By Clare Bratten
NASHVILLE, TN — When it comes to pregnancy and the birth of a child, Black women statistically suffer far more serious complications and mortality rates than white women. This is true both in the state of Tennessee and in the nation according to Dr. Cornelia R. Graves, medical director of Tennessee Maternal Medicine and Director of Perinatal Services for St. Thomas Midtown. Graves said that even Black women who have a college degree are still more likely to die in pregnancy than white women who do not have a college degree
Graves helped form the Tennessee Mortality Review Committee that tracks maternal deaths throughout Tennessee. “There’s a two times increase [of maternal death] for African American women over that of Caucasian women. Nationwide, that rate increases more to two to three times. Truthfully, if you happen to be a woman who is over 40 [having a baby], your risk is the same as it would be if you lived in a Third World Country,” Dr. Graves said.
“Always remember that medicine started out as a segregated proposition. So systemic racism has always been present in medicine and has carried down to women’s health. If you look at the data, many of the deaths that occur in African American women occur where Black women have less access to care,” Dr. Graves said.
Further, Black women’s concerns, even when expressed to a physician, are often ignored or minimized. The problem has become so evident that the Center for Disease Control now has a program called “Hear Her” to remind medical staff to take seriously the symptoms and concerns reported by women patients and Black women patients, in particular.
The problem with poorer maternal health among Black women is also based in economic disparities. Black families often rely on the incomes of Black women as the primary economic support and Black women earn $0.62 for every dollar a White man earns according to the National Partnership for Women & Families in 2020. These jobs may not offer adequate health care coverage. Medicaid stops covering women eight weeks after the birth of a child so long term care is not available. This is especially problematic for women who have medical conditions going into their pregnancies because the period following the birth of a child is now seen as critical as the pre-birth pregnancy.
“Once the baby is out, does not mean your pregnancy is over. In fact, one of my friends on the board of the Society for Maternal-Fetal Medicine calls it the ‘fourth trimester’ – i.e. the baby is out but the mother is still at risk,” Dr. Graves said.
“We know that some diseases during pregnancy increase this risk – hypertensive disease increases the risk of hypertension post-delivery and stroke. This is true especially for pre-eclampsia – they increase your risk lifelong for heart disease, high blood pressure and having strokes.”
Graves worries too that Black women also often have conditions they are not aware of and which may complicate their pregnancy.
“One of the things I’m interested in looking at is what women perceive to be ‘high risk.’ If you come into pregnancy overweight, especially morbidly obese or with high blood pressure or with diabetes or other chronic diseases, that increases your risk and the baby’s risk of having a poor outcome. Therefore, if you don’t know you are high risk and you become pregnant and don’t have access to care or you feel unheard when you do express your concern, that is almost a prescription for our current situation.”
In the era of COVID-19, the already daunting challenge of having a successful pregnancy and delivery have become even more complex. Dr. Graves points out that women of color are disproportionately affected by COVID-19. Further, she stated that patients who get pregnant while they have COVID are more likely to have respiratory symptoms which is associated with a higher incidence of ending up in the ICU. However, Graves states there is no firm evidence that a child in utero contracts the disease and a mother with COVID may safely nurse the baby after birth, although the infected mother should wear a mask.
Graves spent 20 years at Vanderbilt. She was the first black woman to be in the OB program, the first black person to be in house staff counsel for the office of the president and first black division chair at Vanderbilt prior to leaving for her position at St. Thomas.