The System ‘Failed Us’: Black Maternal Health Week Highlights Racial Disparities in the Doctor’s Office

Giving birth is “one of the most dangerous experiences a Black woman can have in America,” a public health expert said in a panel this week.

Tomeka Isaac and her husband Brandon founded the nonprofit Jace’s Journey in 2019 in an effort, she said, to “pick up the pieces of the unimaginable.” They named it after her son.

Speaking on Wednesday at a panel discussion in North Carolina to highlight Black Maternal Health Week, Isaac said her organization helps Black women find the resources they need for a healthy pregnancy. 

Like many advocates for Black maternal health, the work is personal.

“At 35 weeks into what I thought was an amazing, normal pregnancy,”  Isaac said of her pregnancy with Jace, “I was rushed to the hospital after passing out at home.”

She was told at the hospital that Jace had died in utero, and that she had HELLP syndrome (Hemolysis, Elevated Liver enzymes and Low Platelets), a dangerous and elusive form of preeclampsia.

She did not know she was at risk for this condition, she said, which could have been detected much earlier with a blood and urine test that she said her doctors never ordered.

“We soon realized that the medical system we had trusted had failed us,” Isaac said. 

“[Jace] died because I had not received quality routine, prenatal care. I almost died because for more than three hours the hospital failed to give me a CT scan which would have shown I was bleeding internally.”

She had seven surgeries in 45 days, she said, and developed infections that kept her in the hospital. She could not attend Jace’s funeral.

“I have two masters’ degrees and over a decade of professional experience,” Isaac said. “I had private insurance, never missed a prenatal appointment and had no preexisting conditions, but none of that protected me or my baby.”

Isaac’s ordeal is not an isolated trauma.

Giving birth is “one of the most dangerous experiences a Black woman can have in America,” said Tchernavia Montgomery, the executive director of Care Ring, a non-profit in Charlotte that helps provide health services to uninsured and underinsured people.

The Data Is Stark

Black women are three-to-five times more likely to die in childbirth or soon after than white women, regardless of income level, insurance or college degree. The problem is historical and indisputable, but, a panel of public health experts said on Wednesday, most people are completely unaware of it.

“A lot of people do not recognize that in the US our maternal mortality statistics are worse than any other developed and high income country. Much, much, much worse,” Dr. Pamela Cobb, an obstetrician for Atrium Health in Charlotte, said. “And the rates are three to four times as high for Black women.”

And it’s getting even worse. 

In 2018, Black women died during or soon after pregnancy at a rate of 37.3 per 100,000 live births. In 2020, the rate jumped to 55.3.

For white women in those years, the rate was 14.9 and 19.1. (And it’s not just deaths. According to Centers for Disease Control and Prevention data, Black women are also two to three times more likely to have unexpected complications during labor and delivery that result in serious short- or long-term consequences to their health.)

But the deeper crisis, said US Rep. Alma Adams, who represents most of Charlotte and hosted the panel, is that “a staggering 60% of these deaths are preventable.”

Simple, standard, competent prenatal care and screening is often not adequately delivered to Black mothers, studies have shown, and there are several reasons, most prominent among them an undeniable systemic bias that minimizes the concerns of Black women.

Several studies have shown that doctors and medical professionals often underestimate pain levels of Black Americans and undertreat their conditions as a result. A 2016 study found that half of 400-plus resident doctors and medical students surveyed held false and unfounded beliefs about the pain threshold of Black people, beliefs that often led them to “make less accurate treatment recommendations.”

This is especially true with Black women during pregnancy.

Black women “are not monitored as carefully as white women are,” Ana Langer of Harvard’s T.H. Chan School of Public Health told the American Heart Association in 2019. “When they do present with symptoms, they are often dismissed.”

A Crisis of Morality

At the start of this week’s panel discussion in NC, organizers showed a video about Kira Johnson, a Black woman who died in a Los Angeles hospital after what was supposed to be a routine C-section. 

She started bleeding while in the recovery room, and though nurses ordered a CT scan, which would have shown the source of the bleeding, the scan was never conducted despite pleading from both Johnson and her husband, and despite several other signs of a serious problem. 

Ten hours after the tests were ordered, surgeons operated on Johnson to see what was going on, cutting along the same incision they made to deliver her child. They found three liters of blood in her abdomen. During the C-section, doctors had unknowingly lacerated her bladder, and a CT scan would have shown them the problem in time to solve it. 

Johnson died during the operation. 

“It astonishes me that with all of our advances we pride ourselves on in the health and human services field, that we have not managed to solve the crisis of Black maternal health,” Care Ring’s Montgomery said.

“Why in North Carolina,” she asked, “are we 46% more likely to experience preterm birth?”

“Why is it that my child in my beloved county is five times more likely to die in his first year of life as compared with other races?”

“Where is the intentionality to protect what should be one of the most joyful and momentous occasions of a woman’s life?”

It is, she said, “a crisis of both morbidity and morality.” 

What Can Be Done

Adams has introduced several pieces of legislation aimed at solving the problem, including the Kira Johnson Act, which was folded into a larger series of bills that have passed the House but have not gotten a vote in the Senate. She and other lawmakers are also pushing for a similar “Momnibus” act that would, among many other things, make targeted investments in community-based organizations, and train doctors in recognizing bias and racism.

Care Ring is one of these community-based groups the legislation seeks to better fund.

Care Ring provides “culturally competent, affordable and situationally sensitive professionnels,” Montgomery said, who offer several vital services for 500 low-income pregnant women in Mecklenburg County, including home visitation and telehealth services to monitor symptoms, resources for substance abuse and depression, and postpartum services.

The dividends are paying off, she said, adding that 94% of the women Care Ring works with have babies born at healthy rates and are less likely to have postpartum depression.

“While we as Black women are at the center of this continued crisis,” Montgomery said, “I also have confidence that we ourselves will be at the helm of the solution.”

And the solution starts, the panel said, with increasing the spotlight on the problem beyond a single designated week. 

Before her pregnancy, Isaac said, “I had no idea there was a Black maternal health crisis.”

She continued: “We need to amplify these voices, and amplify this conversation, not just this week but throughout the whole year.”