According to the CDC, a pregnancy-related death is the death of a woman while pregnant or within 1 year of giving birth. This type of death is not from an accidental or incidental cause, but aggravated by the pregnancy or a result of poor pregnancy or delivery management.
While these deaths stem from a variety of causes like hemorrhaging, infection, and heart conditions, most of the deaths are preventable. And an added layer of tragedy to this problem is the disproportionately higher rate of pregnancy-related deaths among women of color—especially Black women.
Here’s the breakdown based on a CDC study comparing pregnancy-related deaths between 2011 and 2016. The following graph shows deaths per thousand.
Unfortunately, racial disparities have persisted. In 2020, the death rate among Black pregnant women is still 3-4 times higher than among White women.
Where Do Racial Disparities Stem From?
A mix of systemic issues and racially-charged myths have led us to this point.
The problem often starts with limited access to healthcare among communities of color, especially Black communities. In the US, access to private health insurance coverage is tied to employment and marriage. Rates of employment and marriage are lower among Black people than other groups, limiting their access to regular, ongoing health coverage.
Even though the Affordable Care Act has worked to reduce uninsurance rates in women of color, disparities remain. Black women are less likely to be insured before they become pregnant and they are more likely to start prenatal care later. They also might not get the postpartum care they need when they need it.
Additionally, Black women are more likely to have chronic conditions such as obesity, diabetes, and hypertension that make pregnancy more dangerous.
Racial biases disproportionately affect the quality of care Black pregnant women receive. Studies show that physicians spend less time with their Black patients and subsequently this results in lower-quality care . It’s also common for doctors to underestimate the pain of their Black patients, dismiss their complaints, or ignore their symptoms.
According to Kelly Hoffman, head of study into medical bias and a doctoral candidate in psychology at the University of Virginia, 58 percent of the study's general group said they believed that "blacks' skin is thicker than whites'." When it came to participants’ recommendations for treating pain in Black and White patients, Hoffman found that pain among Black patients was underestimated. This stems from a common belief that Black people have a higher pain tolerance which leads to less accurate treatment recommendations.
Furthermore, hospitals in predominantly Black neighborhoods often provide lower-quality care than those where white women deliver their kids due to limited resources in these communities.
All of these factors contribute to the perfect storm, resulting in higher deaths among Black pregnant and postpartum women.
What Should Change in Healthcare?
Solving the issue of high pregnancy-related deaths among Black women requires systemic efforts to reduce racism among medical professionals. Solving this problem also calls for improvements in the quality and affordability of health insurance.
Reducing disparities will require the participation of multiple systems to address each contributing factor.
Healthcare networks and hospitals in minority-dense areas can standardize protocols in quality improvement initiatives. In addition, universities, medical schools, and residency advisors can better train medical students to identify and address implicit bias in healthcare.
What Can Black Women Do?
Black women are not responsible for reducing biases in the healthcare system.
However, there is plenty that women can do to help keep themselves safe while medical professionals weed out dangerous biases in hospitals and clinics.
Do Your Research
If you’re having your first baby, there are likely a ton of important facts about pregnancy and birthing you don’t know yet. Unfortunately, this can put you at a disadvantage during your pregnancy. Spend some time taking birthing classes to understand what’s normal during pregnancy and what’s not.
The Source offers a number of pregnancy classes where you can get the detailed information you need. Book an appointment today to get enrolled in a free pregnancy class with other pregnant women in your city.
Interview Potential Healthcare Providers
Inviting someone to join you on your pregnancy and birth journey is a big deal. You’ll share big moments with this person: Ultrasounds, excitements, fears, baby names, information about your family history, and intimate details about your life to date. Before you commit to a provider and develop a relationship with them, schedule a short interview to get to know them and their practice.
Ask your potential provider hard questions like their thoughts on the high pregnancy-mortality rates among Black women. Ask them how many Black women they typically serve and how comfortable they are treating Black people.
Not only are their answers important indicators of how much you can trust their expertise, but it also helps determine the level of emotional trust you can put in them. They may have all the right answers, but if your gut tells you they’re not the right provider for you, consider interviewing other doctors. While medical training is relatively standard, you can’t train people on empathy.
Get a Doula
Compared to women of other races, Black women are 36% more likely to have a C-section. A doula can help create goals and a birth plan as well as give additional prenatal support. Doulas are also excellent delivery room advocates and can reduce C-section rates.
Whether or not you plan to deliver at a hospital, a doula can be a source of calm during a hectic pregnancy and ensure you get the best possible care from your medical team.
Find a Team You Can Trust
Before committing to your physician, spend some time getting to know your doctor on a personal level. Do they value trust, empathy, and relationship-building? Could you consider them a trusted advisor to your birthing experience or does it feel more clinical?
If your choice of medical teams is predominantly White, it’s critical that you feel comfortable with their level of cultural competence and their familiarity with the history and present reality of discrimination in the healthcare system. Even if your doctor is White, they can still be passionate about fighting discrimination in their birthing rooms. That’s a physician you can trust.
Even if your doctor is a woman of color, it’s still important to air your concerns and give your physician the chance to address those concerns. The same goes for the staff members who attend to you.
Know Your Birthplan Inside and Out
If you have a doula, set a time to talk about all the details of your birth plan. Get as detailed as possible—talk about contingency plans if something goes wrong, who you want in the room, and what family members or friends you want in the room with you. Explore your options and talk about the benefits and risk factors associated with different treatments—Spell out what interventions are acceptable under what circumstances. Do you want an I.V.? Do you want fluids? Do you want an epidural?
If you plan to deliver at a hospital, ask your doctor who will be in the room during your birth. For some healthcare facilities, your primary physician may not be in the room during your delivery. Ask all those questions early and make sure you’re happy with the plan. Also, be sure to go beyond the logistics and figure out what kind of birthing experience you want. Are there traditions you want played out in your delivery room? Is there music you want played or prayers prayed?
Even though your birth plan is a personal play by play for such an intimate event, make sure your doula, doctor, and support system are also deeply familiar with it. This way, the people around you can make decisions during your delivery that align with your wishes.
Prepare for Pushback
As a Black woman, your credibility, intelligence, and your pain may be in question. Be emotionally and mentally prepared for that.
Have a plan in place in case you get pushback from your doctor. If your doctor isn’t cooperating with you and your doula, have a back-up physician in mind. Your delivery and birth plan is not worth getting resistance about—your life and your baby’s life is on the line. If you find yourself fighting with your physician for things that are necessary for you, move on but also make sure you are adequately informed about the medical nuisances and hospital protocols to make sure your birth plan is feasible.
After Labor and Delivery
Make Sure At Least One Other Person Knows Your Birth Plan
If you’re giving birth at a hospital, your doctor may not be the one delivering your baby. Make sure at least one other person in your delivery room is very acquainted with your plan–maybe it’s your doula, significant other, or a family member. That way, if you’re unable to advocate for yourself if something doesn’t align with your birth plan, someone else can speak up on your behalf.
Be Vocal If Something Feels Wrong
By now, most of us have heard about Serena William’s delivery experience. The 23 Grand Slam title-holding tennis player said of the experience,
“I almost died after giving birth to my daughter, Olympia. Yet I consider myself fortunate.”
And this line is true of many other Black women each year. Serena has a history of blood clots, so when she felt shortness of breath right after giving birth, she got nervous. She told her nurse she wasn’t feeling well and wanted a CT scan and blood thinners to avoid a potential pulmonary embolism due to a blood clot. The nurse assumed Serena was confused because of the pain medication she was on and a doctor ordered an ultrasound of her legs instead.
After the ultrasound, the medical staff did a CT scan which showed several blood clots in her lungs. She was immediately treated with a heparin drip which saved her life.
Your biggest asset in the delivery room is your voice—if you suspect something is wrong, don’t relent. Keep speaking up until you get the care you need.
Get Postpartum Check-ups
Delivering a baby is a unique experience for every individual—it can range from blissful to traumatic. Regardless of your birth experience, you’ll need weeks and months of care. If this is your first baby, you may not know everything you’ll need to do after delivery. Work with your healthcare provider on your postpartum care needs.
You might have swelling in your legs and feet, feel constipated, have period-like cramping. You can also have milk leaking from your nipples, and your breasts might feel full and uncomfortable.
Your clinician will have important advice on how much rest and activity you should get and how to care for your body post-birth.
Lean On Your Community
Surround yourself with family and friends to support and love you during this transition into early motherhood. Being a mother is a rewarding, wonderful, and challenging role—you might suffer from postpartum depression as well as physical ailments. Make sure to have people around who can get you get the care you need. Please immediately report any symptoms such as chest pain, difficulty breathing, or suicidal thoughts.
If you’re the first woman in your circle to give birth, surround yourself with other Black mothers who can give you the emotional, mental, and spiritual care you need. You’ll have plenty of amazing days with your newborn, but you may also experience waves of sadness as your hormones come back to a normal pre-pregnancy level. It’s critical that you can get advice if you need it and can talk through any fears or insecurities you have. If you don’t know any other moms, join a support group within your community or church.
Come See Us
If you’re a pregnant, Black woman, know that you’re not alone. Your community is filled with women who’ve had an amazing birth experience, and others who can help you navigate tough circumstances. The Source is also here to make sure your needs and wants are met during your pregnancy. If you need to talk to someone about your pregnancy or create the kind of birth plan that works for you, come see us for a free appointment today.