U.S. Maternal Mortality Crisis Hits Black Women Hardest
With Roe v. Wade hanging in the balance and nearly half of all American states ready to practically ban abortion if the leaked draft opinion from the Supreme Court stands, the realities of giving birth in this country are being put under a microscope, and for good reason.
"Today, [America] is considered the most dangerous developed nation in the world in which to give birth," said Stacey Stewart, president and CEO of the March of Dimes.
"Our rates in the U.S. of maternal mortality have actually doubled over the past 30 years, where in every other highly industrialized country their rates of maternal mortality have been declining," Stewart said in a HealthDay Now interview.
There are also glaring disparities. Black women are three times more likely to die from causes linked to pregnancy than white women, according to the U.S. Centers for Disease Control and Prevention.
"So we are unique," Stewart said, noting the United States is in a position of "really failing far too many moms and babies, especially moms and babies of color."
The CDC estimates that about 60% of maternal deaths are preventable, but not enough women receive the comprehensive medical care they need. Access to quality health care throughout pregnancy -- from conception to delivery and well into the postpartum period -- plays a fundamental role in maternal mortality.
Reducing maternal deaths will require expanded access to routine maternity care to ensure that signs of a complication can be quickly spotted and treated, and underlying conditions can be closely monitored.
Scarce maternity care
According to the March of Dimes, about 7 million women ages 15 to 44 cannot obtain maternity care in their area or have dangerously scarce options. Of these 7 million women, more than 1 in 3 are women of color. "We know that in 54% of all the counties in the country, there is little to no access to obstetric care," Stewart said.
Many women feel this neglect. In a survey conducted by the Harris Poll in partnership with HealthDay, 76% of women strongly or somewhat agreed that there's not enough focus on health care for mothers after pregnancy and birth, and 71% strongly or somewhat agreed that it feels like mothers are forgotten once the baby is born.
Other contributing factors include gaps in insurance coverage that leave mothers without prenatal or postpartum care and high rates of preexisting conditions. Offering women options to prevent unwanted pregnancies is associated with lower maternal mortality rates, adding to concerns that a reversal of Roe v. Wade could have deadly implications for mothers. States with restrictive abortion laws already tend to have higher maternal mortality rates.
All of these forces disproportionately affect women of color, but Black mothers face additional, more systemic threats. "Eighty percent of our health is really determined by how we live, whether or not we have access to safe, decent housing, good nutrition, access to good care and all of those things," Stewart said.
Dr. Chereena Walker, 33, a hospitalist in Kansas City, Mo., and mother of two, has experienced what too many women of color can relate to: Despite her position as a trained physician, she struggled to have her voice heard by her own doctors as she experienced complications throughout each of her pregnancies.
Walker has a history of asthma, which can up the risk of complications during pregnancy. Like many other preexisting conditions linked to high-risk pregnancies, asthma strikes Black women at significantly higher rates than white women.
During Walker's first pregnancy, an asthma flare-up at 25 weeks landed her in the hospital, where she was intubated for three days to regain control of her breathing. She found herself in the intensive care unit again during her second pregnancy after developing a respiratory virus and severely low oxygen levels. At that time, the doctors also discovered a small hole in her heart, called a patent foramen ovale, or PFO.
While she carried both pregnancies to term and brought two healthy babies into the world, Walker and her husband were fearful of trying for a third.
Severe pain led to wrong diagnosis
Despite her apprehensions, Walker said she "had more love to give" and decided to try again with an expanded maternity care team that included a cardiologist and a pulmonologist. Seven weeks into her third pregnancy, Walker developed severe abdominal pain and checked herself into the emergency department at the hospital where she worked. The doctors there diagnosed her with hemorrhoids.
"You would expect that I would have more background and more knowledge to talk about what I needed at that time, but I was in so much pain," Walker said. At that moment she wasn't thinking of herself as a physician. "I was a mom. I was a patient. And I just needed someone to advocate for me, someone to dig a little deeper because I couldn't voice anything. I was just so focused on trying to get through."
Her pain intensified after being discharged and soon became paralyzing. "I couldn't get off the floor. Any movement, any driving, anything that caused my abdomen to shift, caused me severe pain," Walker said.
This time, she went straight to the hospital where her maternity care team was based. "But again, my voice wasn't heard as much as I would like it to be. So for hours, I sat there in pain," Walker recalled.
Once she was able to see her doctors, they quickly discovered what was wrong but were unable to save the baby. She had developed a rare type of ectopic pregnancy that caused the fetus to grow in her abdomen instead of her uterus.
Walker persevered and is now expecting again. She feels supported by her maternity team and trusts that they did everything they could to save the baby once she landed under their care. But she also recognizes the unreasonable barriers she faced along the way.
"If I'm saying that I'm in pain -- I have a high pain tolerance -- but I'm telling you that something's wrong, let's look beyond hemorrhoid diagnosis," Walker said. "Let's look into something else that could potentially be wrong."
Serena Williams spoke up
Many other Black mothers have stories like Walker's, including Serena Williams, one of the most influential women in the world. After delivering her baby via C-section, Williams had a pulmonary embolism, a blood clot that travels to the lungs. In a 2018 interview with Vogue, she recounted having to advocate for her needs explicitly when a nurse attributed her symptoms to confusion induced by pain medication.
"Implicit bias stands in the way of far too many women, especially women of color, not receiving the proper treatment, and then that leading to some sort of poor maternal health outcome or even birth outcome," Stewart said.
Stewart and her colleagues at the March of Dimes have examined the issue of implicit bias and how doctors' underlying assumptions can influence the quality and efficiency of the medical care they provide. According to the March of Dimes, almost half of all obstetrician-gynecologists have acknowledged that they hold some biases.
"While I'm trying to bring life into the world, I just want to enjoy my blessing of having another child," Walker said. "And I think it's heartbreaking that we have to think about that. We just want to have our voices heard and have our babies. But we have to think about all these conditions and complications that could happen."
The U.S. Centers for Disease Control and Prevention has more on disparities in maternal mortality.
SOURCES: Stacey D. Stewart, MBA, president, CEO, March of Dimes; Chereena Walker, DO, hospitalist, Kansas City, Mo.