On a busy clinic day in my previous life as an outpatient pediatrician, I recall multitasking from one exam room to the next on a weekday afternoon. Typically, newborns were scheduled for the morning, mostly to ensure things like jaundice checks could be done in a timely manner. This was also done to minimize exposure to sick children in the office after school. For whatever reason, this set of twins came late that particular day. Before I went into the room to examine the patient, a boy and girl pair, my nursing staff was already buzzing with emotion. The Dad was there alone in the office with the twins juggling the two car seats, a diaper bag, and various papers. It was not the fact that he came alone with his newborn children, it was why.
I’ll never forget those beautiful babies who I learned in that newborn visit had just lost their mother shortly after she delivered the babies. From the history I could obtain it sounded like their mom died from respiratory failure. She was young, she was a severe asthmatic, and something had gone wrong after her c-section. The father, her husband, could not give the medical details and I did not pry. It was clear every emotion was at the surface and for me to experience this loss through his eyes was deeply jarring.
Maternal Health for Black Women
The data is clear: we have a problem in our country with maternal mortality among black pregnant women in America. This public health crisis has finally transcended to the elite rooms of mortality and morbidity rounds, peer review, and has reached the halls of congress, social media, television and magazines where it belongs. Black women are dying in childbirth at a rate nearly 3-4 times greater than other ethnicities, even when controlled for socioeconomic status according to many sources. These deaths have been described as largely preventable. In fact, the Centers for Disease Control (CDC) reports that 60% of these deaths could be prevented. The mother of my twin patients perhaps could have been saved.
There is no acceptable explanation or excuse for this tremendous disparity in one of the most technologically advanced nations in the world. We do know that poverty, education, co-morbidities, all impact maternal pregnancy health outcomes. According to the American College of Obstetrics and Gynecology (ACOG), biological factors, like fibroids also increase the risk for life threatening pregnancy related conditions like postpartum hemorrhage. Also reported by ACOG, black women are 3 times more likely to have fibroids and 7 times more likely to have surgery to remove them than white women. However, when all of these variables are controlled, black women are still dying at a high rate of pregnancy related complications. Implicit bias is also a root cause, according to CDC data, with 1 in 7 black women reporting experiencing emotional distress due to how they were treated in society based on race. This impacts the health of black women and our mortality rates are evidence of systemic problems.
The Impact on Black Infants
This health disparity also adversely affects black infants. Black women are also more likely to suffer a stillbirth, give birth prematurely and have a low birthweight (SGA) baby. Black infants are two times more likely to die as white infants in the first year of life? In fact, the infant mortality rate (IMR) of black infants in the United States is higher than many developing countries, and the gap between black and white infant death rates has actually widened over the past 30 years!
Raising Awareness and Other Needed Changes
The first step to overcoming this tremendous disparity and the systemic problems in healthcare is awareness. Black maternal mortality awareness week is essential to this process. Black Maternal Health Week (April 11-17) was started in 2018 by Black Mamas Matter Alliance to highlight and inform the public about the growing national health disparity that disproportionately affects black mothers and their babies. A TV episode of “The Resident” aired during this same week based on the true story of the postpartum death of Kira Johnson, daughter in law of famous Judge Glenda Hatchett, bringing the issue to prime time. Judge Hatchett, her son Charles Johnson, and other families impacted are sharing their stories to educate us all and raise awareness.
The next steps involve our collective and sustained advocacy. Our OBGYN colleagues developed the acronym “TEAM” to help educate fellow physician colleagues, labor and delivery as well as postpartum care nursing staff, medical technologists who obtain vitals, every aspect of society that touches pregnant women. Through timeliness of response to patient concerns, education of staff and patients on the effects of implicit bias on health outcomes, advocacy, and mentorship we can all make a difference. Through this “TEAM” approach hospital systems, private practices, and medical schools can create safety measures to support black mothers and keep them safe during pregnancy and the postpartum period.
This country can and should do better for all women. These are the first steps in a long journey to improving black maternal health outcomes. We also applaud all of the legislative activity that is happening around advocacy and policy. The co-director of Black Mamas Matter Alliance, Ms. Gay sums it up in their motto: Listen to Black Women, Trust Black Women and Invest in Black women.
Bande Virgil, MD is a pediatric hospitalist and clinical assistant professor of pediatrics practicing in Georgia. She can be followed on Instagram @themommydoc1 on Instagram. She is a contributing author to The Chronicles of a Women in White Coats. She has an upcoming book on parenting in the new millennium “A Teaspoon of Honey”. Follow her on IG @themommydoc1.
Natasha K. Sriraman, MD MPH FAAP FABM is an Academic Pediatrician and Associate Professor of Pediatrics at Children’s Hospital of the Kings’ Daughters/Eastern Virginia Medical School. She is an Editor for the Women In White Coats blog and coauthor of “The Chronicles of Women in White Coats.” Find her on IG @Natasha.Mom.MD, also atwww.natashamommd.com.
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