complications in pregnancy that lead to death. So with more obesity comes more complications. If I am seeing a woman who is obese and trying to get pregnant, I typically encourage weight loss in preparation for pregnancy to minimize these risks.


What I tell my residents is when you walk into a black person's room, do not picture yourself in a fancy US hospital. Picture yourself in Mexico or Uzbekistan because the black maternal mortality rate for black women is on par with those countries. It is also important for doctors to recognize the risks that black women have and give them more attentive care to prevent poor outcomes. Our goal at Culture Care is to empower you with the vocabulary to go back to your regular doctor or hospital so that they pay attention more. Whenever I have a family member in the hospital, I call their doctor or show up at the hospital because then the team knows that somebody is watching them. Well we are watching out for you! We have to decolonize medicine and breakdown the structural racism that may impact lives in order to save black lives.


Listen

Beyonce’s lyrics to her song “Listen” say “Oh the time has come for my dreams to be heard. They will not be pushed aside and turned into your own. All ‘cause you won’t listen.” Mothers literally give birth to their dreams and they do not seek help within the healthcare system just not to be heard. Their voices must be listened to and their voices heard in order to give them the best of care. Many of the stories of black women dying in childbirth highlight healthcare workers ignoring more than signs and symptoms, but also their voices. At Culture Care our goal is to give you the jargon to make physicians, midwives and nurses listen to you.

Doctors speak a different language from people in the community. Typically to be effective with our patients, we must translate what we learned in medical school to our patients for them to be able to take care of themselves. With our series on advocating for yourself, we hope to give you the ability to translate your concerns and make them understand how severe they are.

Positives

I know with all of the statistics above it seems like nothing goes right for black people giving birth, but that’s a a lie. Here are a couple of statistics that work in our favor:

1. African-Americans are less likely to have a perineal laceration during birth

2. African-Americans have better rates of vaginal birth after cesarean section


Takeaway Tips

So you’re a black and want to give birth? Check out these tips.

1. You can go anywhere for care. If one hospital discharges you and you still feel unwell, go to another.

2. Listen to your body.

3. Have a healthy pregnancy. Have a happy pregnancy.

4. Watch your weight. (Not just for fat, but also fluid) Sometimes extra water-weight can indicate your heart is not being as effective at pumping your blood or that you may be leaking protein into your urine. So if your eyes and hands or legs look extremely puffy, see a doctor and monitor your weight.

5. Some things are normal when you are exerting yourself but not all the time, like: shortness of breath, swelling in legs (both not one), irregular contractions.


References

1. https://www.propublica.org/article/nothing-protects-black-women-from-dying-in-pregnancy-and-childbirth

2. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Freproductivehealth%2Fmaternalinfanthealth%2Fpmss.html

3. https://mchb.hrsa.gov/chusa13/perinatal-health-status-indicators/p/preterm-birth.html

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