The U.S has the highest maternal mortality rate in the developed world which is driven by the elevated mortality rate among black mothers per the New York Times. The number of black women that make it out alive and deal with postpartum complications (the morbidity part of maternal health) total approximately 50,000 women every year in the U.S. Thus, black mothers have the greatest maternal morbidity rates compared to other races. Why? According to the New York Times - one of the things they hear black women report is "They are not listening to me." I agree. The concern to listen and to take action is missing from the ear of some physicians/healthcare providers in the maternal realm. But is this the only issue - not listening? Black babies are also dying by an exorbitant rate, actually they are more than 2x as likely to die than white babies. Is this just a coincidence that not only black mothers but black babies are disproportionately affected or is there more to it?
Social determinants of health is a big concern. These are social and economic factors such as the distribution of income, wealth, influence, and power. The World Health Organization says, "This unequal distribution of health-damaging experiences is not in any sense a 'natural' phenomenon but is the result of a toxic combination of poor social policies, unfair economic arrangements [where the already well-off and healthy become even richer and the poor who are already more likely to be ill become even poorer], and bad politics." Research also shows that healthcare inequality plays a role in these maternal and infant health disparities.
I often wonder, could I have had a better pregnancy and postpartum recovery?
It was during my 6 months of pregnancy with my last child that I started to develop serious pains. Not abdominal pains but total body discomfort (mainly upper body) that was nagging, sharp, and seemed to be non-stop to the point of not being able to work, sleep and sometimes eat. At times it was difficult to talk, and laughing or crying made it much worse.
Was help available for me?
I was put on bedrest and told to try Physical Therapy (PT). I often wondered "was there more to be done for me medically besides being on bedrest and going to physical therapy." My OB sent me to my primary care physician to be evaluated since I was told my pain was not pregnancy related. It was often hard for me to understand that this undiagnosed condition happened during my pregnancy but was not pregnancy related. Prior to pregnancy I never had such issues. I spoke with the providers and recommended certain labs to be drawn, other non-invasive tests to be done, and even additional specialists to see. After seeing my OB, primary care doctor, a specialist, and doing several weeks of PT, no one knew what else to do. Being offered medication to ease the pain was all that seemed right in their eyes. At this point there was nothing left to do - I basically suffered the next few months. The ironic thing is that my entire pregnancy (up to about 6 months), to my knowledge was normal in-terms of normal labs, normal ultrasound. Nothing alarming was brought to my attention.
Then things started to get really interesting.
An ultrasound showed that my baby was horizontal and not in the proper position for delivery. How was I supposed to deliver my child in a horizontal position? Were there non-invasive procedures available? Would I have to deliver my baby early because of this additional concern? Would my health or the health of the baby be negatively impacted? Would I have to choose between my health and my baby's health? Were the medical providers truly doing all they could do? Would this undiagnosed pain be properly identified and addressed?
At this point, my pregnancy was the horror story and my postpartum recovery was the sequel! Stay tuned for more.
NOW WHAT? Here is what you can do now:
Interview your healthcare team (which may include your OB/GYN, Primary Care Physician, Women's Health Dietitian, etc) and choose the providers that meet your criteria (trust, education, specialization, years in practice, communication skills, etc).
Seek out a Women's Health Dietitian (a food and nutrition expert in preconception, pregnancy and postpartum care) for a prenatal visit. These health professionals are trained to provide an assessment, nutrition diagnose, intervention, monitoring and evaluation on important nutrition and lifestyle factors prior to, during, and after pregnancy. Keep in mind physicians are not trained to do this type of therapy (medical nutrition therapy) so only going to your OB/GYN or Primary Care Provider will not suffice. At 360Girls&Women many of our medical/health packages are eligible for insurance reimbursement and payment can be made by using your FSA (Flexible Spending Account) or HSA (Health Savings Account).
Communicate with your healthcare team in an open and honest manner. Discuss the likelihood of a healthy pregnancy. Ask for a follow-up plan and a referral or a recommendation to see a specialist, if there are issues of concern. Then follow-up right away with those specialist.
Seek a second and even a third opinion when necessary.
Always get copies of your lab results or other pertinent test.
Have an advocate who can check on you before and after medical visits.
If possible, bring your spouse or trusted friend to your medical appointments.
Let me know in the comments how you plan to prepare for a healthy pregnancy.
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References Commission on Social Determinants of Health (2008). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health(PDF). World Health Organization. ISBN 978-92-4-156370-3. Archived (PDF) from the original on 2013-02-04. Retrieved 2013-03-27. Pg 2
The White House issues its first-ever proclamation on Black maternal health.