Severe maternal morbidity was higher among black and Latina women versus white women, according to a study published online on Jan. 9 in Obstetrics & Gynecology. Elizabeth A. Howell, M.D., from the Icahn School of Medicine at Mount Sinai in New York City and her colleagues, looked at women in a NYC hospital and found that maternal morbidity affected 4.2 of black women and 2.9 percent of Latinas versus 1.5 percent of white women. Maternal morbidity is defined as “unexpected outcomes of labor and delivery that result in significant short or long term consequences to a woman’s health,” according to the Centers for Disease Control and Prevention (CDC).
“Our findings raise the hypothesis that other factors such as implicit bias, communication skills, structural racism, and different care patterns may contribute to our findings of racial and ethnic disparities within hospitals,” the authors said in a statement.
The study also found a difference between women insured by Medicaid versus those commercially insured (not provided through the government) at 2.8 versus 2 percent, respectively. However, women insured by Medicaid versus those with commercial insurance had a similar risk for severe maternal morbidity when in the same hospital.
Additionally, Latinas are three times as likely to die during childbirth in NYC while black women are 12 times more likely to die with the leading cause of death overall being hemorrhaging from 2006-2010, according to separate research presented by Howell. She adds that for every maternal death, 100 women experience severe obstetric morbidity.
The complications from maternal morbidity don’t necessarily occur right after giving birth as the CDC found that a greater proportion of the deaths among black women occurred in the later postpartum period, between seven weeks and a year after the delivery. The U.S. is the only developed country whose maternal mortality rate has been steadily rising, according to the Harvard Business Review. The publication attributes part of the rise to the increase of cesareans which have added risks. According to the CDC, 36 percent of births among non-Latina black women are C-sections versus 30.9 percent for non-Latina white women. Latinas overall are more likely to have a c-section than white women especially in border states and it’s partly due to factors including lack of paid maternity leave, poor nutrition, and pre-term births, according to a study by researchers at New Mexico State University (NMSU).
“A cesarean is good if you need it. But if it’s not necessary, both mother and baby would be better without it,” Jill McDonald, who serves as the director of the Southwest Institute for Health Disparities Research in the College of Health and Social Services at NMSU told Santa Fe New Mexican. “Women giving birth in high-rate counties are probably facing higher risks. And, those women will face those risks again in subsequent cesarean deliveries. After you have one, almost all women will only have cesarean deliveries for subsequent pregnancies.”
The New York Times reports that women should contact their care provider within the first three weeks postpartum, and they should have a comprehensive visit no later than 12 weeks after birth. In order to ensure that Latinas are aware of the risks and better postpartum care, the NMSU study suggests bilingual education in prenatal care going over the risks of a c-section, bilingual public reports of the risks, and more options for doulas and certified nurse-midwives.
“It’s not going to be one easy solution. We’re going to need a multifaceted strategy that works for women, hospitals and state legislators,” McDonald said.