In the United States, maternal mortality rates are higher than in any other developed country. Women die each year during or after giving birth due to pregnancy complications or other factors. These rates are higher for Black women and underscore the importance of Black maternal health — especially because more than 70% of pregnancy-related deaths are preventable.
“Black maternal health is understanding that there are social determinants of race and racism that impact how we access and receive care,” explains Susan Lashley, MD, a maternal-fetal medicine specialist at Atlantic Health System. Dr. Lashley specializes in helping women through complicated or high-risk pregnancies.
She offers some ways that patients and providers can work together to improve Black maternal health.
Provider access and building trust
The best first step for a pregnant person is starting prenatal care early and finding a provider to help you through your pregnancy. Receiving prenatal care late in pregnancy can increase the risk of pregnancy complications.
At Atlantic Health System, there are multiple offices throughout New Jersey, with different types of maternity health care providers. You may work with an obstetrician, maternal-fetal medicine specialist or midwife, along with doulas, nurse practitioners, nurses, social workers and nutritionists.
Sometimes, patients avoid accessing care because they are uninsured or underinsured. Dr. Lashley wants patients to know there are resources, including financial assistance and charity care to help. Your local hospital can provide more information. The important part is getting prenatal care.
On the provider side, Dr. Lashley encourages providers to build trust with patients by listening, addressing any concerns and asking more questions. Providers should be open to learning what the patient expects for their birth experience and what social determinants can impact their outcome.
“We need to ask: Do you have any stressors at home? What is your occupation and does that impact your well-being? Do you have any transportation or childcare issues? Is there food insecurity? Often, patients are misjudged for their circumstances. We may think a patient is noncompliant when really, they just can’t easily get to an appointment.”
Health status and risk for pregnancy complications
In addition to getting care early and choosing a pregnancy provider, it’s important for patients to understand their current health status and what that means for their pregnancy. Patients should share a complete medical and family history with their provider.
Black people giving birth have a higher risk of pregnancy complications — such as postpartum hemorrhage (bleeding), preeclampsia, preterm labor and lower birthweight babies — regardless of education and income. Age, both younger and older pregnancies, and underlying medical conditions can increase the risk.
“If you already have hypertension, you’re at a higher risk for preeclampsia,” shares Dr. Lashley. “But a mom may not know she has high blood pressure because the last time she went to the doctor was a few years ago.”
Though over half of pregnancies are unplanned, providers in almost every field can discuss the potential of pregnancy with patients who can give birth and its impact on their underlying disease. Pre-conceptual consultations with a maternal-fetal medicine specialist offer another way for moms with preexisting health conditions to know health risks before they get pregnant.
Patient advocacy and sharing concerns
Dr. Lashley says that patients must advocate for themselves because they know their body best. If you have a concern, make sure your provider knows why.
Pregnancy complications can look like regular pregnancy symptoms, but that doesn’t mean they aren’t a concern. Be extra mindful of symptoms that intensify, don’t go away or change over time.
“If you had morning sickness in the first trimester that resolves, and now, at 32 weeks, you’re sick again, that’s not normal,” explains Dr. Lashley. “Or if you had heartburn and took Tums, but now you’re eating a whole bottle, that’s not normal.”
Speak up, so your provider can help. If you feel like they aren’t listening, make your concerns known. Many patients benefit from having a doula to ensure their voice is heard. You can also bring your partner to appointments for extra support.
The importance of mental health
We often focus on the physical symptoms of pregnancy, but mental health is important, too. Depression, postpartum depression, anxiety, death by suicide and other mental health conditions impact Black mothers every day. The stigma often prevents people from talking about what they’re feeling and getting the treatment they need.
“Provider bias can also get in the way,” says Dr. Lashley. “A provider may say, ‘Oh she’s angry,’ when really, she has bipolar depression, and that’s how she presents.”
Continued care after pregnancy
Among maternal mortality rates, 50% of moms die up to a year after they deliver. It can be easy to neglect your own care as you take care of your baby. But if you’re not feeling well during the postpartum period, you need to get evaluated.
Watch for shortness of breath, chest pain, heavy bleeding, swollen legs, a high temperature or bad headaches. These symptoms may be signs of postpartum preeclampsia, cardiomyopathy or other illnesses. Ultimately, pregnancy isn’t the end of a health journey — it’s the start.
“Pregnancy is a stress test,” explains Dr. Lashley. “It uncovers things that people are at risk for later in life. If you have preeclampsia, you have a higher chance of hypertension, stroke and diabetes in the future. So, we’re not only looking at your risks in the first year after pregnancy, but long after. And we want patients to stay healthy and have healthy families.”
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