Highlighting Black Maternal Health Week: Maternal Mortality Among Black Mothers

By Dr. Lea Porche, Maternal Fetal Medicine Specialist at The Children’s Hospital of San Antonio

Black Maternal Health Week, which is recognized annually between April 11 and April 17, is an opportunity to build awareness, amplify voices, and promote public health efforts surrounding Black maternal health. Originally founded by the Black Mamas Matter Alliance, the week-long campaign is held during National Minority Health Month and begins each year on April 11, which is recognized as the International Day for Maternal Health and Rights. To promote these efforts, Dr. Lea Porche, Maternal Fetal Medicine Specialist at The Children’s Hospital of San Antonio, has penned a series of three articles to highlight disparities that exist and share educational information for both providers and patients. This is the second article in that series.

Each year in the United States, approximately 700 women die during pregnancy or in the 12 months after delivery, according to the Centers for Disease Control and Prevention (CDC). Many of these deaths are preventable, and racial disparities continue to persist in maternal care. In fact, Black women are three times more likely to die from a pregnancy-related cause than White women in the U.S.

The most common causes of maternal mortality in the U.S. are related to cardiovascular conditions, infection, sepsis, cardiomyopathy, and hemorrhage. For each of these conditions, Black women are at an increased risk of being affected.

What is contributing to these disparities?

Contributing to these disparities are a number of factors including the patient, community, provider, and system. Patient factors may include sociodemographic issues such as education, poverty, literacy, health literacy, health behaviors, and beliefs or social support.

Community factors often point to a person’s social network and environment.

When considering providers, it’s important to look at their knowledge and experience with a wide range of patients as well as their cultural competency and the prevalence of implicit bias.

System factors encompass the larger scope of health care as well as social determinants of health, including whether patients have access to quality care, transportation, and how structural racism is built into our system in ways that can be challenging to define.

Addressing the Issue

Nationally, there are a number of efforts underway to address these issues to create real and meaningful change. In 2021, The Joint Commission introduced new requirements to address complications in the area of maternal hemorrhage and severe hypertension, and preeclampsia. These requirements included mandatory training and education surrounding these conditions for all hospitals or health systems that provide maternal care services.

In addition, a number of states, including Texas, established maternal mortality review committees. These committees meet regularly to review all cases of maternal mortality within the state and they analyze each case to determine if the death was pregnancy-related, whether it was preventable, and what factors led to each death.

The goal is to see if the factors are modifiable, and then that knowledge will help inform ongoing efforts to reduce maternal mortality numbers. These review committees are critical for gathering all the information we need so that we can analyze the current conditions and create actionable steps for change.

In addition, a program called the Alliance for Innovation on Maternal Health (AIM) was created, which is a national, data-driven maternal safety and quality improvement initiative focused on maternal safety and outcomes.

The program promotes the adoption of evidence-based patient safety bundles, which are comprehensive protocols informed by data and best practices to reduce adverse outcomes. Individual hospitals can implement these bundles to help standardize their care.

Here at The Children’s Hospital of San Antonio, we are implementing bundles focused on maternal hemorrhage and severe hypertension. These bundles not only help prepare clinicians for adverse events, but they also help providers better identify patients at increased risk and ensure hospitals have the tools and resources necessary if and when a complication occurs.

Putting standardized protocols like these in place helps ensure that everything that needs to be addressed is addressed and that providers are properly guided in any situation.

Addressing Mental Health

Another leading cause of maternal mortality in Texas is related to mental health, and our team at The Children’s Hospital of San Antonio is working to increase support and resources for patients.

We have a psychiatrist who is available to our patient population and who can perform a full psychiatric evaluation as necessary.

Our patients also have access to counseling and medication support, including medication that is safe during pregnancy. In addition, we screen all of our patients for depression and anxiety to ensure we capture patients who may be undiagnosed or unsupported.

Although the racial disparities surrounding maternal health are a problem all of us need to address, I also encourage all patients to advocate for themselves as much as possible. I hope that women feel empowered to ask questions, to speak up if they are in pain, to learn about their health history, and to press their providers on issues until they feel comforted or satisfied.

My personal philosophy is that if a patient leaves my office with unanswered questions, then I have not done my job. I want every patient to find a provider that can assuage her fears, create a plan, and get her the answers she needs to ensure her health is a priority throughout her pregnancy and delivery.