Women’s Health: The conversation we need to have

Veronica Haywood, New Leaders Council San Antonio

Every week I read a story of families devastated by loss of a new mother birthing her child. The dialogue around rising maternal mortality rates has been ignored and now become a public-health crisis for our nation. I have been a Texas Registered Nurse for the last 5 years and am now studying to be a Women’s Health Nurse Practitioner, yet I am still lost trying to understand what is happening to women during childbirth.

What is the cause of this rising mortality rate? 
Why is it affecting Black women the most in Texas?

I worry about these questions. Sometimes, I am asked, being a birth worker, do I have a child? I usually reply, slyly, in due time, but lately the quiet crisis of maternal mortality rising has me in fear. The Division of Reproductive Health at the Centers for Disease Control and Prevention stated every year, around seven hundred women die as a result of pregnancy in the United States.[1] We live in the United States of America where women are more likely to die of pregnancy related causes than in 31 other industrialized countries. Think about that.

The reality is we need to talk about this and be okay with discussing the fact that as medical professionals we have not been taking this as serious as we should have and women are dying as result. Even worse we are ignoring that implicit racial bias within women’s health care are so entrenched and debilitating that we are now losing lives because of it.

Ashley Green, age 31, is a prime example of the challenge of pregnancy and maternal mortality risk. Her near death postpartum experience followed her daughter’s birth in May 7, 2015. “It took me a long time to fully digest all that happened to me and to be able to speak about how traumatic of an experience it was,” said Green, a Texas Registered Nurse and Lactation Consultant. She recalled that during her birth experience with her second daughter she recognized symptoms of postpartum eclampsia before her doctor acknowledged there was problem.

In Ms. Green’s own words:

“The next day following discharge home I was unable to use my breastfeeding pillow due to intense abdominal pain. I visited my Ob/Gyn and was prescribed antibiotic for possible uterine infection and sent home. The next day I woke up with an intense headache that continued to worsen over time along with a feeling of shortness of breath. I went to the ER and was told my blood pressure was high, but it was probably postpartum anxiety. I was sent home and told to relax. Over the next day my symptoms were worsening, and I returned to the emergency room. At this point I was begging for someone to listen to me. Lab test were ran and I was told that I had an enlarged heart and high blood pressure which was stroke level at this time, but again I was sent home and told to follow up with a cardiologist. I followed up right away with a cardiologist and was diagnosed with postpartum eclampsia which was causing myocardial heart failure and fluid overload. I was started on Lasix and high blood pressure medications among other things to stabilize my symptoms. I lost 30lbs of fluid in one week and was able to breath better within a couple of days. I was encouraged to not have anymore children, as my postpartum experience was life threatening. I literally feared that if no one would listen to me and believe my symptoms I would die.”

Maternal Mortality is defined as the number of deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 births. A 2016 joint report by the Texas Department of State Health Services’ Maternal Mortality and Morbidity Task Force found that black mothers accounted for 11.4% of Texas births in 2011 and 2012, but 28.8% of pregnancy-related deaths[2].

As a black woman, we are often told that you need to be strong and allow no one to see your weakness. You are the backbone of your family and troubles in your life should never be burdened to others. Why? When is it time to speak up? Are women to suffer alone in silence?

Maternal Mortality ranges from a low of 5.8 in Massachusetts to a high of 39.3 in Georgia. Texas maternal mortality rates are 31.5 per 100,000 live births as of 2016 according to America’s Health Rankings. By comparison, the maternal mortality rate in Japan was 5 per 100,000 live births and Poland 3 according to UNICEF’s 2015 data[3]. Although Texas has the worst maternal mortality rate in the nation, other states are struggling as well.

In response to this concerning trend, the California Department of Public Health: Maternal, Child and Adolescent Health Division launched the California Pregnancy-Associated Mortality Review (CA-PAMR) project to identify pregnancy-related deaths, causation and contributing factors, and then make recommendations on quality improvements to maternity care. Since 2006, California has seen maternal mortality decline by 55 percent between 2006 to 2013, from 16.9 deaths per 100,000 live births to 7.3 deaths per 100,000 live births[4].

A healthy pregnancy begins before conception. Women should be assessed for existing health risks to prevent future health problems. These health risks may include: hypertension and heart disease, diabetes, depression, intimate partner violence, genetic conditions, sexually transmitted diseases (STDs), tobacco, alcohol,substance use, inadequate nutrition, and unhealthy weight. The risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to quality care before pregnancy, during pregnancy, and between pregnancies. As a nation we have a ways to go but there are strides in the right direction with Representative Jaime Herrera Beutler (R-WA-3) introducing H.R. 1318, the Preventing Maternal Deaths Act and Senator Heidi Heitkamp (D-SD) introducing the identical companion bill S. 1112, the Maternal Health Accountability Act. H.R. 1318 would require CDC to give grants to every state to create a maternal mortality review board. The boards would review every maternal death to find out what went wrong and come up with training and other ways to lower the mortality rate. Texas like many other states have maternal mortality review boards already, but don’t have the money they need to be effective.

We need to commit to these measures. Think back to Ms. Green, and her experience with postpartum eclampsia. Now, two years later, Green states she still questions the care she received:

“I still question and wonder was I overlooked for some reason. Being a biracial woman and not ‘looking black,’ was I labeled prematurely as an anxious mom, rather than listened to and properly assessed early. What if I had not been a Registered Nurse, where would I be now? Maternal mortality among Black women needs to be addressed, researched heavily, and advocated for. We need to bring awareness to this issue, if not for any other reason than to save a life. ”

If we are serious about securing our future, we need to listen to our mothers. What’s happening in this country with rising maternal mortality deaths is nothing short of a public-health crisis that can’t be ignored. We must dismiss that maternal health inequalities are only related to socioeconomic status and look further at cultural factors, including culturally competent care from health professionals, attitudes, stress, racial disempowerment and implicit bias within women’s health. If there’s a national conversation to be had about improving women’s health care, let it be about the rising maternal mortality.

Veronica writes a column for The New Leader entitled Keeping Her Safe. Check out all of her articles here.

Veronica Haywood is a registered nurse,lactation consultant, women’s health nurse practitioner student, and co-founder of her nonprofit Latched Support. She is also a member of the New Leaders Council-San Antonio Executive Board, a 2017 NLC San Antonio fellow, and a NLC Life Entrepreneurship trainer. She can be reached at veronicahaywood@gmail.com.

[1] “Reproductive Health.” Centers for Disease Control and Prevention. October 27, 2017. Accessed November 10, 2017. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm.

[2] “Maternal Mortality and Morbidity Task Force and Department of State Health Services Joint Biennial Report.” Department of State Health Services. July 2016. Accessed November 10,2017. https://www.dshs.texas.gov/mch/pdf/2016BiennialReport.pdf

[3] Bongaarts, John. 2016. “WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division Trends in Maternal Mortality: 1990 to 2015 Geneva: World Health Organization, 2015.” Population And Development Review no. 4: 726. Expanded Academic ASAP, EBSCOhost (accessed November 19, 2017).

[4] “CA-PAMR (Maternal Mortality Review).” Cmqcc.org, www.cmqcc.org/research/ca-pamr-maternal-mortality-review.