Black Babies Are Dying, And So Are Their Moms … What Can We Do About It?

The recent edition of The New York Times Magazine, the article “Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis” written by Linda Villarosa called out a disturbing and unnecessary truth: the discrepancy in death rates for black babies and mothers is not genetic or biological, instead it “has everything to do with the lived experience of being a black woman in America”.

There is perhaps no better day to draw more attention to this issue than Mother’s Day, a day created to celebrate mothers and their babies.

Here are the sobering facts written by Villarosa:

—Between 1915 and the 1990s, “amid vast improvements in hygiene, nutrition, living conditions and health care, the number of babies of all races who died in the first year of life dropped by over 90 percent — a decrease unparalleled by reductions in other causes of death. But that national decline in infant mortality has since slowed. In 1960, the United States was ranked 12th among developed countries in infant mortality. Since then, the rate is largely driven by the deaths of black babies.”

—The United States now ranks 32nd out of the 35 wealthiest nations in infant mortalities (most are black babies).

—Black infants in America are now more than twice as likely to die as white infants.

— 11.3 per 1,000 black babies, compared with 4.9 per 1,000 white babies, according to the most recent government data — a racial disparity that is actually wider than in 1850.

— Black women are up to four times more likely to die from pregnancy-related causes as their white counterparts.

It’s not just access to quality healthcare, it’s the ability/willingness of the healthcare professionals to treat every woman, whether black, white, Hispanic or otherwise the best possible way, in other words, to optimize care and to offer standardized care for all patients irrespective of race, ethnicity, or insurance status.

“Recently there has been growing acceptance of what has largely been, for the medical establishment, a shocking idea: For black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions — including hypertension and pre-eclampsia — that leads directly to higher rates of infant and maternal death. “ And that societal racism is further expressed in a pervasive, longstanding racial bias in health care — including the dismissal of legitimate concerns and symptoms — that can help explain poor birth outcomes even in the case of black women with the most advantages.

Dr. Arline Geronimus, a professor in the department of health behavior and health education at the University of Michigan School of Public Health, “first linked stress and black infant mortality with her theory of ‘weathering.’ She believed that a kind of toxic stress triggered the premature deterioration of the bodies of African-American women as a consequence of repeated exposure to a climate of discrimination and insults. The weathering of the mother’s body, she theorized, could lead to poor pregnancy outcomes, including the death of her infant.”

So if “the black-white disparity in the deaths of babies is related not to the genetics of race but to the lived experience of race in this country,” the looming question is why? Why are black women having greatly poorer outcomes when genetics are not to blame?

First off, findings show “higher levels of preterm birth among women who reported the greatest experiences of racism.” Villarosa writes, “The bone-deep accumulation of traumatizing life experiences and persistent insults that the study pinpointed is not the sort of “lean in” stress relieved by meditation and “me time.”

“When a person is faced with a threat, the brain responds to the stress by releasing a flood of hormones, which allow the body to adapt and respond to the challenge. When stress is sustained, long-term exposure to stress hormones can lead to wear and tear on the cardiovascular, metabolic and immune systems, making the body vulnerable to illness and even early death.”

This is not mere speculation. The American Journal of Public Health published a study that showed that “persistent racial differences in health may be influenced by the stress of living in a race-conscious society. These effects may be felt particularly by black women because of [the] double jeopardy of gender and racial discrimination. Even when controlling for income and education, African-American women had the highest allostatic load scores — an algorithmic measurement of stress-associated body chemicals and their cumulative effect on the body’s systems — higher than white women and black men.”

Lynn Freedman, director of the Averting Maternal Death and Disability Program at Columbia University’s Mailman School of Public Health says “Disrespect and abuse mean more than just somebody wasn’t nice to another individual person. There is something structural and much deeper going on in the health system that then expresses itself in poor outcomes and sometimes deaths.”

When black women are given access to support, education, and stress management as well as quality care, the death rates for both babies (most often linked to low birth weight) and mothers dramatically decline.

How can we be allowing this to happen in 2108 in the United States, among the richest nations on earth? And the even larger question is what can we do about this?

In my personal experience, black women are more likely to get inferior levels of care because they are more likely to be impoverished, have lower levels of or no health insurances at all, and therefore, have less access to optimal health care the way women with commercial health insurances have. In my personal opinion, we should have universal health care for all pregnant women with access to any physicians or hospitals they want to. That is how it works in all other advanced countries.  Choice of healthcare is taken away when you have inadequate insurance which is not accepted by the majority of physicians. If doctors have the choice to accept a patient with a much higher paying insurance as compared to someone with an insurance that pays much less, it is clear  whom doctors will prefer to accept. And whom they will reject.

Many clinics in hospitals accepting Medicaid patients or patients without insurance have the best of intentions, but it’s still inadequate compared to individualized care that pregnant women with commercial insurances obtain.

If there is one thing I wish for on Mother’s Day it would be that all women in the U.S .have the same insurance and can choose any doctor they want to see independent of their insurance status. And that doctors must accept all patients independent of their insurances.

What pregnancy complications result from donated eggs?

A study published in the American Journal of Obstetrics and Gynecology revealed complications associated with pregnancy with a maternal age of 44 and over. The study involved about 80,000 women in which about 175 women aged 45 and over  gave birth, many of these births resulted from the use of egg donors.

These older women had a higher incidence of maternal complications than younger counterparts. About 17% of the older women were diagnosed with gestational diabetes as compared to only 6% of younger women. Higher blood pressure was a problem for 9% of older women but only 3% of younger pregnant participants. The rate of C-section also doubled in the older population.

In addition to complications during pregnancy, older women presented with an increased rate of complications after birth including fever, excessive bleeding, extended stays in the hospital and more occurrences of intensive care. Infants born to older mothers even showed decreased health with metabolic problems reported in 4% of the newborns born to older mothers compared to 2% born to younger mothers.

 

 

Delivering with a midwife in the hospital: the best of both worlds

When I think back to when my first child was born, one very vivid scene unfolds in my mind. It begins with me pleading for someone to go out and get the doctor who had vanished about an hour prior because this baby was coming now! My husband frantically ran into the hall and called the nurse who in turn called the doctor who yelled down the hall that no, it was not time yet. I was at the point of screaming and through tears said to my husband who had come back in the room, “Oh my god, this baby is coming now.”

Yes, I was young. Yes, it was my first baby. Yes, I had no experience with labor or childbirth and the doctor on call definitely had. So when he said the baby was not coming, I took his word for it…until I felt my daughter’s head crowning and pleaded with someone to believe what I was saying. A sympathetic nurse finally came in, took one look and sprinted for the door to find the doctor, who now ran in and scowled, “Don’t push. At least let me get my gloves on.”

My first daughter was born seconds later and luckily for him, I was so inundated with joy and happiness that I didn’t let him have it (although if I could go back to that day now, well, some things are better left unsaid!).

Naturally, with my next pregnancy, I wanted to avoid anything remotely close to this experience but did want to give up access to medically safe birth. I wanted to deliver in a hospital again, but this time with a more caring and calm professional. I did a thorough search and ended up choosing a team of certified nurse midwives whose practice was overseen by an OB/GYN.

From the first prenatal visit, I felt acknowledged and heard. I was given ample time for my questions at each 20-30 minute visit, and I had access to the team at all hours. I also always felt supported. Their stance was that as long as my wishes were medically safe, they would back me up. So if I wanted to stand up during labor or walk around, or sit or alternate, I could do it, as long as there were no complications necessitating otherwise.

While my midwife was supportive of my decisions and I delivered naturally with no intervention or meds, if I had needed them, they were readily available to me.”

My midwife was so incredibly calm. She had seen it all before and offered motherly support and also made me feel like everything I was doing was fabulous. This was invaluable … there is nothing more than a mother-to-be needs during a harrowing labor than encouragement.

My labor and delivery with my second daughter, and then my son after that, were glorious, in a beautiful wing of a hospital in a private birthing room. I didn’t need any medication whatsoever, no episiotomy, and delivered easily. I would not trade those experiences for anything.

However, while my midwife was supportive of my decisions and I delivered naturally with no intervention or meds, if I had needed them, they were readily available to me. If I wanted an epidural, it was there. I was asked but declined, and was repeatedly told I could change my mind. There was no judgment. If I had planned on a purely natural childbirth but wanted every drug available once the hard labor kicked in, my midwife would have happily given it to me.

Most importantly, if my labor had stalled, or if there was a cord prolapse, or the baby’s heartbeat declined, I would have been given a cesarean section in a matter of minutes because I delivered in a fully equipped hospital, had registered for a birthing room months before, and already had a team of professionals tending to me since early labor.

I wanted the best of both worlds. I wanted the expertise and surgical ability of a doctor along with the experience and support of a certified nurse midwife. I also wanted to deliver in a hospital with an operating room and an entire team of specialists just in case the baby or I needed it.

In today’s world, there is no reason to be extreme; we have great medical advances available to us, we should utilize them all.