What’s a key factor in black moms’ high death rates? Segregated hospitals

The bad news for expectant black moms isn’t confined to those living in the nation’s capital: A new investigation has found higher risks of harm for women in New York, Florida, and Illinois when they deliver at hospitals that disproportionately serve black mothers.

ProPublica, a Pulitzer Prize-winning investigative site, analyzed two years of hospital inpatient discharge data from the three states to “look in-depth at how well different facilities treat women who experience one particular problem — hemorrhages — while giving birth.” Reporters found negative patterns that underscored big woes identified by other research before:

[B]lack women … fare worse in pregnancy and childbirth, dying at a rate more than triple that of white mothers. And while part of the disparity can be attributed to factors like poverty and inadequate access to health care, there is growing evidence that points to the quality of care at hospitals where a disproportionate number of black women deliver, which are often in neighborhoods disadvantaged by segregation. Researchers have found that women who deliver at these so-called ‘black-serving’ hospitals are more likely to have serious complications — from infections to birth-related embolisms to emergency hysterectomies — than mothers who deliver at institutions that serve fewer black women.

ProPublica scrutinized New York’s situation and how expectant black mothers in the Big Apple not only come into health care settings with higher risk factors, many connected with poverty, but then run into dubious care at hospitals serving mostly minority communities. The reporters also contrasted New York’s fight to improve maternal death rates — some 700 to 900 women die each year across the country from causes related to pregnancy and childbirth — with campaigns in California.

The West Coast efforts have shown greater success, partly because advocates have gotten hospitals to adopt life-saving protocols to deal with maternal hemorrhaging. These regimens include “keeping carts stocked with supplies to stave off massive bleeding and holding drills to simulate severe hemorrhage events.”

But such protocols now must be adopted area by area, and hospitals in poor and minority communities in places like New York and elsewhere may struggle to provide the bare basics of maternal care, mothers and experts told ProPublica’s reporters.

Still, some of these institutions are pillars of care in their areas, meaning they treat big numbers of black moms and their babies — and improvements in their patients’ outcomes could be significant in slashing African American women’s maternal mortality and birth complication rates.

ProPublica should get kudos for not only collecting and crunching the data for this story but also for another report in its series “Lost Mothers,” an analysis that found, “the rate of life-threatening complications for new mothers in the U.S. has more than doubled in two decades due to pre-existing conditions, medical errors and unequal access to care.”

The reporters here found that not only has the nation’s health care system done too little to deal with maternal mortality, women’s problems with pregnancies too often also get dismissed too readily:

For every US woman who dies as a consequence of pregnancy or childbirth, up to 70 suffer hemorrhages, organ failure or other significant complications, amounting to more than 1 percent of all births. The annual cost to women, their families, taxpayers and the health care system runs into billions of dollars.

The reporters cite troubling data from the federal Centers for Disease Control and Prevention showing that:

[S]evere maternal morbidity has risen faster than maternal mortality. Based on the rate per 10,000 deliveries, serious complications more than doubled from 1993 to 2014, driven largely by a five-fold rise in blood transfusions. That also includes a nearly 60 percent rise in emergency hysterectomies — removal of the uterus and sometimes other reproductive organs, often to stem massive bleeding or infection. In 2014 alone, more than 4,000 women had emergency hysterectomies, rendering them permanently unable to carry a child. The rates of new mothers requiring breathing tubes, and of treatment for sepsis — a life-threatening inflammatory response to infection that can damage tissues and organs — both increased by 75 percent. And the rate of women needing to be resuscitated from heart failure rose by 175 percent, to a total of roughly 400.

In my practice, I see the major harms that patients suffer while seeking medical services, including the big and many woes and indignities experienced by expectant women and the injuries that also occur to babies and children. It’s unacceptable that pregnancies and delivery still pose huge risks and harms for so many American women, especially mothers of color, and that this country fares so poorly in this area in comparison with other industrialized nations.

The nation’s capital is seeing this scandal play out locally. The Washington Post over the holidays recapped and added more details to its reporting on the mess at United Medical Center, and why the hospital shut its obstetrics service and nursery.

That closure left a major gap in medical services for communities of color in the District’s Southeast area and in Prince George’s County, Md. UMC is the District of Columbia’s only public hospital. It’s a major provider of health care— including maternity services — for residents of the nation’s capital living east of the Anacostia River, where the Post says, “infant-mortality rates are the city’s highest.”

The newspaper has filled out the specifics of a botched case at UMC involving a Southeast mom. It’s sad reading how she sought help at several hospitals in the area, and ended up dying at UMC, leading, in part, to the closure of the hospital’s maternity services.

What will it take — besides DC officials hiring unsuccessful and costly consultants with political ties, then insisting that taxpayers fork over millions of dollars more — so women, especially black women, can access safe, affordable, and quality medical care even somewhat close to where they live? Voters need to keep a close eye to see that things are done better not only in this situation but also with the quiet crisis in maternal care nationwide.