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U.S. maternal deaths keep rising. Black women are most at risk

ANA RODNEY: I have two little stinky little boys. I say that lovingly - Aiden (ph), 8, and Asher (ph), 2.

SCOTT DETROW, HOST:

Ana Rodney is 38 years old and lives in Baltimore, Md., with her sons. She says she always imagined the birth of her first child would be beautiful, what she considered a very natural thing.

RODNEY: I wanted to have a home birth. I wanted to have a water birth. I'm a hippie. I used to tease my friends like, leave me alone. I'm going to just go to the woods and give birth to my son.

DETROW: That didn't happen.

(SOUNDBITE OF MUSIC)

DETROW: During her pregnancy, Rodney had life-threatening blood clots in her left leg. She says she repeatedly told doctors about her symptoms and was repeatedly ignored. That didn't change until a friend who was a nurse went with her to the hospital and demanded that Rodney be admitted. After she delivered her son by C-section, internal bleeding led to an emergency surgery. Weeks later, her incision site became infected. Rodney says that even though the pain was so intense that she could barely walk, a doctor checked the scar and said she was fine. The next day, she went back to the ER and was admitted with an aggressive infection. And while all of this was happening to her, her son Aiden was also struggling for his life.

RODNEY: He was born at 28 weeks.

DETROW: Her son was 1 pound, 5 ounces when he was born.

RODNEY: He spent about six months in the NICU.

DETROW: Rodney spoke to NPR producer Brianna Scott. She says she hoped when she gave birth that it would be a partnership between her and the medical staff. But that wasn't the case.

RODNEY: I was also navigating institutionalized racism, fatphobia and all types of different biases and felt the need to qualify myself. Every time I had a question or a pushback or a concern about my son's care, I felt that I needed to recite my resume or somehow prove that I was worth listening to, as if him being inside me for the last couple of months did not make me enough of an expert on my child.

DETROW: So she had to advocate for herself and her son over and over and over again.

RODNEY: My baby is going to come out of this hospital. My baby is going to survive. I believe that if I hadn't personally made that decision, that I don't know that Aiden would be here playing Switch and going to camp and playing soccer and watching the Mario movie.

DETROW: The U.S. has the highest maternal mortality rate of the world's high-income countries, and in recent years, the numbers have gotten worse. According to a new study published in the Journal of the American Medical Association, maternal death rates remain the highest among Black women, and those high rates have more than doubled over the last 20 years. When compared to white women, Black women are more than twice as likely to experience severe pregnancy-related complications. They're nearly three times as likely to die.

For our Sunday cover story, we look at why this problem is getting worse and what doctors can do to start to fix it. I spoke to Karen Sheffield-Abdullah about it. She's a nurse-midwife and professor of nursing at the University of North Carolina, Chapel Hill. She works with medical staff to help improve maternal health outcomes. I asked her why, in all this time, it's been so hard to reverse this trend.

KAREN SHEFFIELD-ABDULLAH: If I were to be perfectly honest and transparent, I think one of the biggest pieces of it is that we can do a better job of listening to Black women and what they are saying in terms of their own lived experience as they navigate the health care system and, really, how they're interfacing with the health care system in ways that are not optimal and, truthfully, biased.

DETROW: Can you tell me about any one particular situation that comes to mind that you've been in where doctors you worked with or you know have acknowledged unconscious bias that might be getting in the way of listening and any approaches that they took differently, that had a different outcome?

SHEFFIELD-ABDULLAH: I did grand rounds at a particular academic hospital with physicians, medical students, residents, attendings, nurse-midwives, and I was speaking in particular about the importance of listening to Black women when they speak. And so there was a particular attending who identified as a white female physician of 20 years who said, Karen, how do we even have the conversation surrounding stress and mental health for Black individuals in particular? Like, I don't even know where to start. And what I explained was for Black individuals, our pain is notoriously underassessed and underaddressed, and we really need to think about these higher-profile individuals, like Serena Williams, like Allyson Felix, like Beyonce, like Tori Bowie - but as we think about Serena Williams, knowing that she had a history of a blood clot from 2010, and then after her delivery, she was complaining of symptoms, and she wasn't listened to.

And so what happened was this person then took that story anecdotally, and that very week after the grand rounds, she saw a Black patient in the office who came in with really vague complaints of calf pain. And she said it wasn't really high suspicion for a blood clot or what we call a DVT or deep vein thrombosis. But she said, you know what? I listened to what Dr. Sheffield-Abdullah had to say and specifically the story regarding Serena Williams, and I went ahead, and I ordered an ultrasound. And, indeed, this individual had a blood clot.

And it is a direct correlation to the fact that that grand rounds where it was elevated that we need to listen to Black women, that I changed the way in which I practice. And I want to be able to get that message back to Dr. Sheffield-Abdullah. And so to me, that is at the essence of what we need to be doing as health care providers. This person came to the office kind of downplaying her complaint of calf pain, but that particular provider listened, did the testing that needed to be done, and that's a potential life saved.

DETROW: Why do you think doctors have such a hard time listening? Because you mentioned some of the high-profile stories with, particularly, people like Serena Williams, and I feel like that cuts across so much because you see this, and you think - if somebody as accomplished and in tune with her body as Serena Williams is not being listened to, who else isn't being listened to? What do you think the root of this broad problem is?

SHEFFIELD-ABDULLAH: I think as we think about physicians in particular, they tend to not have a lot of time to be able to spend with their patients, right? If we think about their schedules and how many patients they are slotted to see in a given day, they don't have the time to sit down and do the deeper dive, to really sit and listen to what is going on for this particular individual, what's happening socioculturally, what's happening psychosocially, what's happening with their mental health, what's happening with their ability to be able to access certain resources, right? And so if we're not able to assess that, we're not giving optimal care.

DETROW: So listening to you, I hear a way forward on the individual level - on the ground level for doctors and medical professionals of, just listen more. Believe patients more. Seek out subtle clues. What are the broader systemic fixes to this?

SHEFFIELD-ABDULLAH: Certainly, we would - could think about diversifying the health care workforce so that the individuals who are taking care of the community look like the community they're serving - right? - so diversifying the health care workforce, inclusive of physicians, midwives, doulas, mental health care providers. I think funding studies that center the lived experience of Black women and Black birthing people is super important. And I truly believe that if we were to ask the Black community what do they need, they would tell us. And rather than us as acamedicians (ph) and researchers and physicians pontificating from our silos about what we think a community needs, how about we spend the time asking the community, what is it that they need? - because they know better than we do.

If you feel like you are not being heard, then you go on to the next person. You speak to the next person until you feel you are being heard, because it truly is life and death. And I honestly believe that I want to create a society by which Black women are seen, they are heard and they are inherently valued. And that is fundamental. And so if they are not being heard, take it to the next person. Elevate it. Escalate it until you are heard because they are really reconciling - having conversations with their partners, with their spouses - if you have to choose between me and the baby, choose the baby. And the fact that they're having those conversations in 2023, in this here United States, is just unacceptable.

DETROW: You tick through all of these enormous challenges, and you keep coming back in conversation to the solution that seems so simple, but I imagine that there's layers there of just be quiet and listen to people in the doctor's office.

SHEFFIELD-ABDULLAH: When I was thinking about this, listening to Black women - it seems so simple, and yet it is not easy for health care providers, right? And so really spending the time to help educate health care providers of different race ethnicities as they're taking care of this community - of the Black community - to be able to do the work, Scott, to be able to do their work of understanding the historical nature of why a community may show up with mistrust and distrust. Sitting with that, having done your own work - right? - and then sitting and saying, how might I best support you? I don't know that we can ever be culturally competent in another person's culture, but I can certainly show up in a culturally humble way that says, I don't know everything, but I am here to learn to how best take care of you. What do I need to know about you to best support you across your prenatal course so that we can optimize your pregnancy and birth outcomes? And the CDC is clear - 4 out of 5 of pregnancy-related deaths are preventable. We need to do better, and we can.

DETROW: That's Dr. Karen Sheffield-Abdullah. She's a nurse-midwife and a professor of nursing at the University of North Carolina, Chapel Hill. Thanks so much for joining us.

SHEFFIELD-ABDULLAH: Thank you for having me. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Scott Detrow is a White House correspondent for NPR and co-hosts the NPR Politics Podcast.
Brianna Scott
Brianna Scott is currently a producer at the Consider This podcast.
Jeanette Woods
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