Chanel Stryker-Boykin knows about the challenges facing Black pregnant women in Georgia. The doula working in metro Atlanta says a new report from the Georgia Department of Public Health that 56% of pregnancy-related deaths in the state from 2018 to 2020 were Black women should alarm local leaders and health care providers.
“I’m hoping that that is a huge eye-opener for medical professionals, researchers, providers — all the people doing these studies to really take a deeper look into what is the cause of this?” said Stryker-Boykin. “Black women aren’t just dying because we’re born defective, or we’re born broken. … This is due to something, and what are those ‘somethings’ that are causing that?”
The fact that Georgia is one of the most dangerous states in which to give birth isn’t news or lost on advocates like Stryker-Boykin. The latest maternal mortality data from DPH makes it clearer that a push to find solutions will help create more positive outcomes for Black women in the state. Health care professionals and local advocates say much more must be done for that to happen.
The findings and the challenges
According to the study, 63 of the 113 deaths during that span were Black women, who were also two times more likely to die from pregnancy-related illness than white women in the state. A DPH spokesperson told Capital B Atlanta that 85% of the deaths involving Black women were preventable.
Cardiomyopathy and embolisms were the leading causes of pregnancy-related deaths for Black women.
Cardiomyopathy is a disease that limits the heart from delivering blood to the rest of the body, and typically occurs during the last month of pregnancy, or within five months after the birth. Embolisms are caused by a blocked artery resulting from a foreign body, blood clot, or an air bubble in the veins.
“I think that unfortunately, medical classism and medical racism play a role,” said Dr. Michele Voeltz, a cardiologist at Northside Hospital who focuses on cardio-obstetrics and women’s health. “Unfortunately, some of these things are inherent biologically to us, such as we are more likely to have high blood pressure, we are more likely to suffer from obesity.”
Physicians and care environments also share blame for deaths, the report states. Failing to discuss pregnancy risk to patients with chronic conditions, not providing standard of care for treating both diseases, and financial barriers all contributed to these deaths.
Working toward finding solutions
In terms of ways to prevent future deaths, researchers in the report recommend nurse home visits, education, and case management up to one year postpartum.
The state has taken steps in hopes of improving maternal care conditions in Georgia. Some of those steps include expanding Medicaid for low-income women to one year after childbirth — previously it was just six months — and encouraging more collaboration with community based organizations.
The DPH also wants to implement ways through the Georgia Perinatal Quality Collaborative’s Alliance for Innovation on Maternal Health (AIM), Cardiac Conditions in Obstetrical Care patient safety bundle. The initiative is geared toward addressing severe morbidity and mortality connected to maternal cardiac conditions in Georgia. The goal is to reduce maternal deaths due to cardiac conditions by 20%.
The state is also attempting to work with hospitals to implement practices from AIM bundles to address hypertension, hemorrhages, and cardiac conditions in pregnancy.
Not all hospitals have implemented those practices, and the DPH doesn’t have any authority to enforce the recommendations. DPH also started a nurse home visit pilot in certain counties in hopes to reduce complications.
Even with those efforts, the DPH commissioner, Dr. Kathleen Toomey said there are still barriers that need to be addressed, which includes transportation. She also said that by setting the bar for the term “preventable” very high, it requires the DPH to be collaborative to improve the maternal mortality rate in the state.
“Preventable doesn’t mean just medically preventable, [it means] socially preventable, preventable from a mental health standpoint, [or] other circumstances in the community,” Toomey said. “It’s really a multidisciplinary definition, which requires us to work together with everyone in the community.”
Experts and advocates who spoke to Capital B Atlanta agree that collaboration of a care team is key to ensure the well-being of all mothers, especially Black ones. One of those areas for more collaboration includes working closer with doulas, who are often dismissed in care settings, according to Thomecia Busby. Busby co-founded the Goddess Birth Sisters, a collective of doulas who focus on holistic healing practices.
Busby said traditional health professionals can be skeptical of people who might not have their training but advocate for patients’ rights. She also pointed to different hospital systems beginning to implement programs to provide doula care to Medicaid patients, but challenges them to do more.
“Some of these programs where they’re doing like these low income doula services, they’re giving the client one prenatal [visit] and then [the] birth,” she said. “For me as a doula, how do I build a relationship with you if I’m only going to see you once before your birth?”
Stryker-Boykin agreed with the sentiment, and emphasized that mutual understanding for all aspects of birth is helpful for cohesive collaboration.
“When I first came in, I was like ‘I’m gonna fight the man.’ Then I met the man and I was like, ‘Oh, the man needs help, too,’” she said. “Nurses are under an immense amount of stress. Doctors are under an immense amount of stress. They’re short-staffed. … I think if we saw each other as helping versus as adversaries, then we could have a more collaborative, cohesive ecosystem for the families and the client.”
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