Closing the Color Divide in Maternal Mortality Rates

As an aspiring black father, I would have no idea what to do if my wife hypothetically wailed out, “I think my water broke!” We’ve discussed the proposition of having children, how many we want, and how many girls or boys. Together we’ve mulled over what they could look like before they pull from our DNA to manifest as creation, but separately my mind filled with questions. Do I call the ambulance? Do I drive my wife to the hospital instead? Does it matter where I take her? Can she safely have the baby at home? Could she die? Could my baby die?

It sounded a little dramatic until I went down the Google-rabbit hole. Black women are on average three to four times more likely to die while giving birth, also known as maternal mortality, than white women. Black women are also two times more likely to experience infant mortality than white women.

Tennis superstar Serena Williams came dangerously close to losing her life after giving birth to her baby girl, Olympia, while suffering from a pulmonary embolism. One of the biggest takeaways from Serena’s incident was that this maternal mortality phenomenon manifested itself independently of socioeconomic status among black women and the numbers prove it.

Across the board, when observing within each ethnic group, mothers with less education appeared to suffer higher rates of complications than college-educated mothers. But a 2016 study assessing data from 2008-2012 that was associated with severe complications during delivery in New York, found that black college-educated mothers who gave birth in their local hospitals were more likely to suffer severe complications of pregnancy or childbirth than women of any other race who never graduated from high school. 

I reside in Georgia, and “The Peach State” has consistently had one of the highest pregnancy-related maternal mortality rates in the United States, and 52 percent of pregnancy-related deaths in Georgia occurred less than 42 days after pregnancy. According to the Center for Disease Control, maternal mortality rates are at a steady rise since 1986.

Now at first glance, these statistics sound quite grim and alarming, but upon digging into the raw numbers from a 2014 study by CDC, we are talking about roughly 12 white maternal deaths versus 40 black maternal deaths per 100,000 live births. Percentage-wise these national figures constitute an extremely low number of deliveries, however, we cannot minimize the significance of each life that is lost. Advisory boards like the Maternal Mortality Review Committee (MMRC) for the state of Georgia have taken charge to change the disparities in pregnancy outcomes.

Organized in 2010 by Grady Memorial Hospital’s OB/GYN Dr. Michael Lindsay, MMRC provides health care to those who are most disadvantaged and unable to access adequate health care and spreads knowledge about best care practices for both the patient and the doctor.

Dr. Michael Lindsay, MD
Obstetrician-Gynecologist

“Only about 50% of states in the U.S. even have an advisory committee,” Dr. Lindsay said. He explained that without that entity in place, it would be nearly impossible to observe the prevalence of maternal mortality, much less to parse through the data to highlight disparities or short-comings in the system. “Our board is composed of about 30 medical professionals of different backgrounds, from physicians to epidemiologists. We meet quarterly and divide up our meetings between 2 locations [Atlanta and Macon] so that we meet at each site twice a year.” 

It is at those meetings that they sift through the deluge of data one year at a time, as well as formulate universal protocols that are intended to provide a consistent, high level of quality care for mothers. This allows for an informed and structured response to different scenarios in the delivery room, which help deliver the best outcomes.

With over 34 years of delivery experience, Dr. Lindsay is aware of the demographic disparities in delivery outcomes and is involved with investigative studies and comprehensive reviews that aim to outline some of the reasons for these outcomes. 

For instance, one such study pertaining to pregnancy-related maternal mortality, found that the most common contributors to death in Georgia were cardiovascular disease and hemorrhaging. According to a related review that Dr. Lindsay was involved with, hypertension, embolisms, and seizures also rounded out the top 5 causes of death related to pregnancy in Georgia, for black women. 

According to Dr. Lindsay, another risk factor is preeclampsia, an elevated and life-threatening level of hypertension that manifests itself after about the 20th week of pregnancy. This complication arises 60 percent more in black women and on average at an earlier stage of pregnancy than white women. 

When we look at the statistics from 2014, the rate of preeclampsia/eclampsia was roughly 70 occurrences in every 1,000 deliveries for black women in the U.S. compared to approximately 43 in 1,000 for white women, and 47 in 1,000 for women in the U.S. overall. 

Of the many theories as to why black women seem predisposed to preeclampsia, one in particular stands out — a genetic variant of a marker called APOL1. Black women, not just in the U.S. but all over the diaspora, and in Sub-Saharan Africa, almost certainly express this particular genetic variant of APOL1 (there are many iterations of this gene) due to ancient evolutionary pressures that a common ancestor experienced. 

Based on another publication that Dr. Lindsay was involved in, he and his team found that mothers with a high body mass index (more than or equal to 35kg/m2) and a low fetal fraction (less than 4 percent) were at a higher risk of experiencing an adverse outcome to pregnancy. The study also showed that minimally invasive techniques can help predict delivery outcomes and assist in preparing medical professionals for the possible downstream health consequences which may manifest in their patients.

With the help of Dr. Lindsay’s expertise and my own informational digging, here are some ways you can counteract the disparaging reality of these statistics:

  1. Get a physical! Be sure to get a check-up to provide yourself with the most up-to-date snapshot of your physical health.
  2. Know your medical history, as well as your family’s medical history. Pregnancy is the ultimate stress test for a woman’s body and you need to know your strengths and weaknesses, for the benefit of you and everyone involved with your medical care.
  3. Visit some of your local hospitals. Familiarize yourself with their medical staff that would be responsible for taking care of you during your delivery. Pregnant mothers can opt to be transported personally to any hospital they desire, but if first-responders are called, they will more than likely only take you to the nearest immediate hospital, instead. While exploring prospective hospitals, ask yourself: Does the medical staff make you feel comfortable? Do you feel like they listen to you? “All it really takes is a simple visit and a few questions,” Dr. Lindsay said. “If they’re doing more talking than listening, that’s a red flag right there. If I look back 30 years and compare the physician I am now to the physician I was back then, I’d say over the course of time I’ve understood the importance of listening. No one knows your body like you know your body, so if you tell me what you’re feeling, then to do my best job I have to listen and act on what I’ve heard.” Comfort and trust in your medical care, along with satisfactory communication are crucial in optimizing your experience and your subsequent outcome. 
  4. Weigh the pros and cons. Don’t feel completely relegated to hospital birth, as home births by certified and licensed personnel are also a very safe and viable option. However, with any decision, be sure to investigate the pros and cons and weigh the considerations and responsibilities that come with delivering at home, as unique circumstances may make having a home birth a less favorable option. 
  5. Find an awesome doula or midwife. They guide and support you through the delivery process. 
  6. Follow a healthy diet or lifestyle. It is highly recommended that you prepare your body for this demanding event that will last nearly a year, so equipping your body the best you can will aid in making the pregnancy and delivery process as as smooth as possible for you and your baby.

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