Survival guide for women of color

dinah77, ADN · Dec 1, 2018

Okay, I'm gonna break down for you what to actually watch for and be concerned about:

1. Ask your OB if they are present at the hospital during the entire labor- if NOT, ask them how far away they are- most people don't realize that the docs are usually not present for the majority of labor, unless the mom is high risk and sick- the L&D nurses manage the vast majority of the labor- there is always at least one OB doc in the building that can be called for emergencies, but obviously it's not ideal to have someone that doesn't know your wife coming in at a moment's notice

2. Ask the doc or the nursing staff at the hospital ( I highly recommend going in for a tour) what the ratio is of RNs to laboring moms- if a patient is there for induction, a skilled RN can easily handle 2 of those patients at a time ( as that generally takes a loooong time, and there's a lot of down time, but they should never have more than one patient in active labor at a time- nor should they have more than one patient who is high risk at a time-

When you tour, look at the atmosphere of the nursing station and the RNs- do they all seem rushed and stressed? Is there a lot running around despite not many patients on the unit?

3. Ask the doc what happens if there is an emergency- what are the teams that show up look like? If there is need for an emergency c-section ( be clear on what parameters the OB sets for that are) this is what a safe team for mom and baby should look like:

Minimums: For mom: two OB docs- an anthestesiologist- one OB nurse- one OB scrub nurse, one surgical tech

For Baby: One neo natal nurse practitioner or MD, one NICU nurse, ideally two, for standby if baby seems to be in distress.

4. The most common causes of maternal death: embolism, preclampsia, hemorrhage,

Good postpartum/ L&D nurses can easily recognize these and get them treated quickly-

Embolism: Your wife suddenly becomes short of breath and anxious, and/or has a sharp unexplained pain in her back or side- call for a nurse immediately

Preclampsia: ASK YOU OB WHAT THEIR CRITERIA IS FOR DIAGNOSING THIS AND THEIR STANDARD PROTOCOL FOR TREATING THIS- some docs use old standards and do not treat it aggressively enough- elevated BP can occur up to six weeks post-delivery- also ask them if they are aware of what kind of training the RNs get to stay up to date on education for assessing it and intervening- I was in postpartum for almost 5 years, and we had yearly refresher trainings on how to care for a patient with high BP

In a young, healthy mom with no pre-existing BP issues, anything over 140/90 is considered high and should be at the very least monitored very closely, if not have meds started- if she starts to have BPs creeping up in combination with really bad headaches, blurred vision or bad sudden heartburn call a nurse immediately and make a fuss if they do not take it seriously

Hemorrhage: the vast majority of these occur immediately after delivery, or within 6 hours post delivery- you will be brought to your postpartum room somewhere around the 2- 4 hour mark

Hemorrhage is defined as a total loss of blood (don't worry about that too much) and, the things to watch for: soaking more than one pad in an hour OR, passing a clot the size of a golf ball or larger- heavy bleeding and some clots are normal to a point, but these are the standards for too much

IF SHE HEMORRHAGES: the nurse should be agressivley massaging her uterus ( goal is to kick that muscle back into gear and clamp down- if there is a hemorrhage, there may need to be a clot stuck in the uterus that is keeping it from clamping down as it should)

She should also be calling for help, because one RN cannot manage a hemorrhage-

If it's managed well, it's usually not a big deal- but it should be treated as an emergency even though most hemorrhages I've seen look fairly low key and not very dramatice

Your job should this occur is to support mom, but also to take care of baby- a nurse may even offer to take baby to a nursery, I recommend doing this if it's an option, but up to you

I would also recommend asking your OB ( or better yet a RN, hopefully the charge nurse at the hospital) what their team response looks like for any potential hemorrhage- the last place I worked at ( which I consider very high standard) used to have us run mock drills for any and all hemorrhages

Our response looked like this: The initial RN upon discovering the hemorrhage immediately calls the nurses station- the charge nurse comes down with a hemorrhage cart stocked with everything we needed to manage a hemorrhage ( any RNs not busy also come down at that time) - calls are also placed to lab staff, the OB ( or the nearest one) pharmacy, and the blood blank. Someone from all those places come to the room to expeidate any needs ( dosing of meds in an emergency situation, getting IV access if there isn't any, blood typing and screen if a transfusion is needed)

Hemorrhages are generally treated just fine in the patient's room , but depending on the hospital and protocols, she may be taken down to the operating rooms just in case and emergency procedure is needed

The most important thing if an emergency happens is to stay calm and stay out of the way- I know that sounds harsh, and is really hard for dads, but as you can see from the example I gave for a hemorrhage, there is a LOT of people in the room doing all they can to save mom, so they aren't trying to be jerks if they ask you to stand back

I have had two babies of my own in addition to being a RN, so I totally get the scariness and uncertainity-

**NICU Guy, BSN, RN** · Dec 2, 2018

Okay, I'm gonna break down for you what to actually watch for and be concerned about:
1. Ask your OB if they are present at the hospital during the entire labor- if NOT, ask them how far away they are- most people don't realize that the docs are usually not present for the majority of labor, unless the mom is high risk and sick- the L&D nurses manage the vast majority of the labor- there is always at least one OB doc in the building that can be called for emergencies, but obviously it's not ideal to have someone that doesn't know your wife coming in at a moment's notice
2. Ask the doc or the nursing staff at the hospital ( I highly recommend going in for a tour) what the ratio is of RNs to laboring moms- if a patient is there for induction, a skilled RN can easily handle 2 of those patients at a time ( as that generally takes a loooong time, and there's a lot of down time, but they should never have more than one patient in active labor at a time- nor should they have more than one patient who is high risk at a time-
When you tour, look at the atmosphere of the nursing station and the RNs- do they all seem rushed and stressed? Is there a lot running around despite not many patients on the unit?
3. Ask the doc what happens if there is an emergency- what are the teams that show up look like? If there is need for an emergency c-section ( be clear on what parameters the OB sets for that are) this is what a safe team for mom and baby should look like:
Minimums: For mom: two OB docs- an anthestesiologist- one OB nurse- one OB scrub nurse, one surgical tech
For Baby: One neo natal nurse practitioner or MD, one NICU nurse, ideally two, for standby if baby seems to be in distress.
4. The most common causes of maternal death: embolism, preclampsia, hemorrhage,
Good postpartum/ L&D nurses can easily recognize these and get them treated quickly-
Embolism: Your wife suddenly becomes short of breath and anxious, and/or has a sharp unexplained pain in her back or side- call for a nurse immediately
Preclampsia: ASK YOU OB WHAT THEIR CRITERIA IS FOR DIAGNOSING THIS AND THEIR STANDARD PROTOCOL FOR TREATING THIS- some docs use old standards and do not treat it aggressively enough- elevated BP can occur up to six weeks post-delivery- also ask them if they are aware of what kind of training the RNs get to stay up to date on education for assessing it and intervening- I was in postpartum for almost 5 years, and we had yearly refresher trainings on how to care for a patient with high BP
In a young, healthy mom with no pre-existing BP issues, anything over 140/90 is considered high and should be at the very least monitored very closely, if not have meds started- if she starts to have BPs creeping up in combination with really bad headaches, blurred vision or bad sudden heartburn call a nurse immediately and make a fuss if they do not take it seriously
Hemorrhage: the vast majority of these occur immediately after delivery, or within 6 hours post delivery- you will be brought to your postpartum room somewhere around the 2- 4 hour mark
Hemorrhage is defined as a total loss of blood (don't worry about that too much) and, the things to watch for: soaking more than one pad in an hour OR, passing a clot the size of a golf ball or larger- heavy bleeding and some clots are normal to a point, but these are the standards for too much
IF SHE HEMORRHAGES: the nurse should be agressivley massaging her uterus ( goal is to kick that muscle back into gear and clamp down- if there is a hemorrhage, there may need to be a clot stuck in the uterus that is keeping it from clamping down as it should)
She should also be calling for help, because one RN cannot manage a hemorrhage-
If it's managed well, it's usually not a big deal- but it should be treated as an emergency even though most hemorrhages I've seen look fairly low key and not very dramatice
Your job should this occur is to support mom, but also to take care of baby- a nurse may even offer to take baby to a nursery, I recommend doing this if it's an option, but up to you
I would also recommend asking your OB ( or better yet a RN, hopefully the charge nurse at the hospital) what their team response looks like for any potential hemorrhage- the last place I worked at ( which I consider very high standard) used to have us run mock drills for any and all hemorrhages
Our response looked like this: The initial RN upon discovering the hemorrhage immediately calls the nurses station- the charge nurse comes down with a hemorrhage cart stocked with everything we needed to manage a hemorrhage ( any RNs not busy also come down at that time) - calls are also placed to lab staff, the OB ( or the nearest one) pharmacy, and the blood blank. Someone from all those places come to the room to expeidate any needs ( dosing of meds in an emergency situation, getting IV access if there isn't any, blood typing and screen if a transfusion is needed)
Hemorrhages are generally treated just fine in the patient's room , but depending on the hospital and protocols, she may be taken down to the operating rooms just in case and emergency procedure is needed
The most important thing if an emergency happens is to stay calm and stay out of the way- I know that sounds harsh, and is really hard for dads, but as you can see from the example I gave for a hemorrhage, there is a LOT of people in the room doing all they can to save mom, so they aren't trying to be jerks if they ask you to stand back
I have had two babies of my own in addition to being a RN, so I totally get the scariness and uncertainity-

I am confused how this contributes to a higher death rate in WOC. These examples apply to all women in labor, not just WOC. Can you give examples of how they are treated differently?

Disclaimer: This is a post about empirically proven disparities that WOC, particularly black women experience while giving birth- these are verifiable facts, easily backed with stats and research-

I am not seeing the empirically proven disparities.

queenanneslace, ADN, MSN, APRN, CNM · Dec 2, 2018

Kira and her husband needed ALLIES - they needed a nurse, or an aide, a physician, or SOMEONE to give a damn and to advocate for her getting timely care. She died from medical negligence, exacerbated from being a black woman in a racist healthcare system. The system failed them. The lack of allies within that system failed them. The racism/privilege that allowed EVERYONE who came in contact with her to minimize her condition - "you're not a priority" - needs to be identified and counter-acted.

She was exhibiting abnormal signs for HOURS. HOURS.....

What were the nurses doing? Who was notified? Did chain of command get activated? Why was she allowed to languish like that for so long? Why did no one care enough to make sure she was cared for?

Black lives need to matter. That's what needs to change.

Black Lives Matter: Claiming a Space for Evidence-Based Outrage in Obstetrics and Gynecology

American Public Health Association (APHA) publications

**canoehead, BSN, RN** · Dec 3, 2018

Who is Kira?

Hoosier_RN, MSN · Dec 3, 2018

Thanks for the info, and for bringing this into our spotlight. I had been seeing a lot of headlines about maternal deaths, with no attributes specifically to WOC. I had read an article about Kira Johnson, it didn't mention race, but that is beside the point. Any pregnant woman should take this information to heart, because LIFE MATTERS, and every baby should be brought into this world as healthy as possible, with the healthiest mom possible. Thanks, dinah77, as a mom and a grandmother, I know about the birth of babies only from my personal view. As a nurse, I've never worked OB, L&D, etc, so other perspectives have never been presented to me. I appreciate the opportunity to learn. I know that racism and prejudice exist in this day and age, I just wish that healthcare providers were past that!

B52, ADN, BSN, MSN, RN · Dec 3, 2018

Racial and Ethnic Disparities in the Incidence of Severe Maternal Morbidity in the United States, 2012-2015

Read the story here in the Obstetrics and Gynecology journal: Racial and Ethnic Disparities in the Incidence of Severe Mat... : Obstetrics & Gynecology

B52, ADN, BSN, MSN, RN · Dec 3, 2018

NICU Guy, it's called implicit bias.

ThePsychWhisperer, BSN, MSN, APRN, NP · Dec 3, 2018

No doubt this was a very disturbing incident with a massive process failure which unfortunately resulted in the death of a young, healthy woman of color. While I am not arguing the point that racism still exists (as it indeed does), but is there any other possible reason for the general statistic of WOC being 243% more likely to experience a fatal event post-childbirth? Could it be related to WOC being more genetically likely to experience post-partum complications such as hemorrhage?

**LibraSunCNM, BSN, MSN, CNM** · Dec 3, 2018

No doubt this was a very disturbing incident with a massive process failure which unfortunately resulted in the death of a young, healthy woman of color. While I am not arguing the point that racism still exists (as it indeed does), but is there any other possible reason for the general statistic of WOC being 243% more likely to experience a fatal event post-childbirth? Could it be related to WOC being more genetically likely to experience post-partum complications such as hemorrhage?

Recent research is starting to suggest that the lived experience of being a WOC in this nation (due to institutionalized racism and its consequences like the cycle of poverty, lower levels of educational attainment, more psychosocial instability) creates enough chronic stress on the body that WOC's pregnancies are more susceptible to complications like preterm birth, hypertension, diabetes, etc. I would have to dig, but I read a fascinating NYT article about it sometime this summer. Even the microbiome of WOC is different and more susceptible to strains of bacteria that cause BV, which can lead to preterm birth. Interesting but depressing stuff.

Trauma Columnist · Dec 3, 2018

Here is a recent article I authored regarding the increase in maternal deaths:

R ecent Increase in Maternal Deaths

Trauma Columnist · Dec 3, 2018

Disclaimer: This is a post about empirically proven disparities that WOC, particularly black women experience while giving birth- these are verifiable facts, easily backed with stats and research- if you are an individual who chooses to deny reality and wants to quibble about this VERY REAL PROBLEM, move along- nonsense responses denying this issue, or worse yet racism in medical care will NOT be tolerated
Hello all- after seeing yet more dismal stats about how much more likely WOC die during childbirth (yes, in hospitals under the care of RNs and docs or CNMs, not home births) I've been inspired to put together a list of things for women, their partners and families to be aware of-
I'll post what I have thus far, and was hoping to get more suggestions from y'all and eventually edit it down into a smaller, more layperson friendly read
*for a reference point, look at this story about Kira Johnson- this is a woman who was in great health, at Cedars-Sinai for a scheduled c-section, began to hemorrhage, and bled out over 10 hours while the staff waited on a CT scan????? what in the world?
NowThis Politics - Black Women Die from Pregnancy and Childbirth Complications At Alarming Rates | Facebook[0]=68.ARDWgw93pmwsjrHYBjGg_iqV3hGD41nUkYHjPRBfKpPmy3sVZAzyCDAIXF_uky1jddQ8IHXzPIYwFkEqtsjhtaUrY2PDOpv0YS8rAy7wTAgVIwCjhRQW3ILaHpZNS2ooWcYRzduPt-rjhMmwLlaKPUaOAgoWShaQtW5zdOZCJAyqYwcS4xEf6xdSJtqFpmIr0mzfEajuipl1yuwmaw6DkaH0OxK0KDS6ORtly_s7YMlJhJgXCVp6nkC3Nt0FZWb8eDA8OCIm3M3ooAG6qb_VpdHXjvFd6Ha1nneaop8sF51hlZ_SvCfwExbV-IUtOi_L-OiETwEETSbRqAQ95IuuunCUFns_6vE

Would like a citation for this data that the politicians are stating in this YouTube video. This is, in reality an ad for the ACA. Can you cite the source of this data?