Two miscarriages, three cycles of in vitro fertilization and over 10 years of stress, hopelessness and disappointments and finally the words the couple was waiting to hear, “you’re pregnant.” As the months passed, the excitement grew in anticipation of the birth of their son. Then the moment finally arrived and the joy was almost uncontainable. Three hours later, the couple held their son together for the first time for seven short minutes — it was perfect. Then without notice, he looked into his wife’s eyes and saw the light begin to dim and almost instantaneously a part of his heart darkened. He knew she was gone.
How could this be, he wondered as he stood dazed holding his son while staring at his wife’s body that showed none of the pain or anguish she just endured. “She told you something was wrong but you didn’t listen,” he screamed as the nurses tried to pull his son out of his arms. “You said the bleeding was nothing to worry about and she would be fine with a little rest.” But she was not fine, she was dead.
When my friend called to tell me about the unimaginable tragedy her brother had endured, an overwhelming sense of hurt and fear came over me at first, but it quickly turned to anger. I, too, had been trying for many years to get pregnant and had suffered multiple miscarriages. As an acute care nurse practitioner (NP), the possibility of dying during or after childbirth had never occurred to me. Perhaps I was naïve or felt that my role as an NP in the hospital allotted me a sense of security or a spot at the front of the line in receiving the best health care possible. The truth is that Black women like me are dying at an alarming rate from complications associated with pregnancy and childbirth.
According to the Centers for Disease Control and Prevention (CDC) the majority of maternal deaths are preventable. Yet, Black women are three to four times more likely to die from pregnancy-related causes than white women. In 2018, there was 17.4 deaths per 100,000 live births compared to Black women who died at a rate of 37.1 per 100,000 live births. Nearly 700 maternal deaths with two and a half times more Blacks than whites dying. This rate is higher than any other developed nation.
Why is this happening? Certainly, there are a host of contributing factors that have been researched including disparities such as lack of access to prenatal care, little or no health insurance, increased stress, exposure to violence and trauma, comorbidities, food insecurity and mental health issues. However, this was not the case for this Black woman.
Too many Black women are having their voices silenced while providers assert their knowledge and opinion of superiority proposing to know what is best for these mothers who have spent the last nine months nurturing and growing a precious life, only to feel as if their own life doesn’t matter. Nurses and providers are taught to listen to their patients. “Pain is what the patient says it is,” my professor told me. So why doesn’t that hold true for Black mothers? Shouldn’t they be allowed to be the experts over their own bodies? Education nor wealth as it seems can secure your voice as even Black celebrities like Serena Williams have their requests for treatment ignored.
Sure, the death certificate will say she died due to complications caused by infection, hemorrhage or a cardiovascular related condition. The reality is that she died because no one listened to the screams that turned to soft pleas for help she whispered as she felt her body grow weaker.
What’s the solution? Black Maternal Health Week is recognized by many cities in April, but it will take more than a week to end the disparities and address the systemic racial and sexist biases that exist in a predominantly white male-dominated field. Making cultural competence and diversity training mandatory in medical schools should be a starting point. Recognizing the problem and getting involved is part of the solution. Support legislation such as Bill S.3424 the Black Maternal Health Momnibus Act of 2020 that addresses maternal health outcomes in underserved minority populations. Support organizations like the Black Coalition for Safe Motherhood that promotes advocacy and encourages Black women to trust themselves and seek out respectful providers. The time is up, and Black women will no longer be muted.
Patricia Davis is a Bronx resident in the Doctorate of Nursing Practice (DNP) Program at Duke University School of Nursing. She currently works at Montefiore Medical Center in the Bronx as a nurse practitioner in pulmonary medicine.