Tag Archives: birth

Serena Williams — And Other Black Women — Face Terrifying Levels of Risk in Pregnancy

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Debbie says:

Last September, Serena Williams — and it is hard to imagine a healthier woman — gave birth to her daughter, Alexis Olympia Ohanian. The baby was fine, but Williams almost died.

In December, Nina Martin of Pro Publica and Renee Montagne of NPR released their terrifying article on black mothers’ risk of death in pregnancy and childbirth.

… a black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 243 percent more likely to die from pregnancy- or childbirth-related causes. In a national study of five medical complications that are common causes of maternal death and injury, black women were two to three times more likely to die than white women who had the same condition.

Martin and Montagne use the story of Shalon Irving, an educated, insured, supported black woman as the lead-in to their story. Irving died three weeks after her baby Soleil was born, from complications of high blood pressure.  Irving’s story is all too common:

In New York City, for example, black mothers are 12 times more likely to die than white mothers, according to the most recent data; in 2001-2005, their risk of death was seven times higher. Researchers say that widening gap reflects a dramatic improvement for white women but not for blacks.

The disproportionate toll on African-Americans is the main reason the U.S. maternal mortality rate is so much higher than that of other affluent countries. Black expectant and new mothers in the U.S. die at about the same rate as women in countries such as Mexico and Uzbekistan, the World Health Organization estimates.

What’s more, even relatively well-off black women like Shalon Irving die and nearly die at higher rates than whites. Again, New York City offers a startling example: A 2016 analysis of five years of data found that black, college-educated mothers who gave birth in local hospitals were more likely to suffer severe complications of pregnancy or childbirth than white women who never graduated from high school.

Sure, some of the numbers come from low-income mothers without access to good insurance, good doctors, or healthy food. And I have internalized Michael Twitty‘s insight that even for people with access to a generation, or two, or three, of healthy food, a century or more of a slave’s diet will still sit in their genes. But Martin and Montagne focus on the pure racism at the heart of this heartbreaking inequity:

 

In the more than 200 stories of African-American mothers that ProPublica and NPR have collected over the past year, the feeling of being devalued and disrespected by medical providers was a constant theme.

There was the new mother in Nebraska with a history of hypertension who couldn’t get her doctors to believe she was having a heart attack until she had another one. The young Florida mother-to-be whose breathing problems were blamed on obesity when in fact her lungs were filling with fluid and her heart was failing. The Arizona mother whose anesthesiologist assumed she smoked marijuana because of the way she did her hair. The Chicago-area businesswoman with a high-risk pregnancy who was so upset at her doctor’s attitude that she changed OB/GYNs in her seventh month, only to suffer a fatal postpartum stroke.

Her anesthesiologist assumed she smoked marijuana because of the way she did her hair. And, of course, because of the color of her skin. You can bet your last cent that a white woman who did her hair the same way wouldn’t have drawn the same assumptions.

Martin and Montagne go on to discuss the daily stress in the lives of successful black women, identifying it as a factor perhaps as important as medical racism. It seems to me that the two are so inextricably linked that discussing them separately does the otherwise brilliant story a disservice. Black women (and men) live with constant stress because of systemic racism, and that systemic racism is no less prevalent in the medical system than anywhere else. They then go back and fill in many details of Shalon Irving’s story, in detail that would be beautiful if it was a success story, but is crushing because we know Irving is dead.

Serena Williams, who could easily have been a mortality statistic five months before Irving became one, was both forceful and lucky:

The next day, while recovering in the hospital, Serena suddenly felt short of breath. Because of her history of blood clots, and because she was off her daily anticoagulant regimen due to the recent surgery, she immediately assumed she was having another pulmonary embolism. (Serena lives in fear of blood clots.) She walked out of the hospital room so her mother wouldn’t worry and told the nearest nurse, between gasps, that she needed a CT scan with contrast and IV heparin (a blood thinner) right away. The nurse thought her pain medicine might be making her confused. But Serena insisted, and soon enough a doctor was performing an ultrasound of her legs. “I was like, a Doppler? I told you, I need a CT scan and a heparin drip,” she remembers telling the team. The ultrasound revealed nothing, so they sent her for the CT, and sure enough, several small blood clots had settled in her lungs. Minutes later she was on the drip. “I was like, listen to Dr. Williams!”

How did she know that? Because she has a history of pulmonary embolisms, and knows what they feel like. She was right, and she had — and used — the power to make the doctors listen to her, or Alexis Olympia could be motherless, as Soleil Irving is.

Now, Williams is speaking out about black women’s risk in the United States and around the world. She gives her doctors a lot of credit, perhaps more than they deserve if the story above is true.  And then she issues a call to action:

According to UNICEF, each year, 2.6 million newborns die, tragically before their lives even really get started. Over 80% die from preventable causes. We know simple solutions exist, like access to midwives and functional health facilities, along with breastfeeding, skin-to-skin contact, clean water, basic drugs and good nutrition. Yet we are not doing our part. We are not rising to the challenge to help the women of the world. …

You can demand governments, businesses and health care providers do more to save these precious lives. You can donate to UNICEF and other organizations around the world working to make a difference for mothers and babies in need. In doing so, you become part of this narrative — making sure that one day, who you are or where you are from does not decide whether your baby gets to live or to die.

Together, we can make this change. Together, we can be the change.

It’s impossible to argue with Williams’ impassioned plea to save mothers and babies around the world … She’s using her prominence for good, and I applaud her wholeheartedly.

At the same time, having read Martin and Montagne’s article, I want us to save mothers and babies around the world and find ways to balance, minimize — or best, erase — the systemic racism killing black mothers right here in my country, my state, and my city.

Pregnancy: Policies, Policing, and Protection

Debbie says:

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In November, it seems lots of people in my feeds were writing about or linking to articles about pregnancy. Let’s start with the unalloyed good news, from Remy Tumin, writing at TakePart:

… many new moms in developing countries … suffer from postpartum hemorrhage, the leading cause of maternal mortality. Now the LifeWrap is making great strides in reversing the mortality rate in these countries.

Made of neoprene and Velcro, the wet-suit-like garment is cut into segments. The LifeWrap acts as a first-aid device to stabilize women like Aisha who don’t have access to resources to stop the bleeding immediately. The low technology keeps women alive while they travel to a hospital for surgery or wait for treatment.

To date, LifeWraps have been used on more than 10,000 women in 33 countries. According to the American Congress of Obstetricians and Gynecologists, a woman dies every four minutes from postpartum hemorrhage.

According to Tumin, the LifeWrap was developed by Suellen Miller, a nurse-midwife and a professor at the University of California San Francisco. Miller based the design on a garment developed by a female U.S. astronaut; earlier more complicated versions were used on soldiers in Vietnam.

In a recent study in the International Journal of Reproduction, Contraception, Obstetrics and Gynecology it was recommended that the garment be made available by governments and included in all health care centers as a management protocol for postpartum hemorrhage. LifeWrap is on internationally approved lists from the World Health Organization, International Organization of Obstetrics and Gynecologists, and the United Nations Commission on Life-Saving Commodities…

Miller and her team train clinicians around the world on how to use the garment and give presentations to departments of health and professional associations.

One of the most heartening trends in the world today is the continuing development of low-tech medical, communications, and other solutions that serve the poorest people on the globe, including this one.

***

The next piece of pregnancy news is also good, despite the qualifiers at the beginning of the article. Miriam Zoila Pérez at Our Bodies, Ourselves, writes about a movement to change the common U.S. policy requiring women to fast during labor.

The logic behind requiring women in labor to fast is thus: If the labor changed course, and a c-section was needed, a patient who had eaten recently was at risk of aspirating her own vomit if given general anesthesia.

It is a policy predicated on a lot of if/then scenarios, and applied incredibly widely (to pretty much everyone giving birth in a hospital setting) despite a relatively low risk and changes in practice. Most c-section anesthesia is provided in a similar fashion to an epidural (through a spinal block) and not through a mask over the nose and mouth, where the potential aspiration risk came in.

According to the article, in the eight years between 2005 and 2013 there was only one recorded U.S. case of aspiration related to labor, and the article doesn’t say whether or not the patient died. It certainly seems that the risk is vanishingly small.

Midwives and home birth advocates have been encouraging light meals during labor for years; “labor” is well-named, and doing heavy work while fasting is (in most circumstances) an unnecessary burden. The medical establishment in the U.S. is wending its slow, ponderous way toward making these changes, while miidwives have been encouraging their clients to eat light meals for years (and centuries).

***

Supermodel Christine Teigen posted an Instagram photo of her bowl of Fruity Pebbles cereal combined with Captain Crunch cereal. I can’t say I’d eat it, but I’m not a supermodel, I’m not newly pregnant, and I’m not Christine Teigen. Many commenters appreciated it, but some took her to task, and a Twitter-battle ensued. Tracy Moore at Jezebel has the story, and also misses the point.

Moore says:

There is apparently no sweet spot that immunizes any pregnant woman from this scrutiny, even when you are a health-conscious supermodel-type person who likely won’t gain much weight in the first place. It’s nearly impossible that she would not know exactly what is “good” and “bad” for the baby (as much as anyone can), given she has extraordinary access to resources that will ensure a perfect specimen to carry on the legacy of her extremely symmetrical genes.

Moore goes on to discuss uncertainties about fetal health, her own pregnancy story, and generally concludes

there was and always will be a complex negotiation going on between mother and child during gestation for resources, nutrition, and literal space in the body.

She suggests trust (that women are doing the best they can) and compassion for their struggle. Compassion is good and trust is valuable, but neither of them apply here. Teigen’s baby is not public property, and neither is her body. Whether or not she is doing her best, whether or not she knows what’s good, whether or not she even cares is her business. It’s arguably the baby’s father’s business (if there’s an involved father), and possibly the grandparents. You can make a case for it being the obstetrician’s business. You can stretch it to her close friends and family having an interest. But you and I, strangers on the Internet, journalists at Jezebel, bloggers at Body Impolitic, we don’t get to say one damned thing to Teigen about her choices, even if she posts them on the Internet. We get to back off and let her live her life, experience her pregnancy, have her baby, and eat whatever she wants to eat (and show us photographs of it if she feels like it). And we get to appreciate LifeWrap, and better options for women in labor.