Recent studies have revealed shocking differences in who dies in this country from postpartum hemorrhage (bleeding after childbirth). American women of color are three to four times more likely to die during or shortly after pregnancy than whites.
In fact, the U.S. Centers for Disease Control and Prevention (CDC) say this disparity is one of the worst in women’s health. Compared to white women, a black woman is 22 percent more likely to die from heart disease. They’re 71 percent more likely to die from cervical cancer. But they’re an astonishing 243 percent more likely to die from pregnancy-related causes like bleeding after childbirth.
These outrageous differences have existed for decades. In some states, they continue to grow.
As a result, the U.S. maternal mortality rate is higher than that in other rich countries – much higher. Black women who get pregnant in America are as likely to die as those in Mexico or Uzbekistan.
And in Texas, black mothers would stand a better chance if they had their babies in Guatemala, Panama, Jamaica or Palestine.
So what’s causing these deaths?
Some researchers think chronic health issues that disproportionately affect black women – diabetes, obesity, and high blood pressure – are behind these statistics. But evidence also points to differences in the quality of hospital care.
ProPublica found that, when health and other issues are factored out, the pattern of disparities change little. This shows that differences in care matter.
Dr. Elizabeth Howell is a professor of obstetrics and gynecology at Mount Sinai Hospital. She studied New York City’s hospitals and found that black mothers were twice as likely to suffer harm when delivering babies than white mothers. This held true even after accounting for patients’ unique circumstances. And their rate of injury, death and bleeding after childbirth would fall nearly 50 percent if they gave birth at the same hospitals as white women.
Black women of all incomes and education levels affected
Furthermore, neither education nor income make much difference. One analysis found that black, college-educated mothers who had their babies in local hospitals were more likely to suffer severe complications, such as bleeding after childbirth, than white women who never graduated from high school.
Raegan McDonald-Mosley, chief medical director for Planned Parenthood Federation of America, recently told National Public Radio that “(Y)ou can’t educate your way out of this problem. You can’t health care-access your way out of this problem. There’s something inherently wrong with the system that’s not valuing the lives of black women equally to white women.”
And what’s going on in Texas?
Among the studies’ most shocking revelations is that the state of Texas has the highest number of pregnancy-related deaths in the entire developed world.
Read that again. The entire developed world.
A study in Obstetrics and Gynecology found that the rate of maternal deaths in Texas were 35.8 per 100,000 live births as of 2014. The maternal mortality in Japan in 2015 was 5 per 100,000 live births, according to UNICEF.
Texas loses 1,200 percent more new mothers than Poland.
And again, black mothers are disproportionately hit. The Obstetrics and Gynecology study also said black babies make up just 11 percent of the state’s births, but account for nearly 29 percent of maternal deaths.
Critics of Texas’ failures say the state has a weak safety net for the uninsured, contributing to this heartbreaking math. Fully 19 percent of women in Texas lack insurance – but white (29 percent) and hispanic women (56 percent) make up the majority of the uninsured.
The Center for Reproductive Rights has sued the state for preventing Medicaid patients from getting treatment at Planned Parenthood. In its legal brief, the organization points to the differences between black and white maternal deaths. “Many [uninsured minorities] fall into the coverage gap left by the primarily Southern states that have not expanded Medicaid, including Texas,” the brief says. “Black women disproportionately bear the real-life impacts of the United States’ poor maternal health outcome.”
Does racism play a role?
Some research suggests that the extraordinary stress of simply being a black woman in America can take a toll on health during pregnancy and childbirth.
And the way women of color are treated by health care providers has come under scrutiny. “Sometimes you just know in your bones when someone feels contempt for you based on your race,” one Brooklyn, N.Y., woman told NPR. Her response? She brings her white husband or in-laws to every prenatal visit.
“It’s chronic stress that just happens all the time — there is never a period where there’s rest from it. It’s everywhere; it’s in the air; it’s just affecting everything,” Fleda Mask Jackson, an Atlanta researcher who focuses on birth outcomes for middle-class black women, told NPR.
The Harvard T.H. Chan School of Public Health found that 33 percent of black women reported discrimination by a doctor or clinic. And 21 percent said they sometimes avoid seeking care out of concern they would face racial discrimination.
Hakima Payne, a mother of nine, a midwife and former delivery nurse, knows both sides of the system. “The nursing culture is white, middle-class and female, so is largely built around that identity. Anything that doesn’t fit that identity is suspect,” she told NPR. She said some nurses do “a lot of victim-blaming — ‘If those people would only do blah, blah, blah, things would be different.’ ”
Postpartum hemorrhage: the very real risks of bleeding after childbirth
Postpartum hemorrhage (PPH) is one of the main causes of death in pregnant women or new mothers.
Women with PPH bleed uncontrollably from the vagina, and often have blurred vision, chills, weakness or fainting. It’s more likely to happen to women who’ve previously suffered severe bleeding after childbirth, or other conditions that affect the uterus, placenta or blood.
It’s normal for a woman to have some bleeding after childbirth. But PPH can cause a severe drop in blood pressure, too often causing death.
Treatment depends on the cause of bleeding. So it may include IV fluids or even a blood transfusion, sometimes through a needle directly in the uterus. In some cases the woman has to get a hysterectomy.
Luckily, doctors are leaning more about treating PPH. The California Maternal Quality Care Collaborative has compiled a toolkit to help healthcare providers develop methods to respond effectively to bleeding after childbirth. First released in 2010, the toolkit was updated in 2015 to reflect new research into postpartum hemorrhage.
So if you think you’re having PPH, call a doctor right away
PPH usually happens within a day of giving birth, but can happen as much as 12 weeks after having a baby. On average, out of every 100 women who have a baby, one to five will have PPH. So if you’re bleeding uncontrollably from your vagina, have blurred vision, chills, weakness or fainting, call your doctor or 911.
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