Black Maternal Mortality Crisis
The United States has the highest maternal mortality rate among affluent counties in the World. According to the Centers for Disease Control and Prevention (CDC), data collected nationally from 2016 show 16.9 maternal deaths per 100,000 live births in comparison to 7.2 deaths in 1987. However, the nation’s capital holds the number one spot for pregnancy-related deaths. Federal health data collected by United Health Foundation between 2010 – 2014, indicates that 41 women in the District die for every 100,000 live births.
In response to this crisis, DC Mayor Muriel Bowser hosted the first Maternal and Infant Health Summit at the Walter E. Washington Convention Center as a counter to the increase of the District’s maternal mortality rate. DC City Council also approved a Bill establishing the Maternal Mortality Review Committee, which examines all maternal deaths along with possible cause, occurring in the District. Our Vice President-elect Kamala Harris sponsored a bill named the Black Maternal Health Mominibus Act of 2020, consisting of nine bills aimed to improve maternal health in the US; Rep. Lauren Underwood co-sponsored in the House of Representatives. We must work together to combat this crisis and mitigate Black Maternal Mortality.
Standardized Medical Practices
Maternity practices currently in use by physicians were originally developed as interventions for life-threatening events. However, such practices as induction of labor, episiotomies (surgical incision made outside of the vagina), epidural anesthesia, artificial rupture of membranes, and mechanical (use of forceps) and surgical (Cesarean) deliveries have morphed into habits of convenience for the physician; not necessarily taking into consideration what may be best as positive outcomes for the women’s birthing experience.
For example, Electronic Fetal Monitoring (EFM) is routinely used in every hospital setting in the United States, confines the laboring women, inhibiting this natural process. Research studies prove that an increased incidence of surgical intervention (Cesarean deliveries), is linked to this standardized practice, and the potential in the development of morbidities with both mother and baby.
EFM restricts the laboring women’s freedom of movement; its use is routinely implemented by medial staff upon admission to the labor unit. Monitors are placed on the mother’s abdomen, then connected to a bedside recorder, providing a graph for physicians and nurses to interpret characteristic fetal heart rate tracings associated with fetal well-being. This procedure commonly leads to an assumption that there may be no alternative available other than EFM for health and safety of the unborn child. Additionally, this type of monitoring gives way for a false sense of security held by medial staff. Its dependence has the potential for rushed conclusions of fetal distress, negating performance of a full and total assessment of the laboring women prior to making a final analysis that an emergent procedure is optimal. Mechanical and surgical deliveries subject the laboring women to increased traumatic experiences. EFM was invented to detect fetal hypoxia (lack of oxygen) and was intended for use only when the laboring woman had known morbidities such as hypertension or diabetes.
A Common Occurrence
An expectant first-time mom goes to the hospital, via ambulance, suspecting she is in labor. Her contractions are coming every five minutes. Only having visited a doctor two to three times since her pregnancy, she is alone, afraid and in pain. The EMTs rush her into the emergency room and is quickly triaged; she hears the doctor give orders for her to be admitted. After being wheeled to a room, clinging to the stretcher, the nurse comes in and immediately squeezes ice cold jelly on her taught skin, without notice, she winces while two small discs are placed on her swollen belly, tethered to a machine. Told sternly by the nurse not to move, the only conversation she has had with the medical team was a question and answer session to obtain demographic information, and if she has insurance. There is little to no conversation as to what will happen next. The woman’s pain increases as the contractions become consistent. Suddenly, water shoots down from between her legs; she is terrified. The nurse rushes in, looks at jagged lines on paper being spit out of the machine next to her; the doctor is summoned. The first-time expectant mom is told she must have a Cesarean because the babies’ life is in danger. Confused, in pain, alone, she consents and is rushed into the operating room. Seconds later, a mask is pushed down on her face, listening to loud unintelligible background chatter, she blacks out. After surgery, groggy from the anesthesia and still in pain, the new mom is awakened and told she has a healthy baby boy. However, she just stares, without emotion, at the small bundle she has just been handed.
A women’s birthing experience should be held equally important as the health and safety of her unborn infant; an event that has a profound effect on her physical, emotional, and psychological well-being. Supportive care, incorporation of a Doula (a trained technician in childbirth), assists the laboring women in promoting emotional support, helping with comfort measures, and is present as a patient advocate.
The inclusion of a Doula during labor cultivates feelings of control and competence; an evidenced-based practice used to facilitate the natural physiologic processes of labor, reducing the need for pharmacologic and medical interventions. Experiencing the natural birth process allows for freedom of movement, consumption of liquids for homeostasis (natural balance), and reduction in duration of transition, the second stage of labor, and perhaps the most difficult of the three stages.
This health information was presented by Sumayya Lane, RN, and is taken from her research paper, “Effects of Active Intrapartum Support on Childbirth Outcomes,” written as a graduate student at Georgetown University. She is also CEO of Systems Supports for Social Stability, Inc., whose vision is to advocate for healthy conversation on social issues, seek to have optimal mental health with ourselves and family, take action to improve well-being in the Community.