The USA is right up there with third world countries, albeit they have lowered their numbers, with pregnancy and birth related deaths. The reasons are inexcusable - it is one more shame to bear.
10
No one has mentioned the insurance companies! I was a home care nurse for many years. Most of my patients were pregnant or postpartum. During pregnancies that were having complications my visits could pick up things that were going on and notify the OB. I could also see their home, and support systems. My favorite story is a young lady with diabetes. When I checked her blood sugar it was high I asked what did you eat? She said a bowl of Cherios. Since I was at her home, I was able to say show me the bowl. It was a really big bowl, not a cereal bowl. I was then able to look at other foods in her home and talk about serving sizes and show her how to monitor. This would not have happened at most provider offices or in a hospital. Once the baby was born, I could assess both Mom and Baby for complications and teach baby care. No you cant add extra water to the formula to make it last longer!! Most of my patients lived in the inner city of Baltimore. Many were very young (12-17) Insurance companies stopped paying for most of these visits and/or Doctors decided they weren't necessary. I truly believe having these visits could do a lot to decrease Maternal and Child M+M
20
one comment on native Americans- Congress needs to live up to treaty commitments and fund health services at a realistic amount
13
Reporters should all take a year of epidemiology so they know what constitutes a meaningful article.
Obesity, cardiovascular diseases were mentioned. That's not enough. A meaningful report would state whether these risk factors were controlled or not.
Were socioeconomic factors e.g. income, education taken into account and controlled?
How about diabetes?
I may have seen the word "hispanics" in this piece, I don't think the word "asians" appeared at all. Do they not have maternal deaths?
Surely the CDC put out a well considered, highly professional report; would that journalists had the education to transmit it intelligently to the public.
15
citizen vox
Controlling for SES, black women still face mortality and complications with pregnancy. Even pop star Beyonce had problems with her pregnancy. It must be chronic internal stress that indiscriminately affects black women far beyond any other racial group.
7
My experience is that post-natal care for women is so minimal. When I gave birth for the first time almost 10 years, I was shocked by the lack of post natal care. You go the OB once every couple weeks, then every week throughout pregnancy. Once I left the hospital, the expectation was that my OB/GYN would see me in 6 weeks and then only for my annual. I had a complication a couple days after I left the hospital and the nurse I spoke to on the phone told me to call my PCP. I insisted on speaking to the OB. My thinking was that a complication (phlebitis infection) sustained under my OB's watch should be treated by my OB. But that attitude, that once I walk out of the OB unit, I wasn't a maternity case any more really galled me. That's how it is in the US. Post-partum depression is another thing that it seems like there isn't enough followup with the mother to really deal with. My Pediatrician asked questions about my state of mind at my son's appointment. Good pediatricians do this because they know moms aren't getting post natal care.
16
I wish it was because they care. i'm pretty sure it's mandated by the state. at one of my son's check ups the physician assistant gave me a check list - do you want to hurt yourself or your baby etc. in many european countries they send people to your home to make sure you are ok.
7
As Ms. Rabin knows, this is part of a distressingly old and persistent story about racism in our health care system: https://www.commonwealthfund.org/publications/newsletter-article/2018/sep/focus-reducing-racial-disparities-health-care-confronting ("Reducing Racial Disparities in Health Care by Confronting Racism, 27 Sept 2018). That article focused on heart disease, breast cancer, stroke and more. That pregnancy is now formally added to the list is no surprise. Here is one statement from that piece:
"...Black mothers die from pregnancy-related complications at three to four times the rate of white women. And while maternal mortality has been dropping in Sub-Saharan Africa, rates actually increased in the United States from 2000 to 2014. Socioeconomic status, education, and other factors do not appear to protect black women from this risk, while factors including smoking, drug abuse, and obesity do not explain the differences."
The piece goes on to discuss components of the problem including structural racism, transportation and missed appointments.
Our national health care providers should do much better.
7
Sadly -- there is 20% of cases along all race groups that fall into this problem .. and another 20% from simple one week followup failure.
That's a huge part of the problem -- it's not delivery.
The lower rates within the hispanic community show this post delivery care need ... often within the structure of extended families.
These issues do disproportionately impact Women of Color, but Low-income individuals, including White Women, also impacted negatively by their treatment in the American Healthcare System need to be better researched and considered as desirable for mention in these types of articles. They are often forgotten by politicians; perhaps because Whites are a majority in many cases.
5
Obesity seems to be a serious risk factor in pregnancy. Much sound and fury in the article and in the letters because obesity rates vary between racial groups. One practical, non-controversial solution would be to provide more intensive pre and post natal care for all overweight pregnant women regardless of race.
12
@Brian Levene
The lower Hispanic rate of 11.4 suggests that being overweight or obese is not a sufficient explanation. We need much better science so we can have medicine and care that is personalized.
13
Do Nationalists and neo-Nationalists ( like Steven Miler in the mold of his Italian Mussolini fascists who perished in the end) know about this?
2
Pre-eclampsia/eclampsia is much more common in blacks and the highest cause of death so what is the surprise?
9
This is tragic of course, but 700 deaths a year for *all* racial backgrounds sounds like a very very low absolute number indeed.
6
@pd compare it to other western nations. It's atrocious.
8
I'm angry but not surprised that so many comments blame the victim, in particular referring to obesity. And so many of those comments are from male readers.
23
@Martha Shelley The tiresome victim blaming conclusions/opinions are so old! Especially when the article plainly states using that the obesity risk factor alone does not account for the mortality rates.
9
Health care ends for many mothers on Medicaid 6 weeks or 42 days after a vaginal delivery and 8 weeks or 60 days for a cesarean section. Problems that develop as a result of pregnancy - hypertension, diabetes, thyroid disorder or anemia, just to name a few - are left untreated at that point. Many of the deaths occur from these untreated complications that are a direct result of pregnancy. We should continue health care for all women and babies for at least a full year after delivery. That this article comes just before Mothers Day is very timely.
18
@rosy I suspect that diabetes (T2D) is a huge, silent factor in the background of this story. Given undiagnosed T2D or insulin resistance, these moms would be at higher risk.
7
Hospitals are not nearly so comfy to women as they are to men to begin with. Throw in color, indigenous ancestry, and poor people, who are often overweight and you've got a class of females who just don't receive the same care. The complexities of poverty are not well understood by medical staff. Multi-generational trauma doesn't always have the best mental health outcomes. It's a doctor thing. It's not a nurse or social worker thing, it's a doctor thing.
9
@Sam Cheever
Other and larger studies have adjusted for income and education the the same outcomes: Black Women die in numbers disproportionate to other groups. Several authors are beginning to conclude it is insidious bias- racism at its core that results in these poor outcomes. Ugly but true.
7
I am an old black man & I cry when I read what many black mothers/grandmothers are doing to themselves & their babies. My heart broke yesterday when an overweight friend stated on Twitter that she was preparing a heart attack dinner for herself and her grandbabies; smothered porkchops (with gravy, of course) etc and described it as "Yummy!" Heart Attack Alley is consistent with high black population and a refusal to read or even listen to outside voices of caution. It is a stretch across the South with more cardio-circulatory problems than any other in the US. It is a sub-culture thing that will lead to outcast status for any of us blacks pointing it out. It is suicide by predilection.
Having watched so many of my younger relatives be buried along with all my older ones, I run against the grain in having refused all of the old sub-culture dietary staples, replacing them with lots of veggies, fruit, salads, juices with large doses of exercises.
The medically most abhorrent diet and practices are the norms and all statements from any source to the contrary is nodded to when stated by good authorities and thrown out the window once the door is closed.
I will be scorned for this statement but there is no doubt in my mind that the predilections of the subculture, at least for American blacks, is the clear culprit that is causing the devastation. Look at the rate of overweight/obesity(over 70%) in young black women, these are the heads of households in way too high a percentage.
41
I wonder how much of this disparity relates to health care professionals dismissing or ignoring black mothers' concerns about their own pre birth and post birth status. A famous incident is Serena Williams, who nearly died because doctors and nurses refused to listen to her concerns about a medical condition with which she was familiar. When she was finally listened to, it turned out she was correct.
3 of the 4 mothers in the "Black Mothers Respond to Our Story on Maternal Mortality" reported the same issue of reporting a medical condition and being dismissed or ignored by doctors and nurses.
29
@Lynn in DC
You mean the same dismissive commentary seen throughout this comment section: the victim blaming for their obesity, the poverty, too many sex partners. Yeah I see I too. Too many of my fellow practitioners just won’t go somewhere and get their bad cases of elitism and bigotry treated.
9
So sorry that Senator Harris chooses to politicize this. She has be smarter than that. Why not use studies like this to get at the root of this disparity: access to maternal care, obesity, unhealthy choices like smoking, etc. if the Senator truly cared about this issue, that’s what she would emphasize instead of engaging in the demagoguery of race. I was thinking of supporting her.
16
@MD Monroe
How has the issue been politicized by Harris (or Warren) mentioning it as an issue? Is there something more to this beyond what was stated in this article? How can we get to the root of this disparity if no one speaks about it or considers it important? Seems like talking about it and indicating it is a problem worth investigating (and trying to fix) is step 1.
31
@MD Monroe There is no "demagoguery of race". The fact is that the American government and institutions have historically gone out of it's way to disenfranchise certain racial/ethnic groups for 242 years. Nothing has been done to really improve the lives of the people who have been disenfranchised for hundreds of years, with the only real progress being made in the 60s. You don't cure diabetes by taking one pill one day, but rather making several lifestyle changes. Same here.
7
@MD Monroe Why is it that when a woman or a person of color points out the disparities by gender or race, they are "politicizing" or "playing the race card"; but ignoring or covering up the facts is not "politicizing" or "playing the race card"? The answer is prejudice -- believing that when a system is serving the dominant group in power, and under-serving or harming those of marginalized social identities, it is operating normally as it should. Failure to recognize the politicized nature of this, and trying to silence those who point it out, only continues the legacy of discrimination. Not talking about racism doesn't make it go away.
9
like being pregnant at age 15 isn't a major contributing factor.
37
@bx Shouldn't girls giving birth at age 15--which involves a legal definition of rape--be given absolutely excellent care? Your comment appears to blame their childbirth-related illnesses and even death on these girls for having become pregnant so young.
21
@bx first of all, teenage pregnancy has been decking for years. Second, if you pay any attention to the studies you will note thane even when you adjust for all the factors people are using to dismiss this, there is racism disparity. Check out some of the many, many studies of healthy black women are dying.
18
@bx Actually maybe not, health-wise probably preferable to 40 or 45!
15
Does anyone give a thought to the possibility that different races experience different rates of death linked to pregnancy because, well, they are of different races biologically?
It's well known that African Americans have much higher rates of twin birth, for example. How account for that except on the basis of biological differences?
It's also well known that Hispanics have lower death rates linked to pregnancy, and indeed pretty much across the board. This despite their greater economic disadvantages compared to whites.
Is there any genuine interest nowadays in scientific truth, or in a real solution to problems, if it should upset the race taboo applecart?
17
@frankly0 Hispanic is not a race.
7
I like how a large majority of commenters here are on the topic of obesity and diabetes in pregnant women of color and no one yet has mentioned the increasing age of pregnancies in white women. Talk about a risk factor! Just keeping pointing fingers at POC and ignore what's happening in your own communities.
17
@S
What is age a risk factor for? Is it death of the mother or certain birth defects in the child? I thought it was the latter. The article is about death of the mother. It's not about the health of the baby. taht's a different topic.
2
@Anti-Marx You've forgotten the third possibility - both! This is the correct answer.
2
This article would be less racially inflammatory if instead of using white women as the denominator, it grouped American women into High maternal mortality ethnicities (black and Native American) versus Low mortality ethnicities (Hispanic, white, and Asian). Here are the stats from the CDC for pregnancy related mortality ratio:
Hispanic 11.4
White 13.0
Asian/Pacific Islander 14.2
American Indian/Alaska Native 32.5
Black 42.8
So, it's not some kind of white racist conspiracy to kill nonwhite mothers.
21
@Steve Sailer No one said it was a racist consipracy but rather that healthcare disparities persist and are probably due in large part to America's unwillingness to eradicate those disparities. Some people feel that any talk of racism implies that all white people are racist, when we are merely talking about the fall out that persists because of America's history of not correcting institutionalized racism. The problem is less about individuals being racist or elitist but rather the government's support (unintentional or intentional) of racist and socioeconomically elitist policies.
11
@Nora
Or perhaps the fact that Hispanics have a lower maternal death rate than whites means something else unrelated to the conventional trope of system racism is at work here and it would be good for researchers to figure out what it is.
9
I wonder what are the risks of post pregnancy deaths among Hispanic women? They have simaliar levels of poverty and they certainly must be going the day to day stresses of life as well. Could it be the difference in maternal diet , which is culturally influence, familial support or underlying genetics? This continues to baffle me as a person of color. Black women do suffer from stress related to issues such as racism, but could it be that through a poor diet and a poor lifestyle far before a conception and pregnancy and in combination with chronic stress be the reason why Black women are least likely to survive a pregnancy? Chronic stress and the stresses of pregnancy could be the igniting the fuel for major health problems Black women including death.
9
It's interesting that so many claim that obesity is the cause of the high rate of African-American women dying while giving birth. I've spent a lot of time in the United States and, believe me, Black women aren't the only ones who are obese.
What strikes me is the lack of empathy and compassion in these comments. What kind of people are unable to show even the tiniest bit of sympathy for another person's suffering? What does it take away from these people to show some concern for their fellow citizens. Is this why the US is in such a miserable state?
Americans claim that the United States is a 'Christian' nation, but I don't think Christ would agree.
25
@laura174
Jesus, not being a Christian but a Jew, would likely have little to say about whether the United States is a Christian nation.
(It's not). Your conclusion -- based on the relatively small number of critical comments --that the people here have no sympathy or concern for their fellow citizens seems hasty...dare I say lacking in compassion? I urge you to pluck out the misery in your own state before projecting it onto an entire country. I think Christ might agree with that, don't you?
2
@laura174
Bravo Laura! You are on to something indeed.
1
Instead of racial disparity- why are we not looking at 700/3.8m and starting with deaths are rare?
“Overall, maternal deaths are rare: Some 700 deaths related to pregnancy occur each year, while there are 3.8 million births.”
7
@Rick
Because the statistics are appalling when you compare America's maternal deaths to those in the other high income countries. "Abysmal record" is the phrase in the article. It's even MORE appalling when you consider that the U.S. spends twice as much per capita on healthcare than most of the other wealthy nations! We spend nearly $11,000 per person on healthcare annually. Germany, which has the best measures in all healthcare areas, spends $5,728 per person annually.
16
The general overall rate of women dying in childbirth in the United States is much higher than many other countries. Regardless of the color of your skin, or your race, or your ethnicity, you'd be better off having a baby in Libya. Or Kuwait. Look it up.
9
The headline omits what is towards the end of the article, "While 13 white women die for every 100,000 live births, the rate for Hispanic women is even lower: 11.4." There are 60 million hispanics in the U.S. it would be good science to understand the better health outcomes.
12
Make no mistake about them, as controversial as the terms are in some quarters still, but access and opportunity are not the same thing as rights. And health care should be a right. Like many other odd things about the US versus most other industrialized democracies, our aversion to talking about the racial basis of what all have available is often given away by stark statistics of life and death.
I'm sure the argument will now ensue about how this couldn't possibly be the result of racism, even as the facts suggest we cannot begin to have an adult conversation about this racism thing until we admit it is the problem with much of our public policy. And refuse to be an enabler of the past any longer.
7
“three times more likely to die” This isn't racial bias in the health system.
Racism is not some holdover from slavery; it's a white supremacist government strategy like war or unequal justice.
4
@Fourteen14Why do you think this white supremacist govt. strategy isn't used against Hispanic and Asian women, who have very low rates of maternal mortality?
4
If you look at not only the data but the many, many stories African American women have been producing about being in labor, a consistent issue is that nurses and physicians are slow to respond to their pain and concerns. So you end up with women bleeding to death when it could have been prevented. I know it makes people feel better to think that people bring bad outcomes on themselves, but when you know that a black woman and a white woman can go into the hospital with the same health and the back woman dies in labor because they were more responsive at the first sign of the white woman’s issue, the medical establishment needs to step up. And everyone else needs to stop blaming the victims.
32
Did I miss something? Saying that some outcome is 3x more likely then some other outcome is often a misleading and useless statistic. PLEASE share the data...
This is the same way drug companies mislead us. If my chances of dying from some disease are 1 in 1,000,000,000 (a billion) but with the new drug my chances are reduced by 3 times to only 1 in 3,000,000,000 (three billion), this doesn't mean the drug is particularly useful.
Without telling us the actual mortality figures of various racial groups of pregnant women, you have left readers wondering whether this is a really big deal... or not?
10
9 years ago i had my second daughter. The anesthesiologist dismissed my pain post epidural. She actually said. Maybe you are too fat around your spine. I was in pain to the point i couldnt walk when discharged.
It wasnt till i turned and saw she tried to stick me several times. When i asked, she dismissed me even after i told her i was a nurse. She end up damaging part of my spine.
This is an every day occurance for women of color. Of all backgrounds.
18
As an Asian American female , I always wonder why we are left out of these studies? Not to take away from the shocking disparity between white and other minorities, but it’s always dispiriting to be completely ignored .
37
@KHM The study does have a category "Asian/Pacific Islander" -- the mortality rate is far lower than African-American, Native American and Alaska Native, and slightly higher than White.
6
@Joel thank you. It would be nice for them to mention it in the summary somewhere, even if as an afterthought.
4
I think a more statistically significant study would be to compare poor single white women to poor single black women. My assumption is that the rates would be very close.
At the same time, I assume that married middle-class black women have much lower death rates than poor single white women.
Another factor I would look at is obesity and diabetes.
This is about education and poverty, not race. But of course in this era, everything is about race.
33
@Erik
"My assumption" - "I assume" - what you actually know is zero, yet you are ready to assert what isn't and is the cause of these statistics? Why don't you get a graduate degree in statistics, do a study yourself, and then get back to us.
8
I think the burden of responsibility needs to be fairly shared. If you don't take care of yourself, the chances of a difficult pregnancy and an unwell baby are increased. Has absolutely nothing to do with racial bias. Certain populations are clearly afflicted with certain diseases (diabetes, hypertension, etc.) and need to be extra cautious. The author obviously wanted this to be a racially charged essay. The truth is much more basic and banal.
19
Let’s also look at the level of healthcare coverage for pregnant women in the USA. How does that vary by race and what are the outcomes by type of insurance?
6
@vladimir
When is your peer-reviewed study being published? Can you tell us what journal? I want to be on the look out for it. Thanks!!
4
The crux of the argument is:
More women who belong to populations where obesity has increased over time due to poor diet and exercise regimens are dying from complications of obesity and the stress brought on by pregnancy. It honestly has nothing to do with ethnicity; it just so happens that the strong increase in death occurs in those groups.
13
Yes those communities may suffer from excess weight and a lack of exercise. However by blaming the victims you utterly fail to take consideration the political economy of racism. Poor diets are for example due to the lack of access to healthy foods due to income and discrimination in food distribution. As for the lack of exercise that is structured by access and discrimination. The American health care system is based on health as a commodity not a right as it is in so many other advanced wester capitalist societies. That core issue exacerbates problems of access and the quality of care.
23
@Kevinlarson This, from another commenter, seems apt:
@WorldPeace2017
I am an old black man & I cry when I read what many black mothers/grandmothers are doing to themselves & their babies. My heart broke yesterday when an overweight friend stated on Twitter that she was preparing a heart attack dinner for herself and her grandbabies; smothered porkchops (with gravy, of course) etc and described it as "Yummy!" Heart Attack Alley is consistent with high black population and a refusal to read or even listen to outside voices of caution. It is a stretch across the South with more cardio-circulatory problems than any other in the US. It is a sub-culture thing that will lead to outcast status for any of us blacks pointing it out. It is suicide by predilection.
Having watched so many of my younger relatives be buried along with all my older ones, I run against the grain in having refused all of the old sub-culture dietary staples, replacing them with lots of veggies, fruit, salads, juices with large doses of exercises.
The medically most abhorrent diet and practices are the norms...
I will be scorned for this statement but there is no doubt in my mind that the predilections of the subculture, at least for American blacks, is the clear culprit that is causing the devastation. Look at the rate of overweight/obesity(over 70%) in young black women, these are the heads of households in way too high a percentage."
2
Died from hemorrhage shortly after childbirth in 2018:
Age 33; healthy Hispanic woman; college graduate, full time employee with insurance; full prenatal care; full term birth of a healthy infant; delivered in a major hospital in Atlanta GA on Monday afternoon.
Her extended family is still suffering PTSD.
There is NO good reason for American women to die in childbirth.
28
@MGU I'm so sorry.
6
Goodness- these Comments! So many [primarily male] posters oddly defensive about this article. Eager to blame women for not going to appointments, or being obese, or having genetic risk for diabetes, or assuming that Black & Brown skin are equivalent to poverty, and poverty is to blame. Our maternal mortality problem is incredibly complex, and yes, it does involve those things (more co-morbidities in the maternal population, poverty, etc), but there have been tons of studies (some summarized in the embedded links in the article) sorting out these factors, which show that race ALSO matters, independently. Our U.S. healthcare system & culture also seem uniquely at fault, as peer nations don’t experience similar failings. Why the resistance to acknowledging that, and what’s the harm in exploring exactly why race is a factor in America, particularly when it stands to improve ALL women’s health? I’m a nurse-midwife; if anyone should be defensive about poor maternal health statistics and systemic racism in women’s health, shouldn’t it be us OB providers and not random NYT commenters? But no, we women’s health providers want to address these problems, and naming them is part of it. I think most of us in women’s healthcare recognize that the U.S. system is unsupportive of women’s reproductive lives at every turn- impeding family planning, no parental leave, OB care deserts (low payments making OB financially unsustainable), etc. Societally, we must start valuing women’s lives.
79
Though I now live in the US, I had both my children in the UK where I was very impressed with the postpartum care. For two weeks after the birth, a midwife checks on the mother and baby in almost daily home visits. I had difficult births with complications and it immensely helpful to have at home visits. This practice is standard across the UK. It was strange for an American like me to get used to a midwife turning up at my house with no appointment every day, but it was also super helpful and reassuring. They monitored my blood pressure, anemia, stitches, as well as baby’s health. Only when they were sure I was on the right path did they stop coming.
74
@Sahra: Very sadly, if anyone suggests implementing this wonderful program of home visits in the US, cries of "socialism!" will echo off every wall, and every vote will be against it.
27
I think the call got more frequent post delivery checkup is a good idea. A lot goes on after delivery! It would also be an opportunity to screen for depression . Why not combine well baby and well mother visits with a mid-level provider to keep everyone in the new family healthier.
12
Stories about the horrific experience tennis star Serena Williams had giving birth opened my eyes to this problem. She had to fight for her life. Imagine what would have happened if she had not been famous, wealthy and assertive.
48
I am a pelvic floor occupational therapist in private practice. I have approached OBGYNs about doing postpartum house calls where I can screen for medical instability, post part in psychosis, and teach pelvic floor exercises which prevent future incontinence, diastisis recti, and prolapse. Insurance would cover this under the complications related to pregnancy code. I have not been met with much enthusiasm. It could be because I am not part of the hospital system; but it is the hospitals who decided to build Las Vegas style suites in his stead of doing postpartum home visits.
33
@Tara Las Vegas style suites, as you call them, don't reduce the funds available for postpartum home visits. They more than pay for themselves and provide cash flow for other hospital operations.
4
@Tara As You might want to communicate with the public directly, e.g. new mother groups, etc. I am not an OB/GYN not am I in private practice but I do know that MDs are often busy and they forget to order things because of other pressing issues. So, as an MD and academic, I do the occasional talk to educate the public about services they may want to talk to their doc about, e.g. cardiac rehab which is fully reimbursable, medically effective, but shown to be underprescribed to women after heart surgery, heart attacks, etc. People tell me they talk to their docs who then prescribes it. The docs don't oppose it on principle: they just often are too busy.
1
We attended a "natural birth" class when my wife was pregnant with our first baby, and I was frankly horrified. My questions about complications and medical emergencies that might be fatal if they occurred outside of a hospital were met with perplexing equanimity, or deflected with a rant about the evils of the medical industrial complex. The observation that a woman could bleed to death from postpartum hemorrhage in 5 minutes was met with skepticism and a change of the subject.
I imagine that natural birth advocates will seize on this study, to market their services to minority and low-income populations. That will do them no favors.
20
@Patrick
Natural birth, meaning a vaginal, unmedicated delivery, is not inherently more dangerous than a medicated birth.
A c-section is major surgery, and comes with it's own set of risks, but if it is medically necessary, the risks pale in comparison to to losing the mother or child.
I think your terminology is inaccurate, because natural birth isn't unduly dangerous.
2
@Kelly Clark
I have a feeling that you know what I intended, but in the case of the natural birth center I referred to, they defined "natural birth" on a continuum, with the most natural being one that took place in their natural birth business, or at home, or at a lake, or wherever - as long as there were no doctors or medicine.
Un-medicated is all well and good, if that's your choice, but eschewing trained medical personnel in the service of some "natural" ideal, for one of the most fraught and vulnerable moments in one's life... well, that's what the birth center was selling, and they sold it dishonestly.
You may say that the likelihood of complications is less; however, if it goes bad, then the consequences can be so much worse for the mother and the child. Natural birth advocates have the same standing as anti-vaxers in my book.
7
@Patrick My wife is a high-risk OB. She has had about 2 handfuls of cases in her career of frank uterine rupture (meaning, no previous surgeries), where, if the woman hadn't already been in the hospital (because she was on bed rest, or starting labor, etc), she would've bled out in 5 mins or less. Each time they had about a minute or two to get the mother to the OR, perform an emergency c-section, and stop the bleeding.
Now, this is a pretty rare occurrence, but it is absolutely catastrophic if it does occur. Natural birth advocates downplay this too much. Pregnancy is perfectly natural, clearly, but people forget that it's taken the whole of modern medicine to reduce the maternal mortality rate from roughly 1-2% per birth, to about .0001% on average in developed countries.
9
The underlying driver for a significant share of this problem is well known in the medical community - although they often dare not say it out loud. Women of color are manifesting obesity and overweight rates that are without precedent.
"The high prevalence rate of hypertension in black women could be in part attributed to the finding that ≈80% of this population is overweight or obese." (Journal American Heart Association)
This leads to an epidemic of hypertension that is of great danger to moms and their unborn kids and we need to start saying it out loud. And it is clearly not 'racist'
https://www.ahajournals.org/doi/10.1161/JAHA.117.006971
49
Gestational hypertension can develop in any women. I am a young, non-smoking, healthy white woman who weighed 118lbs. before pregnancy. Nevertheless I developed dangerously high blood pressure (also known as preeclampsia) during pregnancy to the point that my organs were shutting down and my baby had to be delivered a month early, then spend a week in the NICU. Maybe you should rethink your stereotypical, knee jerk reaction that fat black and brown women are to blame for their own deaths, and instead recognize that many symptoms of potentially fatal preeclampsia (headache, blurred vision, stomach pain, high BP) can be all too easily written off by prejudiced medical professionals as simply the natural condition of those women most likely to die.
20
@SteveRR The linked report may not be racist, but you sure are close to the line. As are many of the other male commenters. What is it about issues that affect folks that aren't like you than makes you so quick to judge?
9
@AB I wrote a comment along the same line as your about root causes that will get me murdered here as black women get on this article. I have not hit the submit button yet on my comment. I have been busy reading some of the vitriol released against others addressing this.
I look further down and I see patronization by professionals. Patronizing does nothing but exacerbate an already bad situation. Only hard facts and good remedies will turn it around.
4
Racial disparity is no joke. We see it on the news everyday. As clearly stated in the article African-American, Native American and Alaska Native women have a three times higher rate of dying due to pregnancy related causes than white women. We aren’t blind to this fact, but we sure like to pretend like there is no issue. Women who are pregnant deserve prenatal/postnatal care to assure for the best outcome of mother and baby. We have things like Medicaid which is great, but needs to be more accessible. This really is a ‘white-mans’ country… we as a whole have so much money that could go towards the wellbeing of people but we choose to direct it elsewhere and its outcomes are awful. More needs to be done to protect everyone’s lives here.
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Wouldn't your general state of physical health have an impact on how your body handles being pregnant? How much is proper/not proper nutrition a factor?
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As I just noted above, no, your pre-pregnancy health does not determine your pregnancy experience. I am a young, non-smoking, healthy, professional white woman who weighed 118lbs. before pregnancy, ate well, exercised, and sought my prenatal care at a state of the art research university. Nevertheless I developed dangerously high blood pressure (also known as preeclampsia) during pregnancy to the point that my organs were shutting down and my baby had to be delivered a month early, then spend a week in
the NICU. Despite a consistent diet of whole, minimally processed foods both before and during my pregnancy, I developed gestational diabetes as well. Then during labor, because my son had a pointy shoulder, I developed a severe hematoma and required emergency surgery and two blood transfusions. So no - it is neither true nor helpful to say that women wouldn’t die during pregnancy if only they exercised more personal responsibility and took better care of themselves.
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@AB I’m truly sorry to hear of your ordeal, it brings back memories of my wife’s delivery of our now 18yr old daughter. My wife bled severely. Two generations ago, or even today in a third world country, she would have died. And she like you was in good physical condition and ate well.
However, there is a high statistical correlation between preeclampsia and obesity. That doesn’t mean that a normal weight woman will never experience it, or that every obese woman will. But it will strike obese women at a higher rate than normal weight women.
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@Shiv
There are a host of other medical issues that can strike during pregnancy or after delivery other than preeclampsia and which have nothing to do with weight. I suggest you spend a little time googling, Shiv. Pro-Publica has done some great journalism on this topic.
My sister developed preeclampsia with both of her pregnancies. It was well managed under the circumstances--with the second baby, because they were on the look out for it-- and she had a c-section when things started going south.
She also lost half her blood and wound up having three blood transfusions.
All sorts of stuff can go wrong, and it often has very, very little to do with how healthy you are before birth whether you had "proper nutrition." Part of the problem is that women are often not listened to, dismissed, ignored, not taken seriously, etc. Kind of like what you and Josh are doing.
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This would be a more meaningful article if it presented mortality statistics on a basis the excluded factors other than race, such as educational level, income, geography and pre-existing medical conditions. Until that is done, Ms. Harris has no basis for blaming the outcome on racial bias.
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@Joel
All other things being equal, such as socioeconomic and educational level, black and native women have 2-6x more likelihood to die of a pregnancy-related illness.
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@Kelly Clark What is the basis for that statement? The CDC study cited in the article doesn't support it. And 2-6x is such a wide range that one has to wonder about the validity of any analysis that might produce it.
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@Joel
Another article about maternal mortality is linked to right at the bottom of this one: "Why America's Black Mothers and Babies Are in a Life-or-Death Crisis," which says: "Education and income offer little protection. In fact, a black woman with an advanced degree is more likely to lose her baby than a white woman with less than an eighth-grade education." In turn, that articles links to this: https://www.brookings.edu/blog/social-mobility-memos/2016/10/21/6-charts-showing-race-gaps-within-the-american-middle-class/, which proves that very statement.
Maybe instead of doubting race's impact on women's health and asking other people to prove it to you, you could do the research yourself. Nevertheless, this is not about blame, it's about finding out how to solve the problem.
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This problem is not unique to the United States. I am white but I had a horrific experience giving birth to a mixed race child in Germany. I was kicked out of the delivery room because there were not enough staff on hand to oversee my labour, and we were not initially allowed to reenter when we asked to be let back in. A doctor told me the next day that they would have given me better care had they known that my husband and I were professors. I have been in pain for part of almost every day since (nearly twenty years) in consequence, although thankfully following a heart procedure when he was thirteen months my son is fine.
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Is it about health or healthcare? They are not the same. A 300lb person might receive a lot of healthcare yet not be healthy.
We can't address this issue, unless we talk frankly about obesity, health, and race.
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@Anti-Marx I think we do need a conversation about what we mean by health care before any massive overhaul of a broken system. People's health is a function of their life style (both chosen or imposed), luck and genes. Diet is much more important than we are willing to acknowledge. So does stress and anxiety regarding adequate nutrition and housing.
We also need to discuss what limitations on health care we will accept (so called death panels).
Can we act like grown ups and do this? I don't know.
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@Phyllis Sidney
Why would someone who wasn't certain of adequate housing or nutrition have children? Heck, I won't have kids unless I can send them to private school and buy my family a summer home with a tennis court.
Income disparities, education, and access to prenatal and postnatal care are important factors. But not the only factors. Another recent study found that doctors don't listen to black women or take their complaints seriously on the same level as they do white woman. Racial bias has made them more dismissive about legitimate and sometimes serious complaints they attribute to exaggeration or hyper-sensitivity. Women have died because of these assumptions, and not just poor women. Though no doubt the problem is far worse for poorer women. I can't recall bourgeois feminists paying much attention to this. Tragic.
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infections and inequalities plays a role but so do beliefs. certain communities have beliefs that don't always line up with positive outcomes. have you ever heard anyone saying that I need to eat meat everyday to get protein? how about potato chip companies that sell double bag potato chips to African American communities because people think they are a good deal. corporate America greed and an at risk group.
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@rjv I worked at the U of Chicago hospital in Hyde Park where an ER doctor said that it was typical for an African-American coming in to deliver her baby to say that her last meal had been "potato chips and soda pop".
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“Everyone should be outraged this is happening in America,” Ms. Harris said on Twitter, blaming the deaths on racial bias in the health system.
That sort of naked political opportunism makes my skin crawl.
The article is also to blame for highlighting racial disparities, but only some racial disparities, and not others. Like the fact that maternal mortality for Hispanics is lower than that for whites.
To leave that fact out is wrong on at least two counts. First, it leads its readers to grossly oversimplify the problem. It reinforces the narrative endlessly peddled by the NYT that every disparity is the result of discrimination. In the NYT no one dares mention possible genetic differences among populations.
It is also wrong because it prevents us from accurately diagnosing the problem and so helps perpetuate it.
Surely there must be peer-reviewed journal articles that disentangle the different factors that contribute to the US's lousy record. The self-serving statements of on-the-make politicians have no place in a discussion like this.
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@Ian Maitland
This is actually mentioned in the article.
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@Ian Maitland
Direct quote from the article: "While 13 white women die for every 100,000 live births, the rate for Hispanic women is even lower: 11.4. The figure for African-American women is 42.8 for every 100,000 live births, and for Native American/Alaska Native women, 32.5."
The rate for African-American women because the mortality rate is 3.3 times the mortality rate for white women. This is obviously far more significant than the 12% difference between mortality rates for Hispanic and white women.
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@Kelly Clark
Thanks Kelly. My bad.
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If the goal is to prevent maternal deaths of minority women (and also poor white women)–not sure that’s the goal though--then this kind of finding is yet another argument for strong nationwide single payer AND paid parental leave.
This kind of thing also highlights Clinton destroying welfare.
All omitted in this article I see.
Submitted May 7th 4:06 PM Eastern
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Another example of bad faith journalism. Ignores that the actual incidence of maternal deaths is extraordinarily low (about 700 deaths/year). More importantly, exacerbates political divides by stressing racial disparity without discussing differences in pregnancy related deaths by income/wealth level. Are mothers of color dying at disproportionate rates because of racial discrimination? Or are they dying at disproportionate rates because poorer people have different access to resources, including health and informational resources? Shame on Roni Rabin for sensationalized reporting to attract eyeballs at the expense of civic society.
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@scientist
Direct quote from the article: "Overall, maternal deaths are rare: Some 700 deaths related to pregnancy occur each year, while there are 3.8 million births."
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Looks like the increased death rates pretty much match the 'unwed' mothers rates, according to this chart.:https://www.childtrends.org/indicators/births-to-unmarried-women
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@Joe Your point is what? That women who become pregnant when not married are choosing to develop obstetrical complications and die? When did correlation become causation?
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@ MLChadwick: You read a LOT that is not there, and assumed some sort of moral judgement, I think.
I neither SAID nor implied that those moms were making a choice to get sick and die. Not at all! WHATEVER made you think that? But lack of financial resources on the part of an unwed mom, which is much more typical than a married mom with a husband (or in this day and age, perhaps a wife) to help the finances, leads to better availability of money for better medical care. Pre- and post-natal care has a financial cost. If you can't afford to pay for it, you're not getting the same care as you would if you had the money - for food, vitamin supllements, a good diet, doctor's visits, etc. And ALSO, the ability to stay at home with the child, instead of having to rush back to work to pay for normal household expenses means the mom can get better rest, which helps to keep her strong. And stay alive.
Asian - American women?
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As always, there is conspicuous silence about the fact that peripartum mortality is actually lower for Hispanic women than white women.
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It's because they are on average younger.
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@Stephen
That IS in the article.
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The Times is becoming so predictable:
Hispanic-Americans have a lower pregnancy-related mortality rate than whites. Asians-Americans are higher than whites.
Just look on page 35 of the CDC report linked here: https://www.cdc.gov/grand-rounds/pp/2017/20171114-presentation-maternal-mortality-H.pdf
Why doesn't the Times include the link and report all racial groups in the data? You lose credibility when you cherry-pick.
The increased deaths seem to be linked to cardiovascular difficulties. And yes, of course we want to improve maternity risk for all groups, including Black moms.
Accurate reporting is important.
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@Michael Haddon Thank you so very much for noting this & I applaud the NYTimes for not censuring you. We need to have all the voices that are reasonable heard! And we need to have the good ones, like yours, acted upon as soon as possible.
There are so many factors in this complex scenario that we just cannot cherry pick.
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@Michael Haddon Thank you for bringing this up. As an Asian-American woman and medical researcher, I was wondering what the stats were like for someone like me. While the NY Times could pay more attention to Asian-Americans, this is typical of almost all media: when issues about race are brought up, Asian-Americans are generally ignored or not mentioned unless the issue is about academics.
I suppose I would have to read the report in-depth but it's strange how insurance coverage of Medicaid -- which runs out 60 days post-partum -- is buried at the end. Healthcare access plays a huge role in this country vs. other countries with national health care systems.
Also, this story reminds me of Serena Williams and her complicated pregnancy.
6
Republicans seem to care a lot about babies in the womb and 6 week fetuses, but not so much about the health of the mother and the health care provided to the mother.
Government intervention to protect the 6 week old fetus, but government failure to provide medical care to the mother and 9 month old baby.
It’s a disgrace in the wealthiest country on the planet.
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@Patricia Brown I agree, but I don't think this is the wealthiest country in the world. Certainly not in terms of healthcare provided to all, access to pre and post natal care for mothers and infants. And certainly not in terms of generosity of spirit anymore.
2
A breakdown of deaths by race by type of insurance - Medicaid, employer plan, Obamacare, other and no insurance - would be informative
8
I live in a mixed-race, mixed-income apartment complex, and I observe that most of the African American residents, which are predominant, eat only fast food, and fast food kills. There needs to be a huge public health campaign to that effect. But, it's not going to happen.
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@Sara
I have another anecdote. I once lived in a majority white suburb whose residents fought tooth-and-nail to keep a Popeye's out of a popular strip mall. They lost, the Popeye's opened, and every time I passed by, it was packed with white people. Popeye's food may be tasty but everyone will agree it is not a healthy choice. Even white people eat fast food, surprise surprise.
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The other day I was watching an entertainment program of the "real-life-ER" variety that was filmed in an Australian hospital. A couple of episodes centered around the labor and delivery experience of two first-time moms. Watching the film I was struck two things: First by the level of unhurried care provided these women - including the midwives and doulas that rarely left the room. Secondly: the conspicuous absence of any male physicians in the process. Not saying there's a causal relationship there, but our system in the US does seem to drive an agressive, male-dominated, intervention-focused experience as opposed to simply providing the care these women need.
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Read the article closely. According to the American College of Obstetricians and Gynecologists there is systemic discrimination. That means that you can assure that minorities have access to care, but their mortality rates will remain higher because of the prejudices of caregivers.
If prejudice is causing a large number of deaths, that is a criminal issue, not a health care issue. Apparently, health care providers and cops have a lot in common and there a lot of race-based crimes among caregivers.
8
It’s all about the Money. Allocate significantly more Resources to pre and post natal care, and this tragedy could be nearly eliminated within a Decade. But then, the Rich might have to skip another round of Tax Cuts. Or even worse, some huge Corporations might have to actually PAY Taxes.
Vote. 2020. Lives depend on your Vote.
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I wonder if the racial disparities would be mitigated when controlling for income. I'd bet that these minority groups have lower income than their white counterparts; this is significant because it becomes increasingly difficult to live a healthy lifestyle and access healthcare as your income decreases.
Programs like Medicaid and SNAP help, however, thinking about my city, even if someone has a full SNAP benefit, not everyone is close enough to a store that provides healthy options. Even if those healthy options were available, would they be affordable?
Reducing disparities is important. Let's just not be distracted by focusing on race. Focusing on eliminating a racial disparity is to ensure poorer minority receives an outcome equal to the poorest whites, the outcome is improved for the minority but is this still poor outcome now acceptable? When it comes to dying mothers in one of the richest countries in the world, I say not.
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No. Other articles have pointed out that black women with master’s degrees have worse maternal death rates than white high school dropouts. When Serena Williams almost dies because her doctors ignored her very specific and correct concerns, you know it’s not about money.
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@Joe Actually your should research before you comment. With this particular issue a Black women with College Degree and Earnings over 100k per year is still more likely to die from complication than a white women with no high school education or employment. Google is a wonderful thing. And you are not a women so you have no clue how Doctors and Nurse dismiss the health concerns of women of color across the board.
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@Brandi - I'm a gay male. Do any doctors or nurses listen to anyone?
They are obviously all deaf or they would have heard the lecture telling them if Mylantra was right for me or not.
1
In April 2018, the Times did an in-depth article about maternal mortality and black American mothers - linked at the end of this article. Research found that the higher mortality rates were in fact not causally linked to being "of color," nor were they invariably the consequence of differentials in care. African-immigrant black mothers, even from poor communities, even with limited prenatal/postnatal care, nonetheless had mortality and morbidity rates comparable to the white American population. It was African-*American* mothers who were suffering. What's more, high-income, highly-educated African-American women still suffered from higher mortality/morbidity rates, despite getting excellent medical care and being economically secure. This was an extraordinarily thought-provoking article about a critical scientific puzzle, and should be read in conjunction with today's.
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No discussion of obesity, preexisting Type 2 diabetes or gestational diabetes?
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This statistic is not an illusion. Minorities in this country are treated as third class citizens since birth. The socioeconomic structure of this country assures that minorities will grow up less healthfully than their white counterparts. This has been the case throughout this country’s history. Pregnancy is an enormous stress test for a woman’s body. If a youngster is brought up in poverty she is less likely to survive pregnancy. More currently, now that regional hospitals have consolidated into large medical centers to maximize profits women have to travel longer hours for prenatal care, have to spend more money doing so, and are less likely to make it to obstetrical delivery units on time. All these factors will contribute to increased maternal mortality among minority’s and eventually- in spite of what white people think- will eventually affect maternal mortality among rural white women as well.
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@Allan Bahoric, MD Minorities are treated like third class citizens since birth? You are obviously stuck in 1955.
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@Allan Bahoric, MD
In other words, it’s a class issue, not a race issue, as your conclusion makes clear.
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There is indeed a racial disparity, but the majority of this problem is directly related to obesity, which the article didn’t really seem to give its due. The academic literature is filled with maternal deaths being majority associated with obesity, and obesity significantly increasing acute and chronic cardiac problems in mothers, esp women of color, that are either exacerbated by pregnancy, caused by it, or both. Poverty is a definitive factor in this, as it diminishes access to healthcare and higher quality food (esp since Native Peoples/POCs genetics tend to do even worse than whites with a WPD/SAD diet, which is objectively bad for everyone).
I think it’s a problem that changes in healthcare access and procedure can reduce, but only to a degree. The disparity will continue to exist as long as the larger societal issues undergirding it remain.
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@PollyAndy
A key aspect of this problem is that our food supply is theoretically tended by the USDA. Unfortunately, the USDA has been given a conflicting obligation to encourage markets for certain food producers. Grain supports result in well-fed cattle and overfed humans while lack of support to fruit and vegetable producers means most diets are short on fiber, vitamins and minerals and all kinds of micro nutrients, some of which have probably not been identified.
As is often the case, money-fueled legislation prevents the poorest among us from having better health, better health care and more productive lives.
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@PollyAndy Unless you have evidence of these studies you can show, if you've never been a black or Native woman, you will never understand the difference in the level of treatment received by them. Saying the majority of the problem is obesity and poverty is racist in itself. Show some real proof.
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@Deb Google is your friend. But i'll help out this time (these are just a few):
https://www.ncbi.nlm.nih.gov/pubmed/27279358
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263937/
https://www.mhtf.org/2018/01/29/in-jamaica-obesity-is-linked-to-higher-risk-of-maternal-death/
https://www.nature.com/articles/0801670
Obesity is related to a whole host of maternal and fetal morbidities, and Pregnancy Related Death is one very serious outcome. And the only thing race has to do with it is that non-whites generally have higher rates of obesity.
https://www.cdc.gov/obesity/data/adult.html
https://www.kff.org/other/state-indicator/adult-overweightobesity-rate-by-re/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
Poverty and obesity in the US have a direct linear correlation (a strong "r" value):
http://diabetes.diabetesjournals.org/content/60/11/2667
And I never said there is no difference in treatment. I said that regardless if you entirely eliminate whatever difference in treatment there is, there's still going to be a disparity that isn't answered by changes in healthcare policy or practice. It definitely can help. But it isn't the whole story, or even the major part of it.
7
Medicaid provides a lot of care for mothers and babies. Are people making use of what's available? Are people taking care of themselves while pregnant, i.e., going to prenatal appointments?
Are people watching their weight when pregnant? These questions must be answered before assuming the cause is racial prejudice.
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@simon
You have no idea sir. Not only are there racial disparities but the ability of medical staff to accurately hear and respond appropriately to the female patient’s concerns has been or is compromised for a variety of multilayered reasons.
After almost dieing from bilateral third degree vaginal lacerations and bleeding I went home to more bleeding. I was a happily nursing mother, the male ob/gyn proscribed ergot. After one pill and my sense that it may have negatively impacted my child, I researched the drug and found it was counterindicated for infants and in historical matters could have been the biotoxin that created the strange behavior that resulted in the Salem Witch trials. I never saw him again and finally after ten or so years was seen by a hemotolgist who treated me for chronic anemia.
And I am lucky enough to be a physcian’s daughter and worked in the healthcare field. This report is spot on and confirms other recent reporting. Wake up.
21
@simon your question shows that
you assumes 1) Medicaid is the only healthcare resource used by these women and 2) that weight is the cause of all the mortalities. Do you think no one has done any research to back this article?
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@simon
I'm sure that the dedicated research scientists at the CDC who study these issues for a living didn't think about those obvious variables.
Thanks for bringing this to our attention, simon from MA.
/sarcasm
22
The problem isn't merely racial bias within the health care system. The problem also is racial (and class and gender) bias among the people who allocate resources to the health care system, and who allocate resources to the many people who need help in getting access to the health care system. This disparity could have been greatly reduced or eliminated if powerful people thought that eliminating it was important. Why haven't they thought so (and actions speak louder than words on issues like this one)?
25