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This article was written by Wendy Post, DNP, MSN, RN.
New research helps shed light on how racism influences fatal and near-death birthing experiences in five inner-city hospitals.
I’ll never forget the first time I was present when a mother died during delivery. As a young nurse, I held her hand as she took her last breath, and moments later, I explained to her family that their daughter had died. This African American patient was only a few years older than me, and she will remain with me forever.
I now understand that her story is tragically familiar. In 2021, nearly 1,200 women died due to complications from pregnancy in the U.S. The problem is even worse for women of color. According to a 2020 study by The Commonwealth Fund, more than twice as many Black women died during pregnancy and delivery than white women in the U.S.
Studies have shown that as many as 80% of U.S. pregnancy-related deaths are preventable with appropriate care delivered promptly.
In particular, severe maternal morbidity (SMM)—unexpected outcomes from pregnancy and delivery that result in significant consequences to a woman’s health, such as hemorrhage, heart failure, or aneurysm—can be decreased by more than one-third by reforming substandard care such as delay or failure to recognize high risk or an inappropriate diagnosis.
The statistics are stark, yet the narratives of women, especially Black women, who experience life-threatening morbidity, are largely missing from the literature on the subject. I set out to speak with women who could help me understand their experience, what role racism may have played in their outcomes — and how we can spare more families the heartache of losing mothers to childbirth.
Listening to and acting on Black birthing stories.
I conducted a qualitative research study by seeking interviews with Black women aged 18-40 who experienced SMM at hospitals in the five zip codes with the highest maternal mortality rates in the country. These are Washington, DC; Georgia; Indiana; Louisiana; and New Jersey. The goal of the research study was to better understand the lived experiences of these women and how it relates to the serious medical events they incurred.
Twelve Black women agreed to share their stories, along with surviving family members of two women who died during childbirth. Among the patients I spoke with, 66% identified as African American, 66% were married, and 83% had completed graduate-level education—statistics that put to rest assumptions that discrepancies in outcomes result from socioeconomic factors.
These women experienced SMM such as:
- Heart attack
- Pelvic nerve injuries
- Postpartum hemorrhage
- Pulmonary embolism
- Uterine infection
- Uterine rupture
While their stories are moving, meaningful, and tragic, they are also highly informative and can help us improve care for future mothers. Each represents the lived experiences of a person and a family whose life was forever altered—and each serves as a formidable reminder that providers must listen. A primary outcome of this research was that providers must respond to the patient’s needs and always avoid making assumptions about the patient or treatment, which our biases could influence.
Following are a few examples of the narratives this research collected:
- “Before police wore body cameras, their story was THE story…A doctor or nurse is no different. The exception, though, is doctors and nurses are not wearing body cameras.”
- “My cousin delivered in federal custody chained to her hospital bed - and she had a better outcome than I did.”
- “While this is very painful, I have moments where I cry and don’t cry. I’m also angry; I am very, very, very angry.”
Next steps toward health equity.
Stories like these remind us there is much work to be done in our healthcare system and society if we are to reconcile historical medical trauma. Experiences like The Tuskegee Study, Henrietta Lacks, and the Relf Sisters have shaped generational distrust between Black people and medical and research communities.
I hope that gathering these narratives will take us closer to building true equity in our healthcare system.
This research has been submitted for publication in the Journal of the American College of Obstetrics and Gynecology. I hope this phenomenological study and these stories will reach and move health systems administrators and providers to take action and help reverse the steady rise in maternal morbidity and mortality, particularly among Black women.
Further comprehensive research and detailed longitudinal studies of women’s health are necessary so we can understand how their experiences and symptoms impact outcomes. We must undertake this work so more birthing experiences can end in joy instead of preventable tragedy.