Black women far more likely than whites to die giving birth

By Arianna Coghill and Kaytlin Nickens
Capital News Service

RICHMOND — Last fall, Tanca McCargo, a Chesterfield native, found out she was expecting her second child. McCargo, who already had a 3-year-old boy, discovered early on that her second pregnancy would be different. Her complications began when she experienced light bleeding.

“The morning after scheduling an appointment with my OB-GYN, I passed an actual blood clot,” McCargo said.

She was sent to the emergency room for a transvaginal ultrasound, which allowed doctors to examine her reproductive organs. They found that McCargo’s pregnancy was ectopic: Her fertilized egg had attached to her fallopian tubes instead of to her uterus.

McCargo, 22, faced a life-and-death dilemma. If she proceeded with the pregnancy, her fallopian tubes likely would rupture, causing internal bleeding and possibly her death.

There was only one other option. “I couldn’t keep the baby,” McCargo said. “That was the most heart-wrenching and traumatic experience I’ve ever had in my life.”

Three months into the pregnancy, McCargo decided to have an abortion. But even that did not go smoothly.

Doctors gave her chemotherapy injections to stop the fetus from growing, but they initially didn’t work. “Those injections made me feel horrible. I was nauseated almost all day every day,” McCargo said. “I experienced extreme fatigue, I slept less — it was just overall mentally and physically exhausting.”

Eventually, the abortion was performed. McCargo is still recovering from her ordeal. Currently, she is a stay-at-home mom caring for her son, Zakhai.

Her situation is not uncommon. For black women, childbirth can be a death sentence. Nationwide, African American women are three to four times more likely than white women to die from pregnancy-related causes, according to the U.S. Centers for Disease Control and Prevention.

That is true in Virginia as well.

Among white women in the commonwealth, there were 11 maternal deaths per 100,000 births last year, the nonprofit United Health Foundation reported. But among the state’s African American women, there were 36.6 maternal deaths per 100,000 births.

Virginia’s chief medical examiner highlighted the racial disparity in a report released last month.

“Black women in the United States and Virginia are known to suffer the greatest burden of pregnancy-associated death, a perplexing and consistently reported fact. In each of the 15 years of pregnancy-associated deaths reported in Virginia, the mortality ratio for Black women exceeded that for White women,” the report stated.

On the national stage, several black women have stepped forward with their own experiences of pregnancy-related challenges.

In an HBO series, tennis star Serena Williams, who gave birth to a daughter in 2017, described having complications during her pregnancy and labor. And in a Netflix special, the singer Beyoncé opened up about the difficulties she faced when pregnant with twins two years ago. She experienced preeclampsia, a sudden, potentially life-threatening increase in blood pressure.

Are black women treated differently?

Throughout her pregnancy, Jazmine Brown felt uneasy, filled with unexplainable emotions and pressure. She especially resented visiting her doctor.

Brown said the doctor treated her dismissively — not like the other patients.

Brown said she wasn’t sure whether the reason was because she was “young and black” or her insurance situation.

“I felt like they didn’t want me to be there — like I was inconveniencing them,” said Brown, who worked and attended Tidewater Community College at the time.

Brown’s job didn’t cover all of her medical expenses, so she turned to Medicaid. “When I was pregnant, I had Medicaid to pick up what my job insurance wouldn’t,” she said.

Brown said that she received a lot of backlash at her prenatal visits and that the pressure began to weigh on her. The situation came to a head when “we had an ultrasound appointment, and I was no more than 5 minutes late.”

Brown said she arrived at the building on time — but was late to the doctor’s office because she had to take the stairs.

“I was only 23 at the time, and she felt like it was OK to yell at us for being late, and I had never been late before,” Brown said.

The unsettling feeling led Brown to look into other doctors’ offices — where the waiting rooms were filled mostly with white middle-aged women. “I saw how they would talk to them differently,” Brown said.

She tried to find another OB-GYN, but the ones that would accept Medicaid had a waiting list. “In March, I looked, and they said they couldn’t see me until June — my baby came in July,” Brown said.

A month before Brown’s due date, she was diagnosed with preeclampsia.

As her due date approached, Brown received a little more attention, but she said her feelings were still hurt. “I will not settle for that treatment again,” she said. “I know they saw me just as a ‘poor little black girl.’”

Brown subsequently gave birth to a daughter, Jamie. Now 24 and living in the Virginia Beach area, Brown is a currently a stay-at-home mom and a student at Norfolk State University.

Research suggests that it wasn’t Brown’s imagination that she felt mistreated and agitated during her pregnancy. African Americans sometimes are treated differently by health care providers and experience greater pregnancy-related stress, studies show.

According to a 2016 study by the University of Virginia, black people are systemically undertreated for pain in relation to white people. Researchers found that a substantial number of white medical professionals and students held false beliefs about biological differences between black and white people.

For example, they might think black people have tougher skin or that their blood coagulates quicker than in white people.

Moreover, the nonprofit Seleni Institute found that black and Latina women are at a higher risk for mental health issues after pregnancy. Backing that up, the Icahn School of Medicine found that 44% percent of black women — versus 31% of white women — reported symptoms of depression after their pregnancy.

New law calls for ‘awareness and prevention’ about maternal deaths

Maternal mortality rates have alarmed members of the Virginia General Assembly.

At the start of the 2019 legislative session, Democratic Dels. Marcia Price of Newport News and Lashrecse Aird of Petersburg introduced a resolution “recognizing the maternal and infant mortality crisis in the United States.”

The resolution said:

• The United States is the only industrialized country with a rising maternal mortality rate.
• Maternal and infant mortality “is exacerbated by factors such as poverty, gender inequality, age, and multiple forms of discrimination, as well as factors such as lack of access to adequate health facilities and technology and lack of infrastructure.”
• “Considerable racial disparities in pregnancy-related mortality exist, with deaths per live birth for black women nearly three times higher than such deaths for white women.”
• “The root cause of these disparities is longstanding structural racism, which has contributed to poorer health outcomes among communities of color.”

The House Rules Committee never held a hearing or voted on the resolution. However, the General Assembly passed a bill requiring the Virginia Department of Health to review the rate of pregnancy-related deaths.

Under HB 2546, the department will establish the Maternal Death Review Team, which will include state health officials and outside experts.

The bill was sponsored by Republican Del. Roxann Robinson of Chesterfield and Democratic Del. Kaye Kory of Fairfax. It says the team will improve data collection and record keeping regarding maternal deaths and recommend ways “to increase awareness and prevention of and education about maternal deaths.”

On April 3, the General Assembly unanimously approved minor changes that Gov. Ralph Northam had recommended concerning HB 2546. It will take effect July 1.

Birth in Color RVA Provides Help for Pregnant Women

RICHMOND — Pregnant women in the Richmond area can get information and other assistance from a newly formed advocacy group — Birth in Color RVA.

The organization’s goal is to educate and provide support especially for women of color during their pregnancies.

“It’s important that black women are taught about their body — that they’re taught about their options during pregnancy,” said NyTasha Stevens, an advocate at Birth in Color RVA.

The group is a collective and network of birth workers who provide culturally centered support to women and families during pregnancy and birth and postpartum.

Stevens has been a birth worker since January 2018.

“I always tell women to make sure that you and your doctor are on the same page,” Stevens said. “You have to interview the doctor taking care of you. You can’t just assume the doctor giving you pap smears since you were 16 is the doctor you want to help you give birth. It’s a different ball game.”

Stevens speaks from personal experience. She got pregnant at age 20 — before becoming a birth worker. At the time, Stevens was unaware of questions she should have asked her doctors.

With her first pregnancy, Stevens was pregnant with twins. Looking back, Stevens said there was a lack of communication between her and her physicians.

“Before I was in labor, I wasn’t permitted to eat. I wasn’t permitted to stand or walk around,” Stevens explained. Now that she is a birth worker, Stevens knows that she has more options than she originally thought.

Birth in Color RVA seeks to make black women feel less alone during the entire pregnancy — from beginning to childbirth.

As a birth worker, it is Stevens’ job to build a relationship with the expectant mother and to be there for her at every step during the process. Stevens’ responsibilities include advising women about breastfeeding and accompanying them to appointments with their doctors.

Stevens has a gift — and a personality — for anticipating and accommodating the needs of her clients.

“I’m incredibly nosy,” she said.