Do doctors have trouble hearing black women? Serena Williams says, ‘Yes’

When Serena Williams detailed in an interview with Vogue how — after giving birth to her daughter in West Palm Beach — she faced life-threatening blood clots, she underscored a troubling and lingering fact:

American black women die during childbirth at three to four times the rate of white mothers — about the same level as in such countries as Mexico and Uzbekistan, World Health Organization estimates.

St Mary’s Medical Center said it couldn’t comment because of patient privacy laws, but the tennis champion provided a harrowing account of her medical crisis in the Vogue article published this month, though she did not mention the hospital by name. Several news organizations, including The Palm Beach Post, have reported that her baby was born at St. Mary’s on Sept. 1.

Williams has a history of pulmonary embolisms.

Here’s what she told Vogue:

She started feeling shortness of breath the day after the birth by Cesarean section of her daughter, Alexis Olympia. She told a nurse she needed a CT scan with contrast and an IV of the blood thinner medication Heparin. The nurse, though, said her pain medicine might be making her confused.

After Williams insisted, a doctor performed an ultrasound on her legs, and the new mother’s frustration grew. “I told you, I need a CT scan and a Heparin drip,” Williams said. When the ultrasound didn’t reveal anything, doctors sent her for a CT scan and discovered small blood clots had settled in her lungs.

Calling Dr. Williams

“I was, like, listen to Dr. Williams!” the Palm Beach Gardens resident said.

Williams is arguably the preeminent athlete in America, yet she said the knowledge of her own body went initially disregarded. It’s, unfortunately, not an unusual experience for black women seeking medical care.

“There are five years of data showing that black women are not taken seriously when they come to the hospital,” said Dr. Colette Brown-Graham, a Wellington OB-GYN. “It is really painful when it happens.”

What is even more disturbing is that it doesn’t matter if the black mother-to-be is from the inner city or like Brown-Graham, a Harvard graduate. Both women have a higher chance of dying during childbirth than does a high school dropout who is white, she said.

Last month, NPR told the story of Shalon Irving, an epidemiologist at the Centers for Disease Control and Prevention who died three weeks after giving birth mainly because her high blood pressure went undetected.

The list of examples in the NPR story of black women in medical crisis being ignored is chilling. There was the Nebraska mother who couldn’t get her doctors to believe she was having a heart attack until she had another. Another mother was told her breathing problems were due to obesity. In fact, her lungs were filling up with fluid.

Brown-Graham said health-care providers ignore black patients on an “unconscious basis,” but it is still a form of racism that has life and death consequences. She says studies from the CDC bear this out.

“This is not about throwing blame. This is about fixing the issue,” she said. “It is incumbent on all of us to address the problem and work on a solution.”

Health risks for black Americans — high blood pressure, diabetes and obesity — play a role in this trend. As does poverty, inadequate health care and quality of care.

Inherent stress

Brown-Graham adds another fact that studies are taking into account: the inherent stress of living in America as a black woman.

“It is very hard work being an African-American woman,” she said. “You are constantly held at a level to be better than everybody else, and that can lead to chronic stress. It can lead to you getting sick and having a poor outcome when you give birth.”

The United States has the highest rate of maternal mortality in the industrialized world no matter if the woman is black, white or Hispanic – and it’s going up. In 2013, the rate was 18.5 deaths per 100,000 live births.

“It is a very alarming statistic for all women in the U.S.,” said Dr. Lee Learman, an OB-GYN specialist who is a dean at Florida Atlantic University in Boca Raton.

Learman, who serves as FAU’s senior associate dean for graduate medical education and academic affairs, said inequities in health care exacerbate medical problems that particularly burden black Americans and serve as underlying factors in maternal deaths. ProPublica last year published a story on how black women dependent on “black-serving” hospitals are more likely to have serious complications.

“We can make an immediate difference in reducing the inequity if we as a society broaden access to primary care,” he said.

In Palm Beach County, four women died from complications of childbirth in 2016. Three were white and one was black.

Statewide, 50 women died from complications of giving birth in 2016, according to Florida’s Health Department. Forty percent of those deaths were black women in a population that makes up 17 percent of the state.

Between 2006 and 2016, 495 Florida women died in connection with childbirth, but black women make up 45 percent of those deaths.

“Is it a higher nutritional thing, is it an environmental thing, is it an access to care thing? It is probably all three,” said Dr. Maureen Whelihan, a Greenacres OB-GYN.

Health equity

In Florida, the Health Department has made it a priority to provide prenatal care to uninsured, low-income mothers at multiple clinics where they can go regardless of their ability to pay. The Healthy Start program also offers home visits by nurses after the women deliver if they consent.

“Basically, anybody who is pregnant in Palm Beach County can get prenatal care,” said Dr. Alina Alonso, health director for Palm Beach County.

“What we are looking at as a way to correct the disparity that exists between white and non-whites is to look at these health problems through the lens of health equity because many of the factors cannot be fixed just with medical care,” she said.

Health equity, Alonso explained, is not just for access to health care but for a variety of other issues, such as joblessness, housing and proper nutrition.

“You can have access to a clinic right next door to where you live, but if you don’t have access to a job or home or food, that medical clinic might not be able to help you as much.”

Whelihan added that getting the word out to populations in need is a constant struggle.

“I see women of all socioeconomic levels who just don’t know where to start,” she said. “They say, ‘OK I’m pregnant, what do I do?’ I think there is a moment of panic, ‘Oh, I’m pregnant. What do I now?’ And they wait and they wait.”

Serena’s close call

For Serena Williams, the confirmation of blood clots was only the beginning of her medical emergency.

The blood thinner to combat the clots caused her C-section wounds to pop open after a coughing fit. The medicine also caused a large pool of blood in her abdomen. She then underwent surgery to have a filter inserted into a major vein to prevent more clots.

After leaving the hospital, she was bedridden for the first six weeks of motherhood. But now, she is gushing about her new baby and planning a return to the court, aiming to set a record for all-time singles Grand Slam titles.

“I absolutely want more Grand Slams. I’m well aware of the record books, unfortunately. It’s not a secret I have my sight on 25,” she said in the Jan. 10 Vogue article.

But she adds her daughter will always be the priority in her life. She was pregnant when she won the Australian Open last year.

“Knowing I’ve got this beautiful baby to go home to makes me feel like I don’t have to play another match. I don’t need the money or the titles or the prestige. I want them, but I don’t need them. That’s a different feeling for me.”

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