The roles of race and mental health in maternal mortality

GRAND RAPIDS, Mich. (WOOD) — As it becomes more dangerous for American women to carry and give birth to a child, new data from the Centers for Disease Control and Prevention shows, West Michigan programs are working to protect patients.

The U.S. has the worst outcomes for pregnant women compared to the rest of the industrialized world, according to the CDC data, with a rate of death that far surpasses every other developed nation.

There is one group in particular that suffers high maternal mortality; Black women. The rate for this group was already high in 2020, with 55 deaths per 100,000 births, but it grew to about 70 deaths per 100,000 births in 2021, according to the new data from the CDC.

Dr. Cheryl Wolfe, the vice president and department chief for women’s health at Corewell Health in Grand Rapids, said Black women enter pregnancy with more comorbidities, like high blood pressure, diabetes and asthma. But there something else that contributes to the problem that’s not medical:

“Patients are just not heard,” Wolfe said. “They’re not listened to. So if someone says, ‘I don’t feel right, this doesn’t look right,’ or someone asks a question, a lot of times it’s just not heard. (They are told) ‘Oh, you’ll be OK. Oh, that’s just something that happens when you’re pregnant. Oh, you know, that happens after you deliver. Don’t worry about it.’ So it’s really a call to action for us to listen to our patients.”

“Some of our providers have really started now saying, ‘You’re a Black patient. You’re at an increased risk for death, and I want to help you,’” she added.

Why do so many Black women die in pregnancy? One reason: Doctors don’t take them seriously

Wolfe also noted that poor outcomes for Black women are regardless of education or income, affecting women from all socioeconomic backgrounds. She said Corewell Health has put a number of programs in place to improve these numbers, including a free doula program.

“We know that patients who are matched with a doula who looks like them and may have come from their same community, that patient is going to have a better outcome. There’s data to support that,” she explained.

Through the Corewell Health Healthier Communities program visit pregnant women during pregnancy and stay with them up until their baby is 18 months old, offering peer support, education and access to resources.

“We talk a lot about how to be heard when they go to the doctor, asking more questions like, ‘Is this medically needed,’ or, ‘What is mom’s hope for her birth?’” program supervisor Belinda Cunningham explained.

MENTAL HEALTH LEADING CAUSE OF MATERNAL MORTALITY

The Joint Commission released a report in January that shows mental health as the leading underlying cause for maternal mortality among all races, followed by clinical reasons.

“I think that’s something that’s forgotten,” Wolfe said. “Suicide plays a very large role in maternal deaths, starting in pregnancy, and extending to a year after delivery.”

Other causes include more well-known problems like hypertension.

Centering Pregnancy, a national program available locally through Corewell Health, connects women who are at the same stage of pregnancy and creates a village for them. The women have one-on-one visits with their provider, then meet together as a group 10 times.

“I think feelings of isolation, depression, lacking that community engagement, those can really be addressed well in this setting,” said Katie Clark, a certified nurse midwife who runs the meetings in Grand Rapids. “I can tell who has been in Centering Pregnancy without looking at their chart. They are more well-informed, they feel more comfortable asking questions and practicing shared decision-making with their health care provider.”

In partnership with Centering Pregnancy, Corewell Health is tracking pre-term births. Its data shows women in the program had the same outcomes for pre-term birth, regardless of race, nearly eliminating the gap that exists in the general population.

“I think that when women share their concerns in the group setting, they can get that reinforcement from other women in the group that yes, that is a concern or, ‘That happened to me too and you need to pursue that further,’” Clark said.

Corewell Health has not previously tracked the role mental health plays in pregnancies but says it will start.

“We weren’t aware of it. Now we are, so that means now we have to act on it,” Wolfe said.

The state of Michigan also has not tracked maternal mortality as it pertains to mental health. The state will release new data on maternal mortality in 2024.

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