Racism in the health care system is killing Black pregnant Texans

When issues like bleeding and postpartum depression are left untreated, they can lead to death. Black Texans and other groups of color experience maternal mortality at higher rates, but organizations are working to change that reality.

By Elena River, KERA NewsApril 16, 2024 10:00 am, , ,

From KERA News:

A note: This story discusses mental health and suicide. For resources and support, call 988 to reach the Suicide and Crisis Lifeline, text HOME to 741741 to connect to the Crisis Text Line, or call 1-833-943-5746 for the National Maternal Mental Health Hotline.

A few months after Si’Mone Scott gave birth to her daughter, she knew something was off.

This was her third pregnancy, and her toughest. The Dallas resident had been put on bed rest early on in her first trimester because she was at high risk of a miscarriage.

“I’ve never experienced a miscarriage before and I didn’t want to,” Scott said. “I was already going through a lot at home, and then to basically have to stop working, I couldn’t even clean.”

When Scott gave birth to her daughter via C-section, she started bleeding, losing more than 1,300 units of blood. Postpartum hemorrhage is categorized as losing more than 1,000 units of blood within 24 hours to 12 weeks after delivery, according to the American College of Obstetricians and Gynecologists.

“I basically almost died on the operating table,” Scott said.

She said not being able to get up and move during her pregnancy and after giving birth impacted her mental health. It was like she had the “darkest cloud over my head,” Scott said.

“I called the 988 suicide line, because I was needing their help,” she said. “I was searching for it. I just wasn’t getting it. And I felt like I exhausted all of my resources of trying to find it.”

Yfat Yossifor / KERA News

Simone Scott listens to Prinscilla Moore, Founder and CEO, during postpartum doula training Wednesday, March 27, 2024, at Delighted to Doula in Dallas.

The health issues Scott experienced are some of the most common reasons Texans die in pregnancy. Texas is among the worst states in the country for maternal mortality, and Black Texans die at higher rates than their white counterparts from pregnancy-related causes.

Scott got connected with Delighted to Doula Birth Services, a Black-led organization in Dallas providing postpartum doula support to new parents. The organization’s aim is to reduce maternal mortality rates.

Scott said she felt calm and relaxed immediately after coming to the office and meeting her doula.

“Everything just started coming out of me,” Scott said. “I was speaking for hours, uninterrupted. She just listened. She just listened. And I know I was going on and on and on. But it was just being heard.”

Over the next few months, Scott said she came to Delighted to Doula every week as part of her “self-care routine.” She started to notice changes in her mood. She felt happier and had more energy to play with her daughters.

“They never treated me like I was overstaying my welcome or anything, I was always welcomed,” Scott said. “That helped me to realize that I do matter and that all my feelings are valid.”

George Walker IV / Associated Press

Members of a prenatal group at The Farm Midwifery Center dance during a meeting Thursday, Aug. 31, 2023, in Summertown, Tenn. Led by midwife Corina Fitch, the women shared thoughts and concerns.

What is maternal mortality?

Maternal mortality is the death of someone during pregnancy or within a year of the end of their pregnancy, according to the U.S. Centers for Disease Control and Prevention (CDC). Causes can include pre-existing health issues like hypertension and heart disease; birth-related incidents like bleeding, sepsis or blood clots; or health issues after giving birth, like postpartum depression or intimate partner violence.

In Texas, obstetric hemorrhage (bleeding) was the most common cause of pregnancy-related death, followed by mental health conditions and non-cerebral thrombotic embolism (stroke), according to the Texas Maternal Mortality and Morbidity Review Committee (MMMRC).

In Texas, Black pregnant people die from pregnancy-related causes at two to three times the rate of their white counterparts. The MMMRC’s most recent report found these disparities have not changed since 2013, when the committee was first formed.

People without private health insurance and people over 35 were also more likely to die from a pregnancy-related cause. A 2023 report from the CDC showed “the rate for women aged 40 and over was 6.8 times higher than the rate for women under age 25.”

Jai Fields, a full spectrum doula and the childcare director for the Maternal Health Equity Collaborative (MHEC), provides support to parents from the prenatal to the postpartum period. She said people often don’t know the warning signs for health problems.

“We’re trying to regulate the body, but not educate about the body,” Fields said. “I think that needs to happen more so that people can be informed and know what’s normal, what’s not, what should be a red flag.”

Rogelio V. Solis / Associated Press

Miracle Allen takes a call on her cellphone while waiting to meet with the midwife at Sisters in Birth, a Jackson, Miss., clinic that serves pregnant women, Dec. 17, 2021. The clinic utilizes an integrative and holistic approach to women's healthcare by providing comprehensive services including primary care, midwifery care, home healthcare, childbirth education as well as doula support.

She said health issues that happen after giving birth can often start small, with minor pain or swelling. These issues can be easy for people to ignore as they’re caring for a newborn and managing a household.

“This is a vulnerable time,” she said. “We know Black folks are dying, babies are dying, it’s really vulnerable.”

Fields said her work in the MHEC helps give parents “the space to rest, to breathe, to eat, to take care of their basic needs, so they are able to heal and able to be aware of their bodies.”

“[It’s] being proactive versus reactive to, ‘Oh, now there’s a problem,’ and we’re in crisis mode,” she said.

She said part of her work as a doula is helping people to advocate for their health needs, because “you are an expert in your body.”

“No matter what these books or statistics say, when something is off in your body, you know,” Fields said, “and so your voice is extremely important.”

Yfat Yossifor / KERA News

Prinscilla Moore, Founder and CEO of Delighted to Doula, teaches to a class for postpartum doula training Wednesday, March 27, 2024, in Dallas.

Racism’s impact on pregnancy

Black pregnant people’s experiences are also “further impacted by both structural racism and racial implicit biases,” according to a 2019 article in the Journal of Racial and Ethnic Health Disparities. That can include a lack of health insurance, less access to health care services, and health provider mistreatment.

It’s something Fields has seen firsthand working with her clients.

“When it comes to birth trauma, what we’re seeing is it’s not always the actions of what happened in the birth per se, but how the person felt about their birth,” she said. “If they felt they weren’t heard, if they felt they didn’t know what was going on, if they felt they weren’t believed about their pain, which can all stem from providers being racist, if we’re being real.”

According to a 2019 study in the Journal of Reproductive Health, Black, Hispanic, Asian and Indigenous women are twice as likely as white women to “to report that a health care provider ignored them, refused their request for help, or failed to respond to requests for help in a reasonable amount of time.”

Rogelio V. Solis / Associated Press

Dr. Felecia Brown, a midwife at Sisters in Birth, a Jackson, Miss., clinic that serves pregnant women, left, measures the stomach of Kamiko Farris of Yazoo City, Miss., Dec. 17, 2021. The clinic utilizes an integrative and holistic approach to women's healthcare by providing comprehensive services including primary care, midwifery care, home healthcare, childbirth education as well as doula support. (AP Photo/Rogelio V. Solis)

Brandi Green is a clinical assistant professor at the University of Texas at Arlington who researches maternal and child health.

She said an example of how stereotypes and systemic racism show up for pregnant people is “a Black woman might say that she’s in pain, but the stereotype surrounding that is that Black women are stronger, they can take more pain.”

Multiple studies highlight how this myth about pain tolerance, which began in the United States to justify inhumane treatment of Black enslaved people, leads to “inadequate treatment recommendations for Black patients’ pain.”

Even as a public health professional, Green said there are things she needed to know about pregnancy that she couldn’t find answers to. She said it made her feel hopeless and scared.

“You don’t want to die,” Green said. “You work with maternal mortality all day, and when you get pregnant, the first thing is not like, ‘Oh, my goodness, I’m so excited.’ It’s, ‘I don’t want to end up like a lot of these women that I’m studying on a daily basis.’”

But she’s hopeful her research will underline the importance of cultural competency and equity training for doctors to better serve Black and other pregnant patients of color.

“I want women when they go into pregnancy to feel the joy of pregnancy and not the fear or the anger,” Green said. “Black women should not be dying in pregnancy or after pregnancy.”

Yfat Yossifor / KERA News

A ‘Repose Area’ is a comfortable room set up for mothers to relax in at Delighted to Doula in Dallas.

Maternal mortality data and programs

Recent research has challenged some of the statistics about maternal mortality in the United States, but disparities still exist.

Cande Ananth is a professor and chief of the division of epidemiology and biostatistics with Rutgers. He recently co-authored a study that said data errors, not worsening outcomes, contributed to the United States’ high maternal mortality rate.

A CDC spokesperson told NPR in March that the organization “disagrees with the findings” and thinks the method underestimates the number of deaths. But Ananth said regardless of the percentages, there are still disparities.

“We generally think it’s structural racism that’s affecting why we see such a big disparity across race [and] ethnicities in this country,” he said. “And that’s another very, very important area that we need to start focusing a lot more on.”

Ananth said these issues have been around for a long time but hopes there’s more of a research focus on what’s driving the different pregnancy outcomes based on race.

“The progress to shorten or reduce the gap between Blacks and whites hasn’t met with much success,” he said. “We need to do a better job of figuring out how to reduce or shorten that gap.”

Maternal health and mortality have been a large focus of the Biden-Harris Administration. The administration put out a maternal health blueprint in 2022, which started by proposing a 12-month postpartum extension for Medicaid.

Advocates, birth workers and researchers have said this extended coverage will lower the rates of maternal mortality and morbidity. In March, Texas extended coverage to a year, , which Gov. Greg Abbott said is projected to impact about 137,000 pregnant people in fiscal year 2025.

Wong Maye-E / Associated Press

Ansonia Lyons carries her son, Adrien Lyons, as she takes him for a diaper change in Birmingham, Ala., on Saturday, Feb. 5, 2022. After two miscarriages, Ansonia became pregnant in 2020, and it was difficult. (AP Photo/Wong Maye-E, File)

The blueprint also calls for more funding. The Health Resources and Services Administration (HRSA) dedicated more than $65 million in 2023 to health clinics and programs.

“We need to center our work around what women know they need,” said HRSA Administrator Carole Johnson. “And when they say something’s wrong, that the system responds to it. The burden isn’t on women. No, the burden should be on the system and the policy environment to get the best possible outcome for all families.”

This also includes the maternal mental health hotline launched in May 2022, 1-833-TLC-MAMA (1-833-852-6262). In its first year in operation, the hotline received more than 13,000 calls and texts, primarily around depression, anxiety and feeling overwhelmed.

“What we wanted to do is give people a safe space 24/7 to call or text and have a conversation with a mental health professional,” Johnson said. “That allows you to…talk about your concerns and talk about what you’re feeling and experiencing.”

In Texas, HRSA has provided funding to the Texas Perinatal Psychiatry Access Network (PeriPAN), health centers in places like Houston and San Antonio, five Healthy Start programs, including in Dallas and Fort Worth, and training for health professionals.

“There are far too many women who face structural, systemic issues that make it harder to trust the health care system,” Johnson said. “That is why we have made this such an important line of work for us in this administration, because those things need to change.”

Yfat Yossifor / KERA News

Simone Scott listens to Prinscilla Moore, Founder and CEO, during postpartum doula training Wednesday, March 27, 2024, at Delighted to Doula in Dallas.

‘You never know when someone is going through that what can really happen.’

Nowadays, Si’Mone Scott works for Delighted to Doula, speaking to clients and doing member outreach.

“I found a passion that I didn’t even know existed,” she said.

She said along with the importance of listening, one of the biggest lessons she’s learned is prioritizing rest, especially after giving birth.

“I’ve become a better person, a better mother,” Scott said. “Because I’m no longer pouring from an empty vessel, I’m learning to pour into myself first. I can’t say it enough how thankful I am and how honored I am to even be able to help other mothers who were either currently or previously in my previous position.”

Scott encourages other new parents to reach out for support before health issues become crises.

“This literally saved my life,” she said. “I literally was having suicidal thoughts, even though I didn’t want to go through with them. That dark cloud…you never know when someone is going through that what could really happen. And so whether suicide, or complications, don’t just put it off.”

For resources and support, call 988 to reach the Suicide and Crisis Lifeline, text HOME to 741741 to connect to the Crisis Text Line, or call 1-833-943-5746 for the National Maternal Mental Health Hotline.

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