Birth Daze: Black Maternal Morbidity and Mortality
During my three pregnancies in the 1960s, I had no idea that, as a Black woman, I was at higher risk for pregnancy-related complications, even death. In recent years, however, the ordeals of tennis icon Serena Williams, singer and songwriter Beyonce Knowles-Carter, track and field Olympian, Torie Bowie, and Kira Dixon Johnson, have heightened public awareness of Black maternal morbidity and mortality.
In 2017, after the delivery of her daughter, Olympia, by emergency cesarean section, Williams suspected that her shortness of breath was related to blood clots. (Ten years earlier, she had blood clots in her lungs and has lived in fear of them ever since.) Consequently, Williams asked a nurse at St. Mary’s Medical Center to order a heparin drip, but she denied her request.
In a collection of essays by new mothers, Williams writes, “Lo and behold, (a CT-scan revealed) I had a blood clot in my lungs, and they needed to insert a filter into my veins to break up the clot before it reached my heart." She also underwent surgery for a hematoma (a collection of blood) in her stomach.
(In August 2023, Williams gave birth to her second daughter, Adira River, sans complications.)
In a 2019 interview, Beyonce tells ELLE that during her pregnancy with twins, Rumi and Sir, "I was 218 pounds, “I had high blood pressure. I developed toxemia, preeclampsia … one of my babies' heartbeats paused a few times, so I had to get an emergency C-section."
In May 2020, TV judge Glenda Hatchett’s son, Charles Johnson IV, filed suit against Cedars-Sinai Medical Center in Los Angeles, four years after the death of his wife, Kira Dixon Johnson, 39, who bled to death 12 hours after delivering a son by caesarean section. According to the Associated Press (AP), “(Johnson) said he discovered the disparity in care women of color receive at Cedars compared to white women during depositions in his wrongful death lawsuit ….”
Johnson’s attorney Nicholas Rowley told AP, “She died from internal bleeding — nearly 90% of her blood was later found in her stomach …. Her bladder had been lacerated and she hadn’t been sutured properly.”
The body of Frentorish “Tori” Bowie, 32, an American track and field athlete and three-time Olympic gold medalist was found inside her Florida apartment on May 2, 2022; she was eight months pregnant. According to Fox News Digital, the Orange County Medical Examiner’s autopsy report ruled “eclampsia (seizures that occur in pregnancy) and respiratory distress” as possible causes of death.
Ironically, despite access to quality healthcare, maternal mortality among the highest income Black women is just as high as among low-income white women.
In May, a New York Times article, “Unwanted Epidurals, Untreated Pain: Black Women Tell Their Birth Stories,” details how racism affects birth outcomes for Black women.
“Numerous studies suggest that racism, and how it affects Black women’s health throughout their lives is a primary driver. It starts long before women become pregnant …. It happens across health care settings …. even if medical staff is empathetic overall, just one such interaction can have a big effect. It continues through childbirth, when discrimination, unconscious or not, affects Black mothers’ hospital care.”
Similarly, research studies show that structural racism increases the incidence of underlying conditions such as hypertension and diabetes which can affect birth outcomes.
In the January 2021 issue of Transforming Care , co-authors Martha Hostetter and Sarah Klein write, “providers spend less time with Black patients, ignore their symptoms and complaints, and lose contact with them during the postpartum period when women undergo major physiological changes that put them at risk of death.”
Understanding maternal morbidity and mortality
The National Institutes for Health describes maternal morbidity as “any short- or long-term health problems that result from being pregnant and giving birth. Maternal mortality refers to the death of a woman from complications of pregnancy or childbirth that occur during the pregnancy or within 6 weeks after the pregnancy ends.”
Yale Medicine’s website cites a report from the Centers for Disease Control and Prevention (CDC), shows a rise in maternal mortality rates in the United States: 1,205 U.S. women died of maternal causes in 2021, compared with 861 in 2020 and 754 in 2019.
In March 2023, The Guardian reports, “America has 10 or more times the rate of pregnancy-related death than Australia, Austria, Israel, Japan and Spain.”
The CDC’s National Center for Health Statistics, reports, “Among Black women the maternal mortality rate was 69.9 deaths per 100,000 live births, more than twice the rate for white women.”
The Women’s Leadership and Resource Center notes, “(The) reproductive oppression against Black women is rooted in the US history of commodification of Black women’s bodies, sexuality, and reproductive lives. During slavery Black women were treated as factories of property and producers of wealth for their masters, and were often encouraged to bear children, subjected to rape, and punished for failure to procreate.”
In a 2020 interview for Berkeley News, historian Deidre Cooper Owens, author of Medical Bondage: Race, Gender, and the Origins of Modern Gynecology, says, “… in the South, these doctors … had access to black bodies, particularly (B)black women’s bodies, to experiment on, to examine, and to, in their words, “cure” or “fix” diseases and disorders.”
This history of medical maltreatment, experimentation, and coercion fuels Black women’s mistrust of medical professionals and how they engage with them.
What’s been done?
Johnson’s medical malpractice lawsuit and a civil suit filed in May 2022 were settled. (Litigants did not reveal the terms of these settlements.) Consequently, according to ABC News, Cedars-Sinai will distribute more than $2.2 million in grants to nonprofits addressing racial disparities in maternal care; hold annual training on unconscious bias; conduct research to identify racial disparities, and partner with organizations and Black leaders to find solutions.
The Biden-Harris Administration’s “Blueprint for Addressing the Maternal Health Crisis,” includes expanding postpartum coverage, increasing access to and coverage of high-quality maternal health care, and distributing more than $2.2 million in grants to nonprofits addressing racial disparities in maternal care.
In July 2023, the Department of Health and Human Services launched a civil rights probe into Cedars-Sinai’s treatment of Black mothers.
During remarks at the Maternal Day of Action Summit in December 2021, Vice President Kamala Harris said, “We know that when women do not get the healthcare they need, families suffer, communities suffer, and our nation suffers …. (W)e must do everything we can to protect and to strengthen both maternal health and reproductive health.”
2024 Wista Johnson (Reprint by permission only.) Photo: Rodolfo Quiros (pexels.com)