This NYT Mag story about a young woman who lost a baby to unrecognized preeclampsia and then had another baby shortly thereafter with the help of a doula is arresting. It highlights some of the research (discussed at greater length by ProPublica here) demonstrating that even after controlling for income or education levels, black women are still more likely to die from a pregnancy or childbirth-related cause:
The reasons for the black-white divide in both infant and maternal mortality have been debated by researchers and doctors for more than two decades. But recently there has been growing acceptance of what has largely been, for the medical establishment, a shocking idea: For black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions — including hypertension and pre-eclampsia — that lead directly to higher rates of infant and maternal death. And that societal racism is further expressed in a pervasive, longstanding racial bias in health care — including the dismissal of legitimate concerns and symptoms — that can help explain poor birth outcomes even in the case of black women with the most advantages.
I want to highlight something that Dr. Anthony Bradley mentioned on Twitter: for infant mortality, the black-white gap converges when mothers are married (this study seems to be the source for this claim, though the authors note that race is still a stronger risk factor than marital status). I’d be surprised if marriage is as protective for maternal mortality as it is for infant mortality, but other data and common sense tell us that having someone who lives with you and loves you is good for your health. Conversely it’s not surprising that, given what we know about the role of stress and mental health on perinatal health, that being in a tumultuous, unstable, violent relationship (as the subject of the story was in) would be more harmful to mothers and their children. (Don’t forget that one of the most common causes of death for pregnant women in America is homicide.)
So, then, having someone supportive and knowledgeable (e.g. a doula) is helpful. But programs like the one described in the article probably also help just by linking pregnant women to care when they need it:
“Being a labor and delivery nurse in the United States means seeing patients come in acute medical need, because we haven’t been practicing preventive and supportive care all along,” Giwa says. Louisiana ranks 44th out of all 50 states in maternal mortality; black mothers in the state die at 3.5 times the rate of white mothers. Among the 1,500 clients the Birthmark doulas have served since the collective’s founding seven years ago, 10 infant deaths have occurred, including late-term miscarriage and stillbirth, which is lower than the overall rate for both Louisiana and the United States, as well as the rates for black infants. No mothers have died.
There are no straightforward interventions for fragile families or toxic physiologic stress. Things like doula programs and universal healthcare (so that women can be in care before they even get pregnant, which will allow them to prevent or control any pre-pregnancy health issues) are accessible, and we ought to use them to chip away at maternal and infant mortality while we can.