Updated: Sep 15, 2021
LET US TALK
Maternal Mortality in the African American Women
Quality improvement initiative for African American maternal health
Quality improvement (QI) is a planned activity implemented and guided by outcome data; this outcome data is used to achieve rapid improvements in healthcare delivery (Tracy & O’Grady, 2018). Healthcare disparities are defined in the differences in access to healthcare, availability of medical services, patient outcomes, and the difference in the variety of diseases that occur in a particular race, population, age, socioeconomic resources (Agency for Healthcare Research and Quality, 2021). Furthermore, African American females (AAFs) are three to four times more likely to die during childbirth or pregnancy-related conditions than white women. As a result, AAFs in America experience impermissible maternal health outcomes that could have been avoided (Issue Brief, 2018). In addition, AAFs are more likely to die from pregnancy or childbirth than any other race of females in the United States (Issue Brief, 2018).
In addition, AAFs face social detriments that also contribute to disparities that include but are not limited to education, job opportunities, living conditions, access to health insurance, and equal healthcare (CDC, 2021). A QI I would like to participate in is reducing the maternity mortality rate in the African American community. It is noted in several research studies that most maternal deaths in the United States are preventable; however, for every 100,000 live births, 56.3 African American females died whereas 20.3 white females for every 100,000 births in the United States (LU, 2018). Unfortunately, racism is prevalent, and AAFs deal with racism, sexism, healthcare providers failing to listen to AAF concerns. Issue Brief 2018 states that interventions can be implemented to reduce maternal mortality in AAF’s; furthermore, it shows that the interventions will reduce complications, mortality and improve maternal health outcomes.
This initiative is vital to me as I know a few African American females, including myself, who experienced maternity emergencies. When I had my third son, I had postpartum eclampsia. After pushing him out, I had a significant headache, and I told the nurse my head felt like it would explode. She took my blood pressure (BP), and it was extremely high. Had it not been for her listening to me, the result would have been less than ideal. My sister almost had to have a hysterectomy at thirty due to complications during cesarean delivery. My cousin just had a baby three weeks ago, had an emergency C-section, lost a substantial amount of blood, and her son's Apgar score was one. My sister's best friend lost her baby at six months, two months ago; she went to two different hospitals informing them that she did not feel right, and birth hospitals dismissed her concerns, the following day, she miscarried. I mention these circumstances because these conversations need to be had, and awareness is imperative to bridge the gap with African American maternal deaths. I want to use my voice to have uncomfortable conversations, shed light on the disparities that AAF face that lead to higher incidences of complications during childbirth, preventable deaths, poor outcomes that should not have occurred.
Breaking down barriers
As I mentioned previously, conversations, awareness, and acceptance that there are disproportionate maternity health outcomes and deaths that AAFs face is necessary if a change is made. AAFs make less money than white females; this contributes to less AAF being able to afford housing, health insurance, food, which may cause them to choose between gas, rent, paying health insurance, childcare, etc. Black women also have the highest rate of unintended pregnancies; this is correlated with lack of money and inability to afford birth control, plan B pill, counseling (Issue Brief, 2018). Acknowledging inequities and social detriments is imperative to improve maternal health outcomes.
Interventions to bridge the gap
Ways to help reduce the gap and decrease mortality rates in black women is to make sure that AAFs have access to healthcare and healthcare coverages. Listening to AAFs concerns, I gave two examples of prior one in which a nurse intervened and listened and another where the mother lost her child. Building trust, many African Americans distrust the healthcare system; we see currently in this pandemic the countless lives that are being lost to Covid-19; many black people think about the Tuskegee trial, Mississippi appendectomy, the research trial in New York where black foster children were intentionally giving HIV in the 1990s. Provide care to AAFs that acknowledge their concerns, respect them as a whole, are culturally competent, safe, and of high quality. AAFs health issues are not requiring the healthcare system to do anything that cannot be done; it just requires the same access and availability that other races receive. Addressing the disparities and social detriments that AAFs face can help improve their healthcare outcomes and reduce maternal mortality rates. Providing resources for AAFs, expanding healthcare coverage, investing in healthcare safety, and implementing quality improvement initiatives are steps in reducing maternal mortality rates in the AAF population, implementing policies that address racism and social detriments to improve and reduce maternal mortality rates in AAFs, having community-based programs to help females during their life span of being able to have children, improving quality of care in hospitals, tracking outcomes for the AAF, evaluation and quality improvement (Collier & Molina, 2019).
You are your advocate in healthcare; you know your body better than anyone else in the world; if something does not feel right, speak up. If you notice a change and you are unsure of it, seek clarification. Each pregnancy is different. I have five children and five completely different births. Just because you’ve delivered before does not mean it will be the same. Be optimistic. Have your plan in full effect, bag packed, and your birthing plan with you. It’s okay if your plan does not go perfectly, or even if it’s in disarray, it happens, and your baby is on their own time and schedule. Plan a hospital tour. We are amid Covid-19; make sure you find out how many support members can be in the room with you. Follow all prescribed doctor orders and advice. Baby Blues and postpartum depression are real, and AAFs can be affected by depression; if this occurs, reach out to your provider, you are not alone.
Pertinent Questions to ask your OBGYN
-What is your practice doing related to the maternal mortality rate in the African American Community?
-What can I do to reduce my risk of birth complications?
- What support do you offer pregnant women
-Ask about birthing plans, emergency delivery
-Ask about the facilities percentage of unplanned c-sections
-What are common complications during labor?
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Agency for Healthcare Research and Quality. (2021). Disparities. https://www.ahrq.gov/topics/disparities.html
Collier, A. Y., & Molina, R. L. (2019). Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions. NeoReviews, 20(10), e561–e574. https://doi.org/10.1542/neo.20-10-e561
CDC. (2021, April 12). Working together to reduce Black maternal mortality. Centers for Disease Control and Prevention. https://www.cdc.gov/healthequity/features/maternal-mortality/index.html
Issue Brief. (2018, April). Black women’s maternal health: National Partnership for Women & Families. https://www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html
Lu, M. C. (2018). Reducing maternal mortality in the United States. JAMA, 320(12), 1237. https://doi.org/10.1001/jama.2018.11652
Tracy, M. F., & O'Grady, E. T. (2018). Hamric and Hanson's advanced practice nursing: An integrative approach. Saunders.