Contributor: Fatmata Williams

I wrote this post for my blog “Fatmata’s Blog: Journeys and Perspectives”  in April 2018, and it is reassuring to see the attention that maternal mortality, including the disparity therein, has gained over the years. I decided to revise my post to share it with nursing colleagues broadly.

According to the World Health Organization, maternal death is when a woman dies from direct or indirect obstetrics causes during pregnancy, childbirth, or up to forty-two days after termination regardless of the pregnancy site. With advancements in medicine, medical and other technologies, we assume giving birth is “routine.” There is nothing routine about giving birth today, especially for Black, Indigenous, People of Color (BIPOC) women, and birthing people.

Approximately fourteen years ago, I lost my sister from postpartum complications, precisely one month after she gave birth to her first and only child. The circumstances surrounding her death mirror the ones described later in this post. It was déjà vu when I heard Shalon Irving’s story on public radio; her story reignited buried mistrust, so I researched the subject at the Centers for Disease Control and Prevention (CDC) website and what I found was sobering.

According to the CDC, the U.S. has a higher maternal death percentage than other developed countries. Black women in the U.S. are three times more likely to die during and after childbirth than their White and Hispanic counterparts.

The Shalon Irving story, which aired on Public Radio (All Things Considered –December 07, 2017) “Lost Mothers: Maternal Mortality in the U.S.”  Black Mothers Keep Dying After Giving Birth. Shalon Irving’s Story Explains Why details one Black mother’s fight for her life. According to this report, all Shalon’s accolades did not prevent her from becoming a part of this dire statistic. Shalon’s work at the CDC aimed to eliminate inequities and ensure better health outcomes for all. Isn’t it ironic that a woman with such an advantage, working for the agency that sets and dictates healthcare standards, died three weeks after giving birth to her baby from complications of high blood pressure? Granted, Shalon went into pregnancy with some chronic health conditions, the actual events surrounding her death are questionable. This young woman sought assistance from healthcare providers shortly after discharge; each time, she was evaluated and sent home with instructions to monitor her condition, follow up with a primary care provider, or seek emergency treatment if the condition worsens. Her final attempt to seek care received a similar response – tests were normal, so she was sent home with a high blood pressure medication script. She died on her way to the hospital from complications of high blood pressure.

Now juxtaposed with Serena Williams’ experience as written in the January 10, 2018 issue of VOGUE Magazine;  also, a very prominent Black woman, elite athlete, and millionaire, went into pregnancy with a known clotting disorder. One day after C-section, Serena started experiencing shortness of breath and suspected pulmonary embolisms due to not taking her blood thinner. Serena recounted getting out of bed and walking to the nurses’ station to request a C.T. scan and intravenous heparin; however, the nurse told Serena that the pain medication confused her. Despite the nurse’s dismissal, Serena insisted on a C.T. scan and IV heparin. Next thing, a doctor was performing a Doppler on her legs, but according to Serena, “I was like, a Doppler? I told you I need a C.T. scan and Heparin drip.” Worthy of mentioning, the Doppler was normal; however, the C.T. scan showed several small blood clots in Serena’s lungs, and she was immediately started on a heparin drip. Serena explained, “I was like, listen to Dr. Williams!” Thankfully, Serena lived to tell her story!

Finally, Patrisse Cullors (co-founder of Black Lives Matter and author) also described her birth experience in the February 01, 2018, issue of Essence magazine. Patrisse’s plan to have her baby with nurse-midwives fell through because of a necessary C-section. According to Patrisse, everything went downhill after arriving at the hospital. The surgeon did not explain the procedure or what to expect, and when she asked, the reply was, “what do you want to know?” After the surgery, Patrisse described gross undertreatment of her pain. Patrisse stated that she did not achieve adequate pain control for the entire duration of her hospital stay. Patrisse went home, only to return to the E.D. with respiratory symptoms and was diagnosed with pneumonia.

Without a doubt, Serena knew her risks, happened to be at the right place and time, recognized her symptoms quickly, and insisted on the kind of care she needed, notwithstanding dismissive attitudes from healthcare providers. Likewise, Shalon knew her risks, recognized her symptoms, and sought care at the right place and at the right time; however, she was dismissed by healthcare providers. Patrisse demanded the care she needed but was also rejected by healthcare providers.

Should Shalon have insisted and refused to leave on that fateful day when all the tests were normal, but she knew something was wrong? Should Patrisse have raised the roof of the hospital when she was being undertreated for pain? We hear only about those cases that pertain to the affluent, well-placed, or where the situation is so egregious that it can’t be ignored; what about the thousands of cases that go unnoticed? We cannot Monday morning quarterback these issues; we can learn, increase awareness, appreciate the nuances of being Black in America and become proactive in changing the culture.

I’d be remiss if I failed to mention that a lot has happened at federal, state, and local levels since I first wrote this piece in 2018. Federal laws support the expansion of postpartum coverage for women and birthing people from two to twelve months. Different states are implementing expanded postpartum coverage and providing prenatal and postpartum coverage to undocumented women and birthing people; The CDC launched a campaign to improve maternal health outcomes with an emphasis on women of color. There is also the official recognition of the Black Maternal Health Week from April 11 to 17 every year officially recognized by the Biden administration on April 13, 2021.

 Hospitals across the country are implementing patient safety bundles such as hypertension and hemorrhage bundles to improve safety and maternal and birth outcomes for women and birthing people. Some payers include doulas and breastfeeding supports in their value-based payment  reform models to remedy disparities and improve outcomes for women and birthing people. Most organizations have implemented implicit bias training to impact providers’ attitudes, especially toward BIPOC women and birthing people.

 Change begins with awareness; the more informed we are, the better we can advocate for ourselves and our loved ones. Black people, pregnant or not, must endeavor to learn about their risk factors and be their best healthcare advocates despite numerous existing barriers. Knowledge is power; if you know your body and are informed about your risks, you can partner in your health care and demand care that is right for you. Black women can and should be a part of the solution.

As nurses, we can play a pivotal role in empowering BIPOC women and birthing people to demand high-quality, empathetic, and safe care at all levels of the healthcare delivery system. We can achieve this by educating our patients about their risk factors and how to advocate for themselves. We can also advocate for our patients during vulnerable moments when they cannot do it for themselves. When I was going through my unpleasant birthing experience in 2005, my obstetrics nurse’s quick action and swift advocacy saved my baby and me. The swiftness of her movements, words, and subsequent action was aesthetic nursing. My nurse knew exactly what to do; it was admirable and automatic. It was an art! Even though the situation seemed dire, the nurse first and my O.B. second turned things around.

Nurses can also use personal knowing to relate to their patients. Our lived experiences can help us to understand why a BIPOC woman and a birthing person may seem hesitant or uneasy when they enter a hospital to deliver a baby (1 – (see https://doi.org/10.1177%2F08980101211072289). Our professional obligation is to help each patient in a way that meets their need. Finally, we can use emancipatory knowing to turn the tide on overall maternal mortality and morbidity, especially for BIPOC women and birthing people. We can use our collective voices to advocate for federal and state policies to address the issue. Representative Lauren Underwood (former nurse) introduced H.R. 959 – Black Maternal Health Momnibus Act of 2021 to improve maternal health, especially for racial minorities. As nurses, we should use our collective voices and power to foster change at the highest level.

Sources

    1. Graham MM. Navigating Professional and Personal Knowing Through Reflective Storytelling Amidst Covid-19. Journal of Holistic Nursing. January 2022. doi:10.1177/08980101211072289

About Fatmata Williams

Fatmata Williams is a registered nurse with twenty five years of nursing experience. She experienced a horrible birthing experience in 2005 and lost her sister in 2008, thirty days postpartum. Fatmata is passionate about reproductive health and is an ardent advocate for equitable maternal health policies.