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A tough job, more dangerous for some
Being a new mom is tough, whatever their background. Tired, overwhelmed, it’s not uncommon for new mothers to miss crucial follow-up appointments that would detect hidden perils like high blood pressure or an infection after birth.
“You’re recovering from a delivery, whether it’s a vaginal delivery or a C-section, so this makes life easier,” Dr. D’Angela Pitts, director of maternal health equity at Henry Ford, said of the home visits, which began this year.
“And as new moms we tend to, of course, put everyone first. You may not think about the symptoms that you have.”
As tough as new motherhood can be, it is demonstrably more dangerous for women of color. The data is stark and has been for decades.
In Michigan, 29.8 black women died per 100,000 live births between 2015-2019, compared to a rate of 10.7 per 100,000 for white women over a five-year period ending in 2019, the most recent state data available. American Indian and Alaska Native women were 1.8 times more likely than whites to die of pregnancy-related causes.
National numbers and trends are no less worrisome. Indeed, between 2018 and 2020, maternal mortality among all women in the U.S. actually worsened — from 17.4 to 23.8 per 100,000. Again, it was worse for Black women, who died at 2.6 times the rate of whites.
Think the differences are related more to poverty than race? Think again. Experts at the Stanford University’s Institute for Economic Policy Research found that, among Californians, the wealthiest black women are more likely to die from pregnancy-related causes than the poorest white women.
These broad disparities have been magnified by a few high-profile tragedies, and near misses, in recent years, lending credence to the role unconscious bias can play in the treatment of Black patients.
In 2017, Shalon Irving, an accomplished Black researcher of health inequities, died of cardiac arrest following childbirth after her distress was dismissed again and again by doctors.
“It didn’t even matter that Shalon had two master’s degrees, one of them a master’s in public health from Johns Hopkins,” her mother, Wanda Irving, said in a Ted Talk entitled “How the U.S. medical community fails Black mothers,” or that she was a highly respected epidemiologist at the Centers for Disease Control and Prevention.
“She was still a Black woman — a Black woman accessing a system that saw her as a stereotype and responded to her as such.”
In May, three-time Olympic medalist Tori Bowie, 32, was found dead at her home in Florida. She was eight months pregnant. The medical examiner cited possible complications from respiratory distress and eclampsia, a condition of high blood pressure during pregnancy.
Tennis superstar Serena Williams wrote in 2022 about a nurse dismissing her complaints of sharp pain during labor, telling her, “I think all this medicine is making you talk crazy.” Williams had to repeatedly insist that doctors perform more testing, which revealed a life-threatening blood clot in her lung.
Dr. Joneigh Khaldun, Michigan’s former chief medical executive and an emergency department physician, shared her own experience of feeling ignored when she complained of terrible headaches after giving birth: “I felt brushed off and did not know what to do,” she said in 2018.
A CT scan revealed the life-threatening brain bleed. Doctors had to drill holes in Khaldun’s skull to release the blood, she told Crain’s Detroit in 2020.
Unconscious bias can play a factor in a clinician being more likely to dismiss a pregnant Black woman who complains of something like a headache, said Pitts, the Henry Ford doctor.
“We want to treat everyone the same, and unfortunately it’s not just happening,” she said.
Instead, she said, too many patients of color are dismissed with assurances that “it’s normal in pregnancy.” “You’re going to be fine.” Or “there’s no need to come in.’”
To be sure, deaths among pregnant women and new moms are a tiny sliver of overall deaths. Fewer than 100 people die each year from pregnancy-related causes in Michigan.
But among 11 developed nations, women in the U.S. are the most likely to die from complications related to pregnancy or childbirth, according to a review by the Commonwealth Fund, a New York-based health care research organization.
Each death leaves a wake of misery, and children who are sometimes left without a parent. But Pitts notes another maddening fact: Maternal deaths are most often preventable.
In a review of 996 maternal deaths in the U.S. from 2017 to 2019, the Centers for Disease Control and Prevention concluded 84 percent were preventable. In Michigan, one review of deaths between 2015 and 2019 found 64 percent of pregnancy-related deaths could have been avoided.
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