Maternal Health and Awareness

Many medical providers are dismissive of the voiced medical concerns of Black women, ultimately resulting in inferior care.

Dr. Sharon K. West
Dr. Sharon K. West
By Dr. Sharon K. West –

Each year in the US, 700 women die during pregnancy or within one year after.

She was in her mid-twenties when she delivered her third child. As a single mom of three children under the age of 4, she brought the newest member home to receive the love of his big brother and sister. Within a week upon arriving home, the single mother of three was dead after internal hemorrhaging.

This was my first exposure to maternal death. She was the daughter of my best friend from early childhood. I was living in Durham (NC) when I received the call.

I remembered when she was born. How could this be? What happened? Though that happened 20 years ago, I recall it as vividly as if I received the call only yesterday. Though having been a nurse at the time for 18 years, I had no clue that she was but one out of many Black women who lost their lives during, or very soon after, giving birth in the United States.

What do Grammy award-winner Béyonce, and Grand Slam titlist Serena Williams, have in common with me and other Black women living in the US? As Black women living in the US—no matter the socioeconomic status—it took much effort for both women to advocate for their bodies and their babies before someone listened.

As noted, 700 women die annually in this country during pregnancy or within a year after giving birth. I am stunned by this statistic. Furthermore, Black women in the US are 3.5 times more likely than white women to die between six weeks and one year after delivering their little one. Possible reasons for this disparity include chronic conditions (diabetes, heart disease), structural racism, and implicit bias. I am extremely grateful that each of my own pregnancies was a positive experience; that fact makes it even sadder for me to learn the stories of those who did not have good outcomes.

What is most disturbing to me, and what I have uncovered as a common thread woven throughout each story, is the dismissive attitudes these women experienced from the medical team when they voiced concerns about what they were feeling—in their own bodies. For example, Serena Williams tells her story—and she was very familiar with her symptoms because of her medical history:

She walked out of the hospital room so her mother wouldn’t worry and told the nearest nurse, between gasps, that she needed a CT scan with contrast and IV heparin (a blood thinner) right away. The nurse thought her pain medicine might be making her confused. But Serena insisted, and soon enough a doctor was performing an ultrasound of her legs. “I was like, a Doppler? I told you, I need a CT scan and a heparin drip,” she remembers telling the team. The ultrasound revealed nothing, so they sent her for the CT, and sure enough, several small blood clots had settled in her lungs. Minutes later she was on the drip [heparin].”

Chanice Wallace, a physician—a fourth-year pediatric chief resident—died four days after giving birth to her daughter. She died from complications of preeclampsia (high blood pressure, protein in the urine, and swollen extremities). Her preeclampsia diagnosis was revealed at 35 weeks into her pregnancy, and she spiraled downward from there.

Shalon Irving, an epidemiologist at Centers for Disease Control, collapsed and suffered a heart attack three weeks after giving birth at age 36. She had completed a visit with her medical provider just hours earlier. Her mother stated, “She repeatedly told her provider she didn’t feel well, but her pain had been denied.” [That is, dismissed.] Shalon had written a note to her mom as she acknowledged her downward spiral: “Mommy, I will fight hard, but if anything happens, if there is no hope, please let me go.”

There are so many more cases similar to these, such as Tanisha Dickey, Kira Johnson, and others, no matter the geographic location, no matter the socioeconomic status.

This is now known as “cumulative de-prioritization.” This occurs when many (not all) medical providers are dismissive of the voiced medical concerns of Black women, ultimately resulting in inferior care. Many “fractures in the ice” are due to the minimalizing categorization of Black people; of Black women who are birthing Black babies. This minimalization triggers actions driven by bias (mostly unconscious, unintentional associations) but can also be also overt and intentional. The system designed to care for us is not always reliable.

It pains me to even write this, knowing the children who are now being raised without their mothers. Fathers who have taken up the mantle of single parenthood. Grandparents who are punted into the role as surrogate “Mama,” rather than observing and loving and supporting their adult child in raising the grandchild.

This is intergenerational trauma.

My thoughts begin with the obligation of my fellow health professionals to recognize and intervene.

Positive Practices for Providers and Medical Teams

Self-reflection is necessary. Face the hidden biases. Bias can result in inflicting harm upon another. I believe that it is our personal biases that determine the quality of care one receives. Face this and remove it.

Stop categorizing people. When you see a person and the first characterization is race, gender, age, STOP the script and immediately think of three positive characterizations about this person that do not include race, age, or gender. Example: Sharon is a mother of three, a nurse, and a native Ashevillean.

Ask yourself, what role does this person hold in their family?

Establish a cultural focus with these questions: How am I keeping this person from teaching me? Am I listening?

Advocate for significantly more funding for Doula services. Doulas are essential for certain populations. Doulas, for those who are unfamiliar, are trained professionals who provide ongoing physical, emotional, and informational support to a mother before childbirth, during childbirth, and shortly after childbirth (home visits). All their work is designed to support successful outcomes for mother and baby.

Offer support from Doula programs such as SistasCaring4Sistas (Asheville). Medical teams should order this service early and often. I am totally supportive of all vulnerable ethnic and racial populations having this service available.

Honoring cultural congruence in medical care has been proven time and time again to produce better outcomes. People tend to broach difficult subjects more readily when there is a person who looks like them, someone they can address their concerns with.

Hire Black healthcare professionals. Advocate and demand the intentional emphasis on increased hiring of Black health care professionals—nurses, doctors, researchers, health care administrators, allied health professionals. The percentage of Black male doctors in the US is the same today as it was in 1940: 3%. The percentage of Black doctors, male and female, is only 5% of the physician population, compared to the 14% of the US population who are Black.

Support legislation such as the Momnibus Act. SB 65 aims to close existing racial gaps in maternal and infant mortality rates, end preventable maternal mortality, and close disparities in maternal health outcomes.

I just want my fellow health professionals to care about this at the end of the day. Use your voice to advocate for those who are characterized as the least, the least likely, and the unlikely. It starts with you.

 

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