SAN ANTONIO – The subject is quite literally life or death, but City of San Antonio staff members believe Black maternal health isn’t being addressed enough.
The latest research reported by the U.S. Centers for Disease Control and Prevention shows Black women are three times more likely to die from a pregnancy-related cause than white women.
Compared to other high-income countries, the United States remains the country with the highest rate of maternal deaths.
“I was affected personally by implicit biases in the medical setting,” said Chelsea Coleman, a San Antonio mom of three.
Coleman said she’s had her pain minimized and watched her concerns ignored.
“I have an amazing doctor. So it wasn’t specifically an experience with her personally. It was other medical professionals that I ran into these issues,” she said.
The first experience was when she was around four months pregnant with her son, and she started bleeding heavily.
“I get to the ER, and before they even did a workup, the doctor comes in, and it’s like, ‘Yeah, you had a miscarriage.’ I was like ‘Oh my gosh! I said, ‘OK, are we going to draw any blood? Are we gonna do an ultrasound? Are we going to check the heartbeat? Anything?’ It was automatic, ‘You had a miscarriage,’” Coleman said.
She demanded testing, and they found out her son was, in fact, OK. He was born healthy months later.
“It was the lack of bedside manners, the lack of the lab work before they just drew a conclusion. That, of course, messes with your mental health,” Coleman said.
Her next pregnancy was with her daughter, and the issue happened after she delivered the baby.
“All of a sudden, my blood pressure spiked after pushing her out,” Coleman said. “They just started pumping me with like a bunch of different IV fluids and medications, but not really giving me the reason why.”
While Coleman was worried about the way she felt and asked not to be released, she said the medical staff discharged her anyway and sent her home.
Coleman said the following day, her vision was blurry, her head was pounding and she felt that she was going to pass out.
“My blood pressure was like 200 over one something,” Coleman said. ”I mean, we were talking stroke level numbers.”
At the emergency room, Coleman said she was finally diagnosed with pre-eclampsia, something that could have killed her. Experts have said it is a condition that is commonly misdiagnosed or undiagnosed in Black women.
Coleman said many people without this lived experience might wonder what these problems have to do with race and inequity.
To that, she said, “We are looked at as being strong. We are looked at as being able to push through a lot of things. But that’s not always the case. History shows that we are just often overlooked just because of our race.”
The CDC and other agencies have documented why Black women are three times more likely to die from pregnancy complications than white women, which includes:
- Deep-rooted biases against Black people
- Black women’s different underlying conditions
- Lack of training for medical professionals
- Less medical access for disadvantaged families, including insurance
- Lack of inclusion in medical research
All of those issues, plus historically documented medical abuses against Black people, result in a mistrust of the medical system.
“So you see a lot of mothers that are turning to doulas or outside practices away from hospitals and having those home births because they just feel like they’ll be safer delivering at home,” Coleman said.
She said many wonderful doctors are investing time in understanding the Black experience, but there needs to be more of them.
“My provider is not a Black woman, and yet she gets it,” said Sian Elmore, the San Antonio Metro Health Public Health administrator.
“We really need more doctors that are willing to understand the cultural differences and be more responsive and respectful,” Elmore said. “Listen when a Black woman is speaking. Talk to me. Lean in, ask questions. Allow me to ask questions, and when I do, don’t be dismissive of those questions.”
Elmore, an administrator at Metro Health’s Center for Policy and Health Improvement, selected a community awareness project. She chose Black Maternal Health.
She just oversaw a Black Maternal Health Week at the beginning of April, full of workshops, trainings, and other events dedicated not just to educating the community, but also demanding action.
“This works better when health care systems, public health, and community organizations work together and we’re not siloed,” Elmore said. “One clinic or one program can’t do it. We change the narrative when we work as an ecosystem.”
There are already local ideas in the works to close those gaps.
“We have a care initiative, and it’s a community alliance for results in equity. We are now moving towards piloting this initiative with a mental health provider and an OBGYN,” Elmore said. ”The idea is to find those gaps and fill them. See where folks are lacking, where they need education, and fill the them however we can.
“Whether that’s training, whether that is providing a tool and a piece of equipment that is needed so they can see a certain type of patient.”
The Policy Center for Maternal Mental Health has recently released a report listing the following recommendations to address these systematic issues affecting maternal health outcomes:
1. Increase the number of Black and BIPOC obstetric professionals: Federal and state agencies should provide and promote training and scholarship funding to increase the number of Black and BIPOC midwives, OB-GYNs, and family practice providers. To support Black and BIPOC obstetric providers, a model similar to the HRSA’s Rural Maternity and Obstetrics Management Strategies Program should be implemented.
2. Test for proficiency in recognizing bias, cultural competence and Maternal Mental Health: State licensing and certifying boards, for obstetric providers such as midwives and OB-GYNs, should require proficiency testing in cultural competence and bias recognition before issuing or renewing licenses.
3. Mandate insurers and health plans to report provider demographics and conduct network adequacy assessments: Insurers should collect and publish demographic information (race, ethnicity, etc.) for providers in their networks, making it easier for patients to find culturally concordant care. Additionally, network adequacy assessments should ensure that provider demographics align with the patient populations served.
4. Support research and adoption of community-based organization (CBO) interventions: Increased investment is needed in research studying CBO-led interventions and incentivizing the adoption of evidence-based practices through grants, community learning networks and insurance billing support.
5. Fund maternal mortality review: Congress should continue to fund maternal mortality reviews to track maternal deaths and to do so by cause. Maternal mortality review committees are state-based committees that conduct thorough reviews of maternal deaths and feed their findings into Federal data sets for national reporting. It’s critical that Congress continues funding this work. The Preventing Maternal Deaths Act, signed into law by President Donald Trump during his first presidency, directs the CDC to provide resources and funding to states. However, funding was not included in the 2024 final continuing resolution passed by Congress in December.
While groups across the nation fight for these changes, Coleman and Elmore have a message of self-advocacy for other Black women.
“It’s our bodies. We know when we’re not feeling OK,” Coleman said. “You keep asking, and you keep speaking up until someone listens to you. You have to shop around sometimes to find the right fit and to find a doctor that will listen.”
To learn more about Black Maternal Health Week’s accomplishments or to share a personal story with Metro Health, click here. Metro Health also has a page of resources on maternal health.
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