“We don’t take walk-ins,” the receptionist at my obstetrician-gynecologist’s office at a large academic medical center told me when I showed up without an appointment on a Friday afternoon and asked to be seen by a nurse.
I was close to 28 weeks pregnant. I’d suffered severe headaches throughout my pregnancy. For the past several days, my feet and ankles had been so swollen that I could not lace up my sneakers. The night before, while receiving an award, I was so short of breath that I had trouble speaking.
The prior weekend, I phoned the nurse on call and told her my blood pressure had been gradually increasing. She believed my symptoms to be a “normal” part of pregnancy and told me to call back if my blood pressure rose over 140/90. I’d just received a blood pressure reading of 142/94 at a medical appointment that wasn’t pregnancy-related.
As a Black woman older than 40 and as a health disparities researcher, I knew that I met several of the risk factors for maternal morbidity and mortality. Instead of going home and calling the 800 number to speak to a nurse on call as the receptionist suggested, I called a friend, colleague and OB-GYN professor who insisted that I go to the emergency room immediately.
By the time I was admitted to the ER, my blood pressure was 182/110 — indicative of a severe hypertensive crisis. Hours later I was admitted and diagnosed with severe preeclampsia.
Preeclampsia is a rare condition affecting 1 in 25 pregnant women a year in the U.S. that is characterized by high blood pressure (over 140/90 mmHg), swelling in the hands and feet, and protein in the urine. Women who are Black and have an advanced maternal age and a history of high blood pressure are at increased risk for preeclampsia. In the U.S., preeclampsia is a leading cause of maternal death, severe maternal morbidity, maternal intensive care admissions, cesarean section and prematurity. The only “cure” for preeclampsia is to deliver.
The preeclampsia rate is 60% higher in Black women than white women. Black women are twice as likely to have preterm births, experience three to four times the maternal death rate and are at increased risk for other poor maternal health outcomes, including miscarriage and low birth weight babies. Black newborns die at three times the rate of white newborns. Black mothers of all incomes and their babies have the worst childbirth outcomes in the U.S.
Racism in health care likely contributes to the misidentification of symptoms, mistreatment of conditions and inadequate access to high-quality health care resources that, combined, lead to poor maternal health outcomes among Black women. Despite the rarity of preeclampsia, the majority of Black women in my social network who have been pregnant have had it — and two of them, unfortunately, lost their babies as a result of the condition.
Chronic stress, which is disproportionately experienced by Black women, is a likely contributor to the increased risk. As a clinical psychologist, I often hear Black women talk about their stress related to employment, finances and family responsibilities. For many Black women, their stress is left untreated as they prioritize taking care of everything and everyone else. Stress that is left unaddressed can negatively affect mental and physical health and reduce life span. The life expectancy for Black women is 76 versus 80 for white women.
I spent the following week hooked up to fetal heart monitor and had my blood pressure monitored around the clock. It became progressively harder to control my blood pressure, and intravenous injections of the beta blocker Labetalol for immediate treatment of severe blood pressure became more frequent. The doctors told me that if my blood pressure could not be managed, I was at risk for seizure, stroke or even death. Nurses attempted to offer me reassurance by saying, “You know, Black baby girls have the best outcomes in the NICU (neonatal intensive care unit).”
The following Friday, I delivered my daughter by cesarean section at 2 pounds, 4 ounces. In the hours leading up to my delivery, a Black female physician from maternal fetal medicine sat by my bedside to explain what was happening and to offer comfort. When I was wheeled into the operating room, another Black female physician put her arm on my shoulder and said, “I got you.”
When the surgery was over, the Black female neonatologist I had seen earlier that week held my baby up for me to see and smiled before she whisked her off to the NICU. Studies have found that when Black patients are paired with Black providers, the quality of their care improves — they spend more time with the patients, and communication is better, ultimately improving health outcomes.
I often replay the multiple critical decision points that ultimately led to a positive outcome for my daughter, Grace, and me. What if I had gone home as the receptionist suggested?
There is much more work to be done to understand the myriad factors that contribute to disparate maternal health outcomes among Black women. To achieve equity in Black maternal health outcomes, we must truly see Black women and the way their lived experiences take a toll on health and the social-political context in which we are desperately trying to survive.
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ABOUT THE WRITER
Inger Burnett-Zeigler, Ph.D., is a clinical psychologist and an associate professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine.
