Tennis superstar Serena Williams in a recent Vogue profile disclosed her harrowing experience with serious postnatal complications. Williams' experience, P.R. Lockhart writes in Vox, illustrates not only the potential risks of childbirth but also racial inequity in maternal care.
Williams gave birth to her daughter, Alexis Olympia, in September 2017.
While her pregnancy and birth went smoothly, Williams began having trouble breathing the day after her daughter's delivery. Williams has a history of pulmonary embolism—having nearly died from one in 2011, according to the New York Times—and "immediately assumed she was having another," Vogue reports.
Williams told her symptoms to a nurse and asked for a CT scan and blood thinner. However, the nurse suggested Williams might be experiencing confusion from pain medication. Williams insisted she get a CT scan and blood thinner, according to the Times, but a doctor instead ordered an ultrasound of her legs. Williams recalled, "I was like, a Doppler? I told you, I need a CT scan and a heparin drip."
After the ultrasound found nothing, Williams received a CT scan that found small blood clots in her lungs. She was immediately given a heparin drip—but that wasn't the end of Williams' health complications: The embolism had caused Williams to cough so severely that her cesarean section wound opened. During surgery to close the wound, doctors found a hematoma—a pool of blood outside of blood vessels—in her abdomen. After that, Williams underwent more surgery to prevent additional clots from spreading.
She was bedbound for the first six weeks of motherhood.
Maternal complications and racial inequity
William's experience underscores the risks and racial disparities of maternal health care in the United States, Vox reports.
Organisation for Economic Co-operation and Development (OECD) data show maternal mortality is far more common in the United States than elsewhere in the developed world—and, according to Vox, both pregnancy-related complications and maternal mortality are more common among black U.S. women than among white U.S. women.
According to CDC, more than 50,000 U.S. women experience pregnancy or delivery complications each year, and about 700 women die from them. When considered on the basis of race, CDC data show maternal mortality is three to four times higher among black women in the United States than among white women: On average, the maternal mortality rate among black women is 43.5 deaths per 100,000 live births, compared with 12.7 deaths per 100,000 live births among white women.
Research has found several factors likely contribute to the higher maternal mortality rate among black women, including poor access to care, prior inadequate medical treatment, chronic stress, and the effects of racism.
Elizabeth Howell, professor and director of the Women's Health Research Institute at the Icahn School of Medicine in New York, said, "Everyone always wants to say that it's just about access to care and it's just about insurance, but that alone doesn't explain it."
According an investigation by NPR and ProPublica, many pregnancy- and childbirth-related deaths are preventable. However, because of systemic racism, including discrimination in medical settings, black women are still more likely than other racial groups to die from a pregnancy-related health issue, Vox reports. For instance, ProPublica found that women who hemorrhage at hospitals that serve disproportionally black patient populations are more likely to have serious complications such as embolisms and emergency hysterectomies.
And those disparities in care remain even after economic status is accounted for, Vox reports, citing research showing that black women in higher income brackets are more likely than white women to die from complications during pregnancy and childbirth.
Efforts to improve maternal care, increase equity
The importance of ensuring medical professionals are responsive to the concerns of new mothers has gained traction in recent years, according to the Times. For instance, the "Stop. Look. Listen!" campaign, which launched in 2012, seeks to empower women to report pregnancy-related medical issues and bolster awareness and responsiveness among providers.
The industry also has seen a growing number of black doulas and midwives who are working to counter inadequate medical care, Vox reports.
But activists say more research is needed to ensure providers and hospitals are providing proper treatment for black mothers. Patrisse Khan-Cullors, a senior fellow studying maternal mortality with the activist group MomsRising and a co-founder of Black Lives Matter, said, "This is a national tragedy, (but) we aren't doing the research that's needed and could hold hospitals accountable nationwide" (Lockhart, Vox, 1/11; Salam, New York Times, 1/11; Knowles, Becker's Hospital Review, 1/11; Haskell, Vogue, 1/10).
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