Pregnancy means greater risk of death for African American women in Missouri
Chelsea Lopez, an African American woman from Fulton, came close to dying after several traumatic birth experiences, one of which she doesn’t even remember.
“I was highly overmedicated. I don't remember the first day of life for my oldest,” Lopez said. “I look back at the pictures and I just can't remember any of those things, any of those moments.”
All Lopez has to rely on are stories from her mother, one of which involves her being dragged out of bed by nurses and forced to go to the bathroom.
After four days of inactive labor, Lopez gave birth to her son, but he wasn’t breathing.
She wasn’t allowed to see her baby for four hours, and the doctors didn’t tell her what was happening. Her son survived, but Lopez felt ignored and mistreated.
Experiences like this are common in states like Missouri, where the maternal mortality rate for African American women is exponentially higher than that of white women.
Missouri is ranked as the sixth highest state with mothers dying during, or up to a year after pregnancy in the United States. African American women are almost three times as likely to fall under this statistic according to the Missouri Department of Health and Senior Services.
While the maternal death rate is high for all mothers in Missouri, African American women are the group hit the hardest. Between 2014 and 2018, an average of 81.4 out of 100,000 African American women died during or soon after a live birth. For white women, this number was significantly lower at just 31.1 deaths per 100,000 live births.
Director of Missouri DHSS, Randall Williams, said that maternal mortality covers all types of deaths for mothers up to a year after childbirth.
“Car accidents, opioids, homicide, suicide, many of those happen in the first year after the baby's born, and that's part of maternal mortality,” Williams said. “We don't want any baby in Missouri at the end of the first year not to have a mom.”
Williams said it’s difficult to pinpoint one specific reason why African American women are dying more than other groups.
“Unfortunately, we don't have great answers for that,” Williams said.
Evonnia Woods, the Missouri Organizer for Reproaction, says the answer is simple.
“The root cause has been found to be racism, regardless of wealth or education, and African American women are dying three to four times the rate of white women.”
Woods says the reason racism causes these deaths is multifaceted.
“It's not all within the healthcare system,” Woods said. “There's implicit bias from physicians and healthcare professionals… but there's the racism that we have to deal with in our everyday lives.
Williams says his department has heard from advocates about racism and bias as the cause for the high maternal death rate, but he says the bias can go both ways.
“There might be some biases built in there that prevent women from wanting to go to the doctor,” Woods said.
He says that if doctors have biases against African American women, it can prevent them from going to the doctor in the future, which could cause more medical issues for the patient.
To combat the harmful effects of implicit bias, Woods turned to activism with Reproaction, a national group that advocates for increased abortion access and reproductive justice. After analyzing her own traumatic experiences, Lopez felt she needed to do something to help women in similar situations.
Lopez became a doula and a certified lactation counselor. Doulas serve women and their partners before and after pregnancy by helping with care decisions.
Missouri does not require certification for doulas, so Lopez says different doulas have different skills.
“Some doulas come from a nursing background, so they bring that nursing education with them,” Lopez said. “I don't come from a medical background at all. So I don't do anything medical.”
Woods said getting African American women like Lopez involved in reproductive services is important in order to combat the high rate of maternal mortality in African Americans in Missouri.
“A lot of what has been done to address racial health disparities has been done by African American women,” Woods said. “What I see are more African American women fighting to or joining doula collectives, getting that doula training to assist people who are pregnant.
Woods said people of color are mostly handling these issues on their own, by becoming doulas and midwives to help pregnant women in their area. Williams thinks that non-traditional healthcare like this could be beneficial.
“Anything that increases our access to prenatal care, we think is a good thing. And if midwives are part of that, that's great,” Williams said.
Williams said that the Missouri DHSS has joined the Alliance for Infant and Maternal Health or AIM, to learn how to save more mothers and babies.
“When we look we know that about 60%, maybe 70% of mom's dying is preventable,” Williams said. “When we find those preventable deaths, often around care and hospitals, and so AIM comes up with bundles of things hospital should do to prevent those deaths.”
Williams also says the department is now looking at the deaths clinically instead of historically so that they can respond more quickly to figure out what went wrong.
Woods said she is excited because she’s seeing real work being done by health professionals and African Americans. She is also hopeful because of various work being done by legislators and government officials like Williams.
“Not sure we'll turn it around in a year,” Williams said. “It's something incredibly important to the governor. It's incredibly important to me. And so I'm hoping we will make change quickly.”
Lopez is able to make change by helping others through her doula services, in the hopes that they won’t have the same experience she did.
“I just knew I wanted to get out there and get started and help deliver all the babies,” Lopez said. ”I love every minute of it.”