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
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)
While I acknowledge the disparity between the races, the biggest risk factors are HTN, Obesity, Heart Disease which are all pre-existing conditions regardless of race. These issues need to be dealt with before pregnancy. How can this disparity be caused exclusively by racist hospital, nurses and doctors? Shouldn't the patients take responsibility for their own health prior to getting pregnant?
Your second post talks exclusively about what to look for when you get to the hospital in labor. Why not talk about maintaining a healthy weight, getting their HTN under control, and ways to prevent heart disease prior to getting pregnant?
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.
While I acknowledge the disparity between the races, the biggest risk factors are HTN, Obesity, Heart Disease which are all pre-existing conditions regardless of race. These issues need to be dealt with before pregnancy. How can this disparity be caused exclusively by racist hospital, nurses and doctors? Shouldn't the patients take responsibility for their own health prior to getting pregnant?
Your second post talks exclusively about what to look for when you get to the hospital in labor. Why not talk about maintaining a healthy weight, getting their HTN under control, and ways to prevent heart disease prior to getting pregnant?
The best thing our nation can do for people of all colors is bring back home economics classes into the schools. Teach nutrition and cooking from scratch, using healthy ingredients. Ban soda pop and candy vending machines. Offer lots of recess and physical education time with structured activities and sports that include everyone.
We have an unhealthy population, especially lower income people, who often rely on junk food instead of cooking their own food. You can have a balanced diet on a low income, I've done it, but you can't waste limited resources on hot Cheetos and soda pop.
Prevention is key. I was a big supporter of Michelle Obama's campaign for healthy living, I'd like to see her continue it.
The best thing our nation can do for people of all colors is bring back home economics classes into the schools. Teach nutrition and cooking from scratch, using healthy ingredients. Ban soda pop and candy vending machines. Offer lots of recess and physical education time with structured activities and sports that include everyone.
We have an unhealthy population, especially lower income people, who often rely on junk food instead of cooking their own food. You can have a balanced diet on a low income, I've done it, but you can't waste limited resources on hot Cheetos and soda pop.
Prevention is key. I was a big supporter of Michelle Obama's campaign for healthy living, I'd like to see her continue it.
We do have massive systemic problems in our society with regard to access to healthcare for those who need it most, especially if they are people of color. The article that Swellz linked to earlier has some fascinating epigenetic discussions about this topic that have been echoed by other authors.
I work with this visible disparity every day. I float between two physical locations and the patient population is starkly different. We never seem to be backordered or out of supplies at one of those locations...
But seriously, we need to start ensuring easy access to preconception and prenatal care for all women as it's an important investment in their life and their children's lives. There is also substantial evidence that keeping people UNpregnant until they plan to be (investing in free/easily affordable birth control) has a serious return on investment (something like $7 for every $1 spent...I'll find the source).
Also, if a patient tells you something is wrong...listen. Doctors didn't listen to Serena Williams and she had very serious complications.
This isn't going to change overnight and it seems like only lately is this discussion becoming higher priority, particularly as the demographics of the country shift. I'm happy for it as my whole career is focused on lessening the disparities.
Agree with previous posters, I don't really see how any of this information posted by OP specifically applies to women of color. I think all moms should be educated on the dangers of postpartum hemorrhage, hypertension, embolism, etc.
I just don't understand why so many moms who experience these life-threatening complications don't get the monitoring and treatment that could head off tragedy. I have cared for moms several times who didn't get the care/monitoring they needed on the postpartum floor and ended up in the ICU after delivery. I don't want to get into specifics of those stories, but how the moms got from point A to the ICU makes my head spin. Hours and hours of people ignoring really crystal clear signs that something was going wrong. It's like no one ever taught the staff how to track and trend vitals, labs, patient complaints, and put the clinical picture together. Truly mind-blowing.
While I acknowledge the disparity between the races, the biggest risk factors are HTN, Obesity, Heart Disease which are all pre-existing conditions regardless of race. These issues need to be dealt with before pregnancy. How can this disparity be caused exclusively by racist hospital, nurses and doctors? Shouldn't the patients take responsibility for their own health prior to getting pregnant?
Your second post talks exclusively about what to look for when you get to the hospital in labor. Why not talk about maintaining a healthy weight, getting their HTN under control, and ways to prevent heart disease prior to getting pregnant?
Please research the unnatural causes documentary circa 2008. There are two researchers (David and Collims) who studied maternal-infant mortality rate and stress, comparing African Americans to Africans in the continent of Africa and found "startling" data that showed African Americans were more likely to face maternal and infant mortality than Africans. Moreso, stress levels were greater in African Americans than Africans. Africans who immigrated to the states showed similar levels of stress hormones and had similar odds to black Americans than Africans.
So in sum, their data demonstrated that stress, not genetics, showed a greater likelihood tof maternal/infant complications than ones genetics.
It boggles my mind how people "choose" not to see the obvious. You cannot come from a generation of social and psychological stress from systemic racist practices, laws, and institutions, and not come out of it unscathed. It's not possible. In regards to putting the blame on those who have HTN, eat bad foods etc. Sure some of the responsibility lies on the individual, but what if you live in a food dessert? Have you been to some of the hoods with the highest concentration of chronic illnesses. Liquor stores are the only "grocery stores" in the block. City planners flat out refuse to invest. No jobs for people to buy expensive produce. No reliable transportation to go to the next town to purchase real groceries. You know what all of this causes....STRESS! You know what happens with years of generational stress...HTN, CKD, etc....and the cycle continues.
As healthcare providers, you don't have the excuse to be ignorant. All it takes is to open your eyes and SEE!
"Could it be related to WOC being more genetically likely to experience post-partum complications such as hemorrhage? "
I'm not saying this to be inflammatory, just information. Please consider how the idea that people of certain races or ethnicities are ***just more likely to have complications and/or to die*** might be racist in itself.
I've really been thinking about these suggestions - and they are all sound and good. I think we also need to include a primer for people who work in healthcare who want to address the racial disparities in outcomes. Yes, it is important for WOC to be prepared ---but shouldn't we also hold the people working in these institutions accountable for the outcomes produced in them.
Here are some of the questions I came up with after thinking about it (and this is always a work in progress ):
1) ASK: "What are the racial disparities in your institution regarding neonatal and maternal mortality and morbidity? What is your institution doing to address these disparities?"
Ask: "How does your institution respond to patients advocating for themselves?" "Is there a preferential treatment or a different response for white patients who advocate for themselves vs non-white patients?"
Ask: "How does your institution ensure that security calls made by staff are not made inordinately for patients or family or visitors who are people of color?"
Ask: "Does your institution require cultural competency training? What does that training consist of? Who teaches it? Is the instructor a person of color or people from ethnic or racial backgrounds who are served by your institution?"
AsK: "If your institution serves patients from backgrounds with known higher risk for injury or death during pregnancy or birth, what protocols are being implemented, specifically, to address these risks, and to reduce the disparities?"
I think the answers to these questions will reveal pretty quickly if POC's lives are valued in that institution.
And I wish I could say I've ever worked in an institution that was addressing racial and ethnic and socioeconomic health outcome disparities in this manner. This is work for me to do - to advocate for this. Our patients deserve this.
"Could it be related to WOC being more genetically likely to experience post-partum complications such as hemorrhage? "
I'm not saying this to be inflammatory, just information. Please consider how the idea that people of certain races or ethnicities are ***just more likely to have complications and/or to die*** might be racist in itself.
This is the water we're all swimming in.
Exactly what water is that? My comment was in no way meant to be snarky if that's how it was taken. I was speaking as to a biological reason such as a clotting disorder that would make women of color to be more susceptible to hemorrhage after birth. I said this in the same vein as Tay-Sachs would be related to the Eastern Jewish population, or Sickle Cell Anemia is generally associated with the African-American population. Nowhere did I say that certain ethnicities are just more likely to die, and that's the way it is. I don't really appreciate my words being twisted into something that makes me sound like a racist bigot.
Please research the unnatural causes documentary circa 2008. There are two researchers (David and Collims) who studied maternal-infant mortality rate and stress, comparing African Americans to Africans in the continent of Africa and found "startling" data that showed African Americans were more likely to face maternal and infant mortality than Africans. Moreso, stress levels were greater in African Americans than Africans. Africans who immigrated to the states showed similar levels of stress hormones and had similar odds to black Americans than Africans.
So in sum, their data demonstrated that stress, not genetics, showed a greater likelihood tof maternal/infant complications than ones genetics.
It boggles my mind how people "choose" not to see the obvious. You cannot come from a generation of social and psychological stress from systemic racist practices, laws, and institutions, and not come out of it unscathed. It's not possible. In regards to putting the blame on those who have HTN, eat bad foods etc. Sure some of the responsibility lies on the individual, but what if you live in a food dessert? Have you been to some of the hoods with the highest concentration of chronic illnesses. Liquor stores are the only "grocery stores" in the block. City planners flat out refuse to invest. No jobs for people to buy expensive produce. No reliable transportation to go to the next town to purchase real groceries. You know what all of this causes....STRESS! You know what happens with years of generational stress...HTN, CKD, etc....and the cycle continues.
As healthcare providers, you don't have the excuse to be ignorant. All it takes is to open your eyes and SEE!
Now the narrative has been changed from WOC being discriminated at the hospital (from the OP's first 2 posts) to socio-economic status. Yes, the poor neighborhoods are dominated by WOC, but the same applies to poor white and hispanic women living in those same conditions. The title of the thread should be "Survival Guide for Poor Women".
Now the narrative has been changed from WOC being discriminated at the hospital (from the OP's first 2 posts) to socio-economic status. Yes, the poor neighborhoods are dominated by WOC, but the same applies to poor white and hispanic women living in those same conditions. The title of the thread should be "Survival Guide for Poor Women".
Although what you said is not wrong, this IS a WOC problem. Education and social economic status have been included in these studies. An African American mother with an advanced college degree is still more likely to die or her infant die, than a white woman with an 8th grade education. The US has one of the highest maternal and infant mortality rate of developed countries and black women and babies are affected more than any other racial group.
NICU Guy, BSN, RN
4,161 Posts
While I acknowledge the disparity between the races, the biggest risk factors are HTN, Obesity, Heart Disease which are all pre-existing conditions regardless of race. These issues need to be dealt with before pregnancy. How can this disparity be caused exclusively by racist hospital, nurses and doctors? Shouldn't the patients take responsibility for their own health prior to getting pregnant?
Your second post talks exclusively about what to look for when you get to the hospital in labor. Why not talk about maintaining a healthy weight, getting their HTN under control, and ways to prevent heart disease prior to getting pregnant?