March 28, 2011
Why Do Pregnant African American Women Die Four Times More Than Others?
When we hear about maternal death, we immediately think of a third world country but in reality, 2 to 3 women die every day in the U.S. from pregnancy and childbirth. Unfortunately, African American women are affected disproportionately and are four times more likely to die than anyone else. The tragedy is that at least half of these deaths are preventable.
In her article, Special Report: Black Women Die Nearly Four Times the Rate of White Women From Pregnancy Complications, Rita Henley Jensen, describes the dilemma of the acting chief of the maternal and infant unit of CDC, Dr. William Callaghan. Callaghan can’t sleep at night because he wants to know why pregnancy is more dangerous for U.S. African American women.
During my residency training, I witnessed a maternal death. It involved an African American woman who was having normal labor until her baby’s heart rate dropped precipitously. As we rushed her to the delivery room, she stopped breathing and by the time we were draped and gowned for the emergency c. section, she was dead. The cause of death was an amniotic fluid embolism that is both unpredictable and unpreventable. Amniotic fluid from the uterus had somehow traveled into the patient’s lungs and she stopped breathing. Unlike the patient described, most maternal deaths are quite preventable if someone is paying attention at the wheel. So here is a “To Do List” for my colleagues who take care of pregnant African American women:
- Do pay attention to complaints of vaginal discharge and don’t assume it’s a yeast infection if the Chlamydia and Gonorrhea cultures are normal. Do the speculum exam because she could have a Trichomonas infection that needs treatment. Untreated Trichomonas can cause preterm labor with its inherent complications.
- Do not ignore blood pressures if they are elevated, thinking she’s “just having a bad day or is stressed.” Send her to the hospital to rule out Pre-eclampsia. Remember, pre-eclampsia is three abnormal blood pressures taken one hour apart. If you haven’t checked for three blood pressures, you’re not following the standard of care.
- Do not send a pre-eclamptic patient home without blood pressure medication if her blood pressure remains high post partum. She could potentially have a stroke and die.
- Do pay close attention to her if she is obese and assume there will be complications and be pleasantly surprised if there are none.
- Do not ignore complaints of asthma, shortness of breath or chest pain, especially in women over 35.
- Do take the time to obtain a patient history and listen to her complaints. It’s what you DON’T know that could come back to haunt you.
I pray for the day when the term “maternal death” is obsolete. However until then, remember– a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
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March 28, 2011 at 12:39 pm
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Shaunes said,
April 14, 2011 at 11:12 am
I had a situation to occur with a pregnancy in 2009 where an abortion was sneaked on me. I have the medical records to confirm my suspicions that oxytocin was given to me in the iv (unknowing to me) along with fentanyl, morphine, oxycodine, and percocet.I was treated very horrible. I did blackout after they cut the umbilical cord of 18 week old fetus. I was sent home within a few home to die, barely with any blood in me and infection. I didn’t have a bowel movement for about a week. Within 24 hours, I was cold in one part and hot in the other part of my body. My feet were cold and white like a dead person. I couldn’t get any attorney to take the case in TN. I have filed a federal complaint, filed with the TN Department of Health, Joint Commission, and various other outlets. I didn’t contact any media source direct except pro-life. I did continue to have shortness of breath and palpitations even a year later.
The next time around,10 months later, I kept informing the various doctors that I had been having shortness of breath and it was took as a part of pregnancy. I switched between 2 practices. One of the practices was so horrible, they were doing racial politics with us. They knew I was severely high risk and had these dense nurse practitioners. I was complaining about my leg and short of breath. Well approximately 5 months later, with the many hospital trips and visits 2-3x a week, had a gangrene family infection in my leg that was so painful. I stayed in the hospital 1/2 week before delivery and almost a week after. I had to return a few days later, and diagnosed with congestive heart failure.
They need a stiffer legality of nurse practitioners being primary caregivers to high risk. They need a network agency of taking our health serious even though it may seem small. The blood pressure may be normal or seem able to sit home. They need to become more pro to doing echo cardiogram for more detail information that the cuff or sonogram may not pick up.The ultrasound didn’t pick up the infection in my leg that had me at risk of amputation.
drlindagalloway said,
April 18, 2011 at 10:59 am
First, let me thank you so much for sharing your story. I know it well. Nurse practitioners are NOT supposed to manage high risk patients unless they’re under the direct supervisor of a maternal fetal medicine specialist but of course that never happens. Hopefully, you are under the watchful eye of a good cardiologist and if you were to become pregnant again, please insist upon a maternal fetal medicine specialist. Hope your health continues to improve each day. Blessing to you.
Pepyone said,
April 14, 2011 at 11:51 am
I was blessed to have a very caring and concerned doctor. I had fibriods and was over 35 with my first pregnancy. My doctor was astute with checking blood pressure, taking me off work. forcing me to stay on bedrest and continously monitoring me throughout my pregnancy. He informed me as to what to watch out for and never to assume that its minor. I stayed in emergency during my pregnancy so much, they knew my voice at the first word I spoke. I am the proud mother of a 12 yr old son and I praise God for a doctor that did not treat me like an average pregnancy. One that was on the look out for any possible danger concerning me and my unborn child.
drlindagalloway said,
April 15, 2011 at 1:08 am
That’s how it’s SUPPOSED to be. God bless your physician and so happy that you were blessed to have a 12 year old. I’m curious, is your physician still practicing? It’s become extremely difficult for conscientious physicians to maintain a private practice. The hospitals are trying to buy up all the practices so that they can increase their referral base. Thanks so much for sharing your story and please spread the word.
Acyz1@aol.com said,
April 18, 2011 at 11:41 am
Yes. Dr. Alfred W. Sloan in Placentia, CA is still practicing.
Acyz1@aol.com said,
April 18, 2011 at 11:54 am
Also, my ob/gyn is African American. I am so grateful he is!! I strongly believe this aspect preventing the assumption that black women can just pump babies out and are naturally baby making machines. I have seen too many of black woman suffer unnecessarily because of poor care. One was in going into her 4th month and bleeding. It was a Friday night, and they told her to make an appointment for Monday. I told her to use her husband’s insurance and to to emergency. I was totally appalled that she was instructed to do something that even I know could have resulted in the death of her unborn child and her.
Professor C. Toney said,
April 15, 2011 at 9:23 am
As a professor of Psychology & Human Development of a small rural Central Florida College, we note some staggering issues:
We are meeting young woman who have had their first child very young. They may deliver their first child at 13 and have 5 children by the age of 24.
Once they are pregnant, early prenatal care seems to be absent particularly if they have had two children already – considering themselves prepared based on the last child that may seem healthy now.
Unfortunately, we also reside in the crystal meth capital of the state so in many cases drugs could be involved along with additional teratogens. Florida is considering “drug testing” public assistance recipients and this reason and this reason only, I would be in agreement with the passage of such a law – the newborns need the protection.
Early pre-natal care is so important because many believe that if they can bypass early prenatal care at the onset – they have dodged a bullet, not realizing that many health issues will not be found until much later when the child begins to walk, talk and or enter the educational system as our special education teachers are overwhelmed!
How can those of us that teach human development help to get this message across? In many instances we are the young mothers’ first glimpse at prenatal development.
Professor C. Toney
Human Development & Psychology
drlindagalloway said,
April 17, 2011 at 11:25 pm
Professor Toney,
Thanks for your comments. My experience with pregnant women is slightly different. The women who have a large number of children and don’t access prenatal care until late usually do so because they are overwhelmed in taking care of the small children that they have and can’t or won’t take the time to begin prenatal care early. A trip to the NICU to see critically ill babies might change their perspective or speaking with a young mom whose baby’s legs had to be amputated because of the gangrene that set in as a result of extreme prematurity. If you ever need someone to lecture on these issues, I’d be more than happy to comply. Thanks again for your comments.