Singer Beyoncé Knowles-Carter in Vogue's September issue revealed her struggle with a potentially fatal complication during her pregnancy last year— and experts say her story shows how even wealthy, high-status black women in America face disproportionate risks during their pregnancies.
Learn the 9 critical elements of a successful perinatal safety program
How Beyoncé, and other high-profile black women, have struggled with pregnancy complications
During her latest pregnancy, Beyoncé developed preeclampsia, a potentially fatal pregnancy complication that causes high blood pressure and can harm women's organs, including their livers and kidneys.
Beyoncé was bedridden for months by the condition, and in June 2017, she delivered by emergency C-section her twins, Rumi and Sir. Beyoncé said, "My health and my babies' health were in danger, so I had an emergency C-section. We spent many weeks in the [neonatal intensive care unit]." She added, "I was in survival mode and did not grasp it all until months later."
Beyoncé's revelation comes months after tennis superstar Serena Williams in Vogue's February issue disclosed her harrowing experience with serious postnatal complications. While Williams' pregnancy and birth went smoothly, she began having trouble breathing the day after her daughter's delivery. Williams has a history of pulmonary embolism—which occurs when blood clots block one or more of the arteries in the lungs—and "immediately assumed she was having another" after giving birth, Vogue reports.
Williams described 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 needed 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 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.
Beyoncé and Williams aren't alone: Black U.S. women face disproportionate pregnancy risks
Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California at San Francisco, said that these stories "help to put a very well-known face" to the risks that black women face during their pregnancies.
CDC has estimated about 700 women in the United States die annually from pregnancy or delivery complications, but the agency said data from CDC's Pregnancy Mortality Surveillance System showed "considerable racial disparities in pregnancy-related mortality."
According to CDC, black women are three to four times as likely as white women to be at risk of pregnancy-related deaths. Ultimately, black women are 243% likelier to die of childbirth- or pregnancy-related causes, according to a ProPublica investigation published last year.
While many people believe that black women's higher risks are due to factors such as lower education levels and poverty, according to Grossman, research—and the stories of wealthy black celebrities who encounter problems during their pregnancies—suggests that the problem is deeper.
For example, a data analysis published by the New York City Department of Health and Mental Hygiene in 2016 found that black college-educated women who delivered their babies in local hospitals were more likely to experience pregnancy- or childbirth-related complicated than women of other races or ethnicities who had not graduated from high school.
What providers are—and are not—doing to address the problem
According to Grossman, nurses, physicians, and other health care professionals are taking several steps to improve maternal care for people of all races. For instance, some health care providers are finding ways to better:
- Identify the early signs of pregnancy- and delivery-related complications;
- Recognize the risk factors for pregnancy- and delivery-related complications; and
- Treat pregnancy- and delivery-related conditions using current best practices.
But Grossman noted that physicians and nurses have been "slow to acknowledge the role that racism plays in poor outcomes."
Evidence suggests, for instance, that doctors are likelier to dismiss complaints of pain from black patients. A 2011 paper in the Clinical Orthopaedics and Related Research concluded, "[R]acial/ethnic minorities consistently receive less adequate treatment for acute and chronic pain than non-Hispanic whites, even after controlling for age, gender, and pain intensity."
Grossman said, "Until we address the problem of racism in the health care system, we will not be able to fully address the problem of maternal mortality among black women"(Chiu, "Morning Mix," Washington Post, 8/7; Salam, New York Times, 1/11; Haskell, Vogue, 1/10).
Now open to all members: Get our toolkit for improving perinatal safety
Perinatal care is a high-volume service, accounting for one-fifth of all hospital stays. Yet it is also highly variable, with significant differences in complication rates for both vaginal and cesarean deliveries between hospitals nationwide.
Download this toolkit to get best practices and resources collected from organizations that have successfully improved labor and delivery care by reducing clinical variability.
Get the Toolkit
Next in the Daily Briefing
EPA estimates its proposal to replace the Clean Power Plan could lead to more than 1K premature deaths annually