Consider This from NPR - The Black Maternal Mortality Crisis and Why It Remains an Issue

Episode Date: July 9, 2023

The U.S. has the worst maternal mortality rate of high-income countries globally, and the numbers have only grown. According to a new study published in JAMA, the Journal of the American Medical Association – maternal death rates remain the highest among Black women, and those high rates have more than doubled over the last twenty years.When compared to white women, Black women are more than twice as likely to experience severe pregnancy-related complications, and nearly three times as likely to die. And that increased rate of death has remained about the same since the U.S. began tracking maternal mortality rates nationally — in the 1930s. We trace the roots of these health disparities back to the 18th century to examine how racism influenced science and medicine - and contributed to medical stereotypes about Black people that still exist today.And NPR's Scott Detrow speaks with Karen Sheffield-Abdullah, a nurse midwife and professor of nursing at the University of North Carolina - Chapel Hill, about how to improve maternal health outcomes for Black women.In participating regions, you'll also hear a local news segment to help you make sense of what's going on in your community.Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

This message comes from Indiana University. Indiana University performs breakthrough research every year, making discoveries that improve human health, combat climate change, and move society forward. More at iu.edu forward. I have two little stinky little boys. I say that lovingly. Aiden, eight, and Asher, two. Anna Rodney is 38 years old and lives in Baltimore, Maryland with her sons. She says she always imagined the birth of her first child would be beautiful, what she considered a very natural thing.

I wanted to have a home birth. I wanted to have a water birth. I'm a hippie. I used to tease my friends birth. I wanted to have a water birth. I'm a hippie. I used to tease my friends, like, leave me alone. I'm going to just go to the woods and give birth to my son. That didn't happen. During her pregnancy, Rodney had life-threatening blood clots in her left leg. She says she repeatedly told doctors about her symptoms and was repeatedly ignored. That didn't change until

a friend who was a nurse went with her to the hospital and demanded that Rodney be admitted. After she delivered her son by C-section, internal bleeding led to an emergency surgery. Weeks later, her incision site became infected. Rodney says that even though the pain was so intense that she could barely walk, a doctor checked the scar and said she was fine. The next day, she went back to the ER and was admitted with an aggressive infection. And while all of this was happening to her, her son Aiden was also struggling for his life. He was born at 28 weeks. Her son was one pound, five ounces when he was born.

We spent about six months in the NICU. Rodney spoke to NPR producer Brianna Scott. She says she hoped when she gave birth that it would be a partnership between her and the medical staff. But that wasn't the case. I was also navigating institutionalized racism, fatphobia, and all types of different biases and felt the need to qualify myself every time I had a question or pushback or concern about my son's care. I felt that I needed to recite my resume or somehow prove that I was worth listening to, as if him being inside me for the last couple of months did not make me enough of an expert on my child.

So she had to advocate for herself and her son over and over and over again. My baby is going to come out of this hospital. My baby is going to survive. I believe that if I hadn't personally made that decision, that I don't know that Aiden would be here playing Switch and going to camp and playing soccer and watching the Mario movie. The U.S. has the highest maternal mortality rate of the world's high-income countries, and in recent years, the numbers have gotten worse. According to a new study published in the Journal of the American Medical Association, maternal death rates remain the highest among Black women, and those high rates have more than doubled over the last 20 years.

When compared to white women, black women are more than twice as likely to experience severe pregnancy-related complications. They're nearly three times as likely to die. We'll unpack the ongoing struggle to lower the death rates for pregnant black women. From NPR, I'm Scott Detrow. It's Sunday, July 9th. This message comes from WISE, the app for doing things in other currencies.

Send, spend, or receive money internationally and always get the real-time mid-market exchange rate with no hidden fees. Download the WISE app today or visit WISE app today or visit WISE.com. T's and C's apply. It's Consider This from NPR. To really understand the foundation of the Black maternal mortality crisis, you've got to go back to the 18th and 19th century. Georges Cuvier of France, who begins dissecting the cadaver of Sarah Bartman,

diversively known as the Hottentot Venus. But he's doing so because it's this belief that somehow Black people and Black women must be different, you know, perhaps a different species than white people. Deidre Cooper-Owens is the author of Medical Bondage, Race, Gender, and the Origins of American Gynecology. Her book retells the stories of enslaved Black women and Irish immigrant women who were experimented on during the 18th and 19th century. The book shows how racism influenced science and medicine and contributed to medical stereotypes about Black people that affected their treatment. And then when we move to the United States, a still young nation, you have Ephraim McDowell, known as the father of the ovariotomy, in 1809, begins experimenting on five negresses, as he called them. Four of them were enslaved. One was a free woman of color, and one of his patients dies because he is attempting to try to perfect the surgical technique to remove ovarian tumors.

Cooper-Owen spoke to Consider This producer Breonna Scott. This kind of experimentation on enslaved pregnant Black women went on for years, decades, centuries even. When we use these terms systemic or structural, it's not about playing some race card. It's really about showing these are the building blocks that helped to create American modern gynecology. Black women during this time were held down with restraints when doctors did procedures on them. Cooper-Owens says back then, it was a prevalent belief held by many doctors that Black people didn't experience pain. If Black women didn't experience pain, why were you restraining them

during surgery? And the medical consensus created during this period lingered. Cooper-Owens describes 2016 research on racial bias in the treatment of pain to illustrate how the thinking still exists. Overwhelmingly, white medical students surveyed at the University of Virginia, one of the country's top schools, believed in biological differences between white people and Black people. Some of those respondents said that Black people have thicker skin, Black people age faster, Black people don't experience pain. If they do, it's not as severe. I mean, just all of these kinds of tropes of Black abnormality and pathology. Two of the respondents even claimed that Black people were born with tails.

It's those kinds of beliefs that contribute to why Black women are more than twice as likely as white people to experience severe pregnancy-related complications. Anna Rodney, who spoke earlier about her own experiences of not being listened to by doctors, she's been a doula for 16 years. She's been there for clients who weren't listened to by their doctors. Compassion, kindness, active listening, those things don't cost money, right? But they can be absolutely life-saving. She remembers one of the mothers she worked with needed stitches after giving birth. Rodney says the doctor sent in a resident so that the student could learn how to stitch up a patient. So we're sitting there, mom's in pain, medication is worn off. And nobody's speaking to us. Nobody has told us what's happening.

Nobody said, oh, you know, the resident's going to come in and try. Nobody. And so we're at an hour of them just kind of down there poking around, you know, not knowing what's going on. And my client just looked at me like, I don't know, help me. Rodney says she told the doctor it was time to step in and for the resident to stop. Since the U.S. began tracking maternal mortality rates nationally in the 1930s, Black women have been and are still three times more likely than white women to die as a result of complications from pregnancy and childbirth. To talk about how to address this

ongoing problem, I spoke to Karen Sheffield-Abdullah. She's a nurse midwife and professor of nursing at the University of North Carolina, Chapel Hill. She works with medical staff to help improve maternal health outcomes. I asked her why in all of this time, up to 2023, those numbers haven't changed. If I were to be perfectly honest and transparent, I think one of the biggest pieces of it is that we can do a better job of listening to Black women and what they are saying in terms of their own lived experience as they navigate the healthcare system, and really how they're interfacing with the healthcare system in ways that are not optimal and truthfully biased. Can you tell me about any one particular situation that comes to mind that you've been in,

where doctors you've worked with or you know have acknowledged unconscious bias that might be getting in the way of listening, and any approaches that they took differently that had a different outcome. I did Grand Rounds at a particular academic hospital with physicians, medical students, residents, attendings, nurse midwives. And I was speaking in particular about the importance of listening to Black women when they speak. And so there was a particular attending who identified as a white female physician of 20 years who said,

Karen, how do we even have the conversation surrounding stress and mental health for Black individuals in particular? Like, I don't even know where to start. And what I explained was, for Black individuals, our pain is notoriously under-assessed and under-addressed. And we really need to think about these higher-profile individuals like Serena Williams, like Alison Felix, like Beyonce, like Tori Bowie. But as we think about Serena Williams, knowing that she had a history of a blood clot from 2010, and then after her delivery, she was complaining of symptoms and she wasn't listened to. And so what happened was this

person then took that story anecdotally. And that very week after the grand rounds, she saw a black patient in the office who came in with really vague complaints of calf pain. And she said it wasn't really high suspicion for a blood clot or what we call a DVT or deep vein thrombosis. But she said, you know what? I listened to what Dr. Sheffield-Adula had to say, and specifically the story regarding Serena Williams. And I went ahead and I ordered an ultrasound. And indeed, this individual had a blood clot. And it is a direct correlation to the fact that that Grand Rounds, where it was elevated that we need to listen to Black women, that I changed the way in which I practice.

And I want to be able to get that message back to Dr. Sheffield of Doula. And so to me, that is at the essence of what we need to be doing as healthcare providers. This person came to the office kind of downplaying her complaint of calf pain, but that particular provider listened, did the testing that needed to be done, and that's a potential life saved. Why do you think doctors have such a hard time listening? Because you mentioned some of the high profile stories, particularly people like Serena Williams. And I feel like that cuts across so much because you see this and you think, if somebody as accomplished and in tune with her body as Serena Williams is not being listened to, who else isn't being listened to? What do you think the root of this broad

problem is? I think as we think about physicians in particular, they tend to not have a lot of time to be able to spend with their patients, right? If we think about their schedules and how many patients they are slotted to see in a given day, they don't have the time to sit down and do the deeper dive, to really sit and listen to what is going on for this particular individual, what's happening socioculturally, what's happening psychosocially, what's happening with their mental health, what's happening with their ability to be able to access certain resources, right? And so if we're not able to assess that, we're not giving optimal care. So listening to you, I hear a way forward on the individual level, on the ground level for doctors and medical professionals of just listen more, believe patients more,

seek out subtle clues. What are the broader systemic fixes to this? Certainly we could think about diversifying the healthcare workforce so that the individuals who are taking care of the community look like the community they're serving. So diversifying the healthcare workforce inclusive of physicians, midwives, doulas, mental health care providers. I think funding studies that center the lived experience of Black women and Black birthing people is super important. And I truly believe that if we were to ask the Black community, what do they need, they would tell us. And rather than us as academicians and researchers and physicians pontificating from our silos about what we think a community needs, how about we spend the time asking the community what is it that they need because they know better than we do. If you feel like you are not being heard, then you go on to the next person, you speak to the

next person until you feel you are being heard because it truly is life and death. And I honestly believe that I want to create a society by which Black women are seen, they are heard, and they are inherently valued. And that is fundamental. And so if they are not being heard, take it to the next person, elevate it, escalate it until you are heard. Because they're really reconciling, having conversations with their partners, with their spouses. If you have to choose between me and the baby, choose the baby. And the fact that they're having those conversations in 2023 in this here United States is just unacceptable. You tick through all of these enormous challenges and you keep coming back in conversation

to this solution that seems so simple, but I imagine that there's layers there of just be quiet and listen to people in the doctor's office. When I was thinking about this, listening to Black women, it seems so simple. And yet it is not easy for healthcare providers, right? And so really spending the time to help educate healthcare providers of different race ethnicities as they're taking care of this community, of the black community, to be able to do the work, Scott, to be able to do their work of understanding the historical nature

of why a community may show up with mistrust and distrust, sitting with that, having done your own work, right? And then sitting and saying, how might I best support you? I don't know that we can ever be culturally competent in another person's culture,

but I can certainly show up in a culturally humble way that says, I don't know everything, but I am here to learn to how best take care of you. What do I need to know about you to best support you across your prenatal course so that we can optimize your pregnancy and birth outcomes? And the CDC is clear. Four out of five of pregnancy-related deaths are preventable. We need to do better, and we can. That was Karen Sheffield-Abdullah, nurse midwife and professor of nursing at the University of North Carolina, Chapel Hill.

This episode was produced by Brianna Scott. It's Consider This from NPR. I'm Scott Detrow. Support for NPR and the following message come from the Kauffman Foundation, providing access to opportunities that help people achieve financial stability, upward mobility, and economic prosperity, regardless of race, gender, or geography. Kauffman.org.