WASHINGTON — When U.S. Rep. Cori Bush of Missouri was pregnant with her first child, Zion, she saw a sign in her doctor’s office encouraging her to speak up about anything unusual she was feeling.
She did so, telling her physician that she was having severe pains, but her concerns were swiftly dismissed. The doctor told Bush, who is African American, that she was fine and sent her home — and one week later, Bush went into early labor.
“At 23 weeks, my son was born, one pound, three ounces,” Bush told a congressional hearing Thursday on Black maternal mortality. “His ears were still in his head. His eyes were still fused shut. His fingers were smaller than rice, and his skin was translucent, a Black baby, translucent.”
Bush recalled that the doctor who delivered her son apologized for not listening to her.
But when she was pregnant with her second child, she faced the same situation. She again went into early labor, and a different doctor refused to help her, telling Bush in a clear reference to her race: “You can get pregnant again, because that’s what you people do.”
Her story is far from unusual.
Mothers, spouses and loved ones of Black people who have died as a result of childbirth complications described their experiences to the House Oversight and Reform Committee in heartbreaking detail.
Black birthing people are three times more likely to experience pregnancy-related death when compared to their white counterparts, according to the Centers for Disease Control and Prevention. They also experience higher rates of pregnancy complications, infant loss, and miscarriage.
Affluent Black Americans also are disproportionately affected: a Black person with a college degree is twice as likely to experience a severe physical or mental complication from childbirth than a white woman without a high school degree, said Dr. Veronica Gillispie-Bell, medical director for the Louisiana Perinatal Quality Collaborative and the head of women’s services at Ochsner Medical Center in Kenner.
In a Monday interview with the Illuminator, Dr. Gillispie-Bell walked a reporter through a report from the state’s Reducing Maternal Morbidity Initiative, which had been released by the Louisiana Department of Health that morning. The report shows that the state has made progress since 2016 in reducing the number of people giving birth in Louisiana who have episodes of dangerously high hypertension or lose dangerously high amounts of blood.
Severe maternal morbidity events are defined as “unexpected outcomes of labor and delivery that result in significant short or long-term consequences to a woman’s health.”
In birthing centers that are participating in the Louisiana Perinatal Quality Collaborative, severe maternal morbidity events involving hypertension dropped 12% between 2016 and the second quarter of 2020. During that same time frame severe maternal morbidity events involving hemorrhaging dropped 36%.
Louisiana has made that progress, in part, Gillispie-Bell said because more and more doctors and nurses are treating elevated high blood pressure during pregnancy as the emergency that it is and because more medical personnel are measuring the amount of blood lost during delivery and not just estimating it.
At an April 14 hearing of the Louisiana Senate Committee on Health and Welfare, Argarette Weatherspoon-Collins told lawmakers that her daughter Jessica Collins-Ruffin, then 6 months pregnant, went to see a doctor in March 2020 and when she was turned away because her insurance had just lapsed, she went to an emergency room where her blood pressure registered 280/190.
Weatherspoon-Collins said her daughter’s distress wasn’t given sufficient attention and that she had a seizure and a stroke. The newborn, who was delivered via Caesarean-section died days later and his mother died a few days after that.
Although Louisiana’s total number of severe maternal morbidity events related to hypertension decreased overall between 2016 and the first quarter of 2020, the number of those events for Black patients increased: from 734 per 10,000 in 2016 to 789 per 10,000 in 2020.
Despite the recent emphasis on treating hypertension in pregnancy as an emergency that requires quick attention, Dr. Gillispie-Bell said it can take 17 years for new medical strategies based on research to reach the nurses and doctors at a patient’s bedside. When she testified to the congressional committee Thursday, she said that with a targeted strategy, that “evidence-based medicine can be implemented at the bedside” in “only three years.”
Gillispie-Bell and other medical experts said race and the country’s long history of racism are at the root of why childbirth has a greater likelihood of turning fatal for those who are Black.
False medical beliefs about Black people — including that they have thicker skin or a greater tolerance for pain — have contributed to health care providers being less likely to listen to and act upon health concerns raised by Black patients, studies have found.
Dr. Joia Adele Crear-Perry, of the D.C.-based National Birth Equity Collaborative, referred to research which found that Black patients who undergo a cesarean section are less likely to receive the same pain treatment as white patients who have the same surgery. Crear-Perry completed her medical degree at Louisiana State University and her residency and in obstetrics and gynecology at Tulane University’s School of Medicine.
After the doctor refused to help Bush, 44, now a freshman Democrat in Congress, stop her preterm labor in her second pregnancy, her infuriated sister threw a chair down the hallway.
The nurses who responded called Bush’s original doctor — the one from her first pregnancy who apologized for not listening — and the physician was able to place a surgical stitch to keep her cervix closed, allowing Bush to continue carrying her daughter to a healthy birth.
“Every day, Black women die because the system denies our humanity,” Bush said. She did not name the doctors or the health care facility where the incidents occurred.
When Charles Johnson went to the hospital with his wife, Kira, for the delivery of their second son, complications were far from his mind after a healthy pregnancy for both Kira and the baby.
But after her C-section, he grew alarmed when her catheter began to turn pink due to internal bleeding. For hours, he sought help, but a scan that was scheduled to be performed “stat” was delayed.
At one point in his pleading, a nurse told him flatly that his wife was “not a priority.”
When she finally was taken for surgery 10 hours later, three-and-a-half liters of blood had filled her abdomen, and Kira died.
Johnson, who founded an advocacy group on maternal mortality, said that even in her most vulnerable state, his wife urged him to stay calm. She feared that if he raised his voice as a Black man, he would have been seen as a threat and kicked out of the hospital.
“It haunts me. Should I have yelled?” Johnson asked. “But the reality of the situation, as a Black man, I did not have the same autonomy to raise my voice, scream, that a Caucasian father would.”
Johnson said he would like to see Congress take bipartisan steps to make childbirth safer. But he also expressed some resignation about the limits of federal powers. “You cannot legislate compassion,” he said, attributing his wife’s death to a lack of concern and humanity.
Democratic lawmakers have introduced a range of bills seeking to address disparities in the U.S. health care system that make childbirth more dangerous for Black Americans.
Cosponsored by Reps. Alma Adams (D-N.C.) and Lauren Underwood (D-Ill.), a package of legislation dubbed the Black Maternal Health “Momnibus” Act — using a pun based on the term for legislation covering wide-ranging issues — would seek to collect more data on the causes of the maternal health crisis; provide more money to community groups and telehealth services to support care during pregnancy; and aim to grow and diversify the country’s birth workers, including doulas and midwives.
“It doesn’t matter what side of the aisle you’re on: Either you have a mother, or you are a mother or you know women who are moms,” said Adams, co-chair of the Black Maternal Health Caucus.
House Oversight Chairwoman Carolyn B. Maloney, a New York Democrat, also said after the hearing that she has requested three new Government Accountability Office reports on the public health crisis.
One change that advocates urged lawmakers to support: making permanent a provision in the latest stimulus package that temporarily allows states to extend Medicaid coverage for pregnant people for a year after giving birth, instead of just 60 days.
Medicaid pays for nearly half of all births in the U.S., and the longer length of health care benefits is viewed as pivotal in ensuring those who are pregnant receive proper postpartum care for their physical and mental recovery.