On Tuesday Feb. 20, 2018, Serena Williams published an op-ed on CNN that detailed the traumatic complications following the delivery of her daughter, Olympia Ohanian, in September 2017. In the essay, she shared how her birth turned frightening when she became short of breath due to a history of battling a pulmonary embolism, which resulted in emergency surgery after giving birth. Williams shared how she knew exactly what kind of medical attention she needed, but at first had a hard time getting through to her nurses. Serena Williams was lucky; she got the care she needed and soon had life-saving surgery. But her story sparked a conversation on social media about so many other women who are not so lucky when dealing with hospital stays and doctors after giving birth: particularly, black women in America.
If you are a black woman giving birth in the United States, you're automatically at a three times greater risk to die in the delivery room than their white counterparts. According to the Centers for Disease Control and Prevention (CDC), this means black women are 243 percent more likely to die from pregnancy or childbirth-related causes than white women.
A hospital should be seen as a source of safety during medical emergencies, but in today’s society, black women are being taught and prepared for the dangers of being black when going just about anywhere. And though, as Williams pointed out in her op-ed, she had "an incredible medical team of doctors and nurses at a hospital with state-of-the-art equipment," she realized that not every woman in the United States, particularly black women, are as lucky. Whether you're pregnant or the prospect of babies is far in your future, the best way to prevent something from happening is to understand it.
I talked to Patrisse Cullors, senior fellow for maternal mortality MomsRising and co-founder of Black Lives Matter, for an interview with Elite Daily, and Cullors shared a story similar to Williams'. Prior to her delivery, she didn't receive a thorough description of what would happen during the c-section her doctors suggested she have at the last minute. Cullors recalls feeling "a weird resist in telling me what I was going to experience." Following the unplanned c-section delivery, she contracted pneumonia, which can cause challenges in newborn care, like missing out on breastfeeding or crucial bonding experiences with a child, according to the CDC. "It was a nightmare," she says. "A nightmare that I couldn't be with my baby for a few weeks."
But according to Cullors, nothing will change until the health care system believes change is necessary. "When it comes to maternal mortality, there is not a standard of care given across the board. We need to create policies, not just hospital by hospital but nationwide. I think in the short term we actually need to build a movement. A movement that is looking at the most marginalized, which are black women," says Cullors.
Black women are unfortunately facing the most difficult stats when it comes to maternal mortality, on average experiencing 43.5 deaths per 100,000 births, according to data collected between 2011 and 2013 by the CDC. But women of other races (non-white, but not clearly specified by the CDC) die at an increased rate during childbirth, at about 14.4 deaths per every 100,000 births. White women sit at the lowest risk, with around 12.7 deaths per 100,000 births on average. Having less access to medical care (due to being unable to afford insurance or living in more rural areas) contributes to riskier pregnancies as well.
For decades, the United States' health care system has failed black women with visible systemic racism, which minimizes and dismisses health issues. Even worse, clinicians continue to ignore concerns from mothers following childbirth, which results in death for many. Black women are not more susceptible to sickness or biologically deficient, as some doctors used to believe, and unfortunately, still do.
Nothing about black women makes reproduction inherently more dangerous. So why are they being treated as such?
External Contributing Health Risks
Chronic stress related to racism and social inequities also contributes to a higher risk of complications and death for women of color. Other common chronic health conditions, such as high blood pressure, diabetes, and obesity contributes to higher risk in pregnancy and birth, and affects the black community at notably higher rates, according to WebMD. A lack of health care access could be partly to blame as well. When the Affordable Care Act expanded health care to many uninsured adults in 2010, 21 states, most of which are located in the South, decided not to expand Medicaid. As result, as many as 3.1 million poor, uninsured adults who earn too much to qualify for Medicaid went without needed preventative women's health care. The National Center For Biotechnology (NCBI) notes that women with consistent access to a health care provider throughout their lifetime are more likely to manage or address risks or complications early and maximize the chances of a healthy pregnancy and birth, but in the Trump era, access to health care is shrinking.
Under the Affordable Care Act, every plan available was required to cover pregnancy, maternity, and newborn care, but efforts by the Trump administration, particularly with the introduction of the American Health Care Act (AHCA), makes constant efforts to end these services. The proposed AHCA plan allowed insurance companies to define what they consider to be "basic" health care needs for women and require higher premiums for services not covered. The AHCA did not pass in the Senate, but efforts to eliminate Obamacare are still underway.
Once Black Women Are In The Delivery Room, They Face More Challenges
Once black women enter the hospital to deliver, there's a whole other list of racial biases working against them. One of the main reasons? A bias by nurses and doctors that black women "do not know what they're talking about."
In 2012, researchers at the University of Virginia discovered, through a group of 222 white medical students and residents, that doctors believed in phony biological differences between black and white people, including beliefs such as, “blacks age more slowly than whites; their nerve endings are less sensitive than whites’; their blood coagulates more quickly than whites’; [and] their skin is thicker than whites.” If that's not alarming enough, in 2012, researchers at Johns Hopkins University School of Medicine found doctors with “unconscious racial biases tend to dominate conversations with African-American patients,” according to Medical News Today. Patients who feel they can trust their medical provider or feel uncomfortable disclosing aspects of their health, probably won't return to that medical provider for needed treatment — if they return at all.
In her piece for Vogue.com, Williams shared how her nurse chalked up her complaint to be "confusion from pain medication," which happens with more regularity than you'd expect. First-time mothers are quickly labeled with "new-mommy anxiety," despite the fact that roughly 10 percent of new moms have postpartum anxiety, according to Postpartum Support International. Even as the health of Americans overall has improved, the disparities in treatment and outcomes between black patients and white patients continues to be important to address in any medical situation.
Williams' story, like so many other black mothers' stories, illustrates how discrimination and unconscious or unintentional bias by medical staff during treatment are factors that can't be ignored when making changes to the health care system.
In order for real change to occur, systemic improvements in hospitals, beginning with broader diversity among health care providers, are necessary. When looking at America's physician workforce, it's too far away from reflecting the diversity of its people. According to CommonHealth.com, though, 1 in 8 Americans are black, only 1 in 15 black Americans become practicing doctors. In addition, John Hopkins University researchers found that many minority doctors return to work with underserved and poor populations, which allows for patients to respond differently to physicians they feel comfortable with.
Whether it’s culture, race, language, or gender, patients are looking to relate to their medical providers. When there is a clear and working relationship between patient and physician, it allows for conversations to be more patient-centered while developing mutual trust. According to Jama Internal Medicine journal, better relations might in turn lead to greater patient satisfaction, quicker treatment for better health outcomes, and more effective use of the health care systems.
With the closing of several labor and delivery services throughout rural areas, increased transportation barriers, and limited access to care, the health care system has put, many women — specifically black women — at a dangerous disadvantage. Due to limited staffing in rural hospitals, most hospitals don't have high-risk specialists to handle emergency complications quickly. So if something goes wrong, mothers then have to be driven or flown to the nearest hospital with a full-service labor and delivery ward. The time this takes is often the difference between life and death.
Many black women who live in rural areas and have conditions requiring a high-risk specialist go without the level of care they need because they're forced to travel as far as five hours round-trip to receive adequate care, according to EveryWomanCounts.org.
What Can I Do To Protect Myself?
Under the United States' federal acts and regulations, every pregnant woman has the right to make informed decisions based on accurate information. So if you don't understand the way something is explained or printed in materials handed to you, ask for more clarification.
If it still doesn't make sense, ask again.
According to the World Health Organization, the major preventable postpartum complications accounting for nearly 75 percent of all maternal deaths include severe bleeding (mostly bleeding after childbirth), infections (usually after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia), and complications from delivery and unsafe abortion.
These conditions are each preventable, but every 9 minutes, a woman suffers a life-threatening complication during pregnancy or childbirth, according to EveryWomanCounts.org. So what can black women do to protect ourselves?
Regardless of your age, any woman who intends to get pregnant should start prenatal education and well-woman screenings early. A well-woman screening is a complete physical and mental health evaluation, with the opportunity for counseling, catered to a woman's age range that can be completed by her doctor. If you don't know your family history, now is the time to get screened and understand risk factors. The goal of preconception care is to prevent future risk throughout the pregnancy and decrease chances of complications following delivery. The challenge that comes of that care, however, is making sure that anyone who is planning for a pregnancy finds and receives appropriate medical care, which includes educating and screening any woman who could become pregnant on an ongoing basis to identify early potential maternal and fetal risks and hazards to pregnancy before and between pregnancies.
Black women dying from childbirth is nothing new, but the narrative of this public health crisis has been silenced for long enough. Both Williams' and Cullors' stories, like many others, are no longer exceptions — they're slowly becoming the norm. As more women color speak out about their childbirth experiences and the medical care they've received, doctors need to acknowledge black women aren't the ones who need to change; the health care system is. "Because we live in a society where it's a medical business versus obstetric peoples health, I think there is a significant amount of negligence," says Cullors.
Many on Twitter are voicing their concerns and sharing experiences similar to Williams' and using it as a moment to highlight the issue of maternal mortality among black women.
Without a diverse and inclusive health care workforce, how do we expect to improve maternal health? How many more black women will die from childbirth until doctors figure it out?
I'm thankful to Williams for calling attention to her experience, and I applaud her for using her platform to advocate for affordable quality health care, but the reality is, there are many more black women with untold stories.
"[A world with affordable health care] is possible," Williams wrote in her op-ed. "And we must dare to dream it for every black woman."