Black Maternal Health Week: A Call to Action to End Racial Disparities in Black Maternal Mortality
Black Maternal Health Week was recognized last month, April 11-17. The annually-recognized week brings awareness and action to the racial disparities that play into Black mothers’ high mortality rate.
According to the Centers for Disease Control, Black women are three to four times more likely than white women to die while they are pregnant or in the first year after pregnancy. A National Public Radio article entitled “Maternal deaths in the U.S. spiked in 2021, CDC reports” cites the maternal death rate among Black Americans as much higher than other racial groups; in 2021 it was 69.9 per 100,000, which is 2.6 times higher than the rate for white women.
In 2021, U.S. President Joe Biden signed the first-ever proclamation marking Black Maternal Health Week. Every year the president shares a proclamation of Black Maternal Health with the American public. This year in his proclamation he described how his American Rescue Plan gave states the option to provide a full year of postpartum coverage to Medicaid beneficiaries — up from just 60 days of coverage. Colorado is one of 30 states, along with Washington, D.C., to provide women with Medicaid coverage with a full year of postpartum coverage.
During the awareness week in Colorado, the Black Caucus and Soul 2 Soul Sisters were among the organizations that held events to bring awareness of the Black maternal health crisis to the Colorado community. On April 14, which is recognized as Black Maternal Health Day, the Black Caucus hosted a mix and mingle for mothers, birth workers and Capitol staff members to spread awareness of this crisis.
Sen. Rhonda Fields presented a bill for Medicaid to cover the use of doulas for families who are interested in using doulas during pregnancy and postpartum. “If this bill is passed it is going to provide Medicaid benefit coverage for doulas. This means anyone, who is eligible for Medicaid or private or state level insurance, will be reimbursed,” says Fields. “Doulas, right now, are paid for by the families who request the doula’s service. With the passing of this bill, doulas will be reimbursed for Medicaid dollars. We are budgeting for families to receive up to $1,500.00 of reimbursement for doula services. That can be prenatal or postpartum.”
Also in attendance at the mix and mingle was Birdie Evan Johnson, birth worker and owner of Mama Bird Maternity Wellness Spa, and Bianka Emerson, president of Colorado Black Women for Political Action. Last year, CBWPA hosted a talk with Charles Hatchett, son of Judge Glenda Hatchett, the reality court show star. Charles’ wife, Kyria Johnson, died after undergoing a C-section for their second child. He is suing Cedars-Sinai Medical Center in Los Angeles for medical negligence because the doctors and nurses ignored the family’s concerns when Johnson was complaining about abdominal pain while recovering from her C-section. She wasn’t taken back to surgery for another 10 hours after her heart pressure plummeted.
Insights of a Black Doula
“Pregnancy is a time to be taken care of and to be vulnerable. Allow yourself to rest. Live in your soft era during pregnancy,” says Jahala Rose Walker says, referring to the social media trend of women abandoning the idea that life has to be hard to get what you want.
Walker is a mom, a doula and a doula instructor, and is on her way to getting certified as a licensed lactation specialist. A doula is a person who provides emotional and physical support to others during a significant health-related experience, such as pregnancy and childbirth, as well as non-reproductive circumstances, such as dying.
Doulas are not considered health care professionals and can’t deliver babies, but doulas can provide tools to help patients be attuned to their bodies and empower the person to advocate for themselves. Doulas provide encouragement and support during pregnancy, labor and postpartum. An article published by the African American Museum of History and Culture, titled “The Historical Significance of Doulas and Midwives,” reported on a study by the CDC that showed doula-assisted mothers were four times less likely to have a low-birthweight baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding.
Walker, who has been a doula for four years and has assisted with many births for Black women in Colorado, is working on a four-hour workshop addressing obstetric racism as a reason for the high mortality rate of Black mothers during birth and postpartum.
“For the most part Black women don’t have the privilege of seeing someone who looks like them performing their births,” says Walker, who stressed that because Black people are dehumanized, it takes a longer time for doctors to consider Black patients as human or capable of experiencing pain.
A study by a psychologist at Dartmouth University used an interactive module that takes a picture of an animated face and morphs the face until it looks like a live human being. A white animated face had to morph on average 67 percent before people thought it looked like a real human being. But, a Black animated face had to morph to a greater degree before a person could discern it as a human face with an average morph of 80 percent complete.
This implicit bias harms Black patients. Walker points out that Black women’s health care isn’t seen as important during the postpartum period either. In an analysis led by Marian MacDorman of the Maryland Population Research Center (MPRC) at the University of Maryland, postpartum cardiomyopathy (a form of heart failure) and the blood pressure disorders preeclampsia and eclampsia were leading causes of maternal death for Black women, with mortality rates five times those of white women. Biden’s proclamation on Black Maternal Health Week 2023 emphasizes that tackling the crisis of Black maternal health begins with understanding how institutional racism drives high maternal mortality rates. “Studies show that Black women are often dismissed or ignored in hospitals and other health care settings, even as they suffer from severe injuries and pregnancy complications and ask for help.”
Advocating for Proper Care
Sandra Schmeling is on maternity leave with her second child, Malachi. She is adjusting to a mother-of-two life, bonding with her youngest before she returns to work. Schmeling is a certified International Board of Lactation Consultant at St. Joseph’s Hospital. She is one of only two Black consultants in Colorado. Before working as a lactation specialist, she was an antepartum nurse. During that time, she saw implicit biases that some nurses would have toward Black mother patients.
“A lot of nurses and doctors don’t see Black women’s care as important. Black moms’ pain and concerns aren’t heard like they are for white mothers,” Schmeling says. She too experienced some negligence with her care from her first OB-GYN. Preeclampsia runs in her family. Her mother had it and so did her sister. Both had premature babies due to preeclampsia. According to the Preeclampsia Foundation’s study on race disparities, the rate of preeclampsia is 60 percent higher in Black women than in white women and Black women have a higher chance of developing severe preeclampsia.
When Schmeling became pregnant with her first child, Eliot, she informed her OB-GYN that she had a family history of preeclampsia. She says her doctor “brushed off this fact about my family medical history.” The doctor didn’t prescribe her the necessary medicine to prevent her from having preeclampsia, and she became preeclamptic in her third trimester. As a result, she had to be induced at 37 weeks to avoid any dangerous issues for her and her baby. During her induction, she says she began to have complications. “My son’s heart rate was dropping. The induction wasn’t working and I was telling my delivery team to do something else.”
Even as a nurse at the hospital in which she was giving birth, she was being ignored. She quickly realized that she could be a statistic if she didn’t advocate for herself. “Thankfully, the nurses that worked with me also advocated for me to stop the induction,” she recalls. She had an emergency C-section and gave birth to her son. After her experience with her first pregnancy, she decided to switch to an OB-GYN who was going to see her care as a priority. “Second pregnancy, I found a different doctor and he took care of me. He saw my family history of preeclampsia and put me on aspirin immediately,” she says.
Because her new doctor was proactive, she gave birth to another boy at 38 weeks without complications. She believes that the lack of education and exposure to working with women of color is a factor for problems in Black maternal health. Just like Walker mentioned, Black women’s pain isn’t seen during postpartum. “We have seen examples of Black mothers dying during postpartum because they weren’t taken care of very well. For example, a Black mother of five, who comes into the hospital with cramps and abdominal pain after giving birth, is told to use a heating pack or take Tylenol. This doesn’t make sense because we know, as healthcare providers, that the more kids you give birth to the more pain you will experience during your healing process. But for a white woman, in the same scenario, is treated properly to prevent any more pain and death,” Schmeling explains.
According to the CDC, 80 percent of pregnancy-related deaths are preventable. Schmeling feels like her representation when she was a nurse and now as a lactation specialist is very important. “I’m here to stand in the corner for my patients of color. They have someone who is here for them,” she says.
Sacred Seeds Black Birthworker Collective of Colorado is all about connecting Black families to birth workers, sharing tools to increase breastfeeding in the community, and spreading awareness to end health disparities in Black maternal and infant mortality.
Soul 2 Soul Sisters is a grassroots, love-based, racial justice nonprofit organization based in Denver that focuses on the wellness and well-being of Black people. The organization held informative events during Black Maternal Health Week, kicking the week off with a virtual event, “Black Maternal Crisis and Hope” sponsored by Cobalt and the NAACP CO-MT-WY State Conference. They closed the week with another virtual event, “What now? Reproductive Justice in a Post-Roe Nation.” Soul 2 Soul partnered with the Iliff School of Theology to determine how faith leaders can get involved in reproductive justice.
“Reproductive rights also include the right to fair and adequate maternal care,” says Briana Simmons, reproductive justice coordinator at Soul 2 Soul Sisters. “Black women deserve to see fair and equal medical treatment. Black women created the blueprint for many reproductive rights we see today; it’s a disservice to exclude us in fair medical treatment.”