After Serena Williams gave birth to her first child, Alexis Olympia Ohanian Jr., via emergency C-section on September 1, she joined a growing number of women, primarily Black women and women of color, who are facing death after ushering in a new life. In the February issue of Vogue, Williams recounts how she discovered blood clots on her lungs the day after giving birth. She left her hospital room, so she wouldn’t alarm her mother, and told her nurse that she needed a CT scan and a blood thinner immediately. The nurse challenged her, but Williams insisted on the treatment, and the doctors discovered a pulmonary embolism. She later had to have surgery to close her C-section wound after excessive coughing caused it to open, and while in surgery, doctors discovered a hematoma in her abdomen. She had to have another surgery—her third in less than a week.
Williams survived, but so many other mothers don’t. Unfortunately, the tennis legend’s scary story is common. American women are dying more from pregnancy-related complications than in any other developed country. Childbirth is even deadlier for Black women who are three to four times more likely to die during or after pregnancy than white women, which points to a complex amalgamation of racism and sexism in healthcare. Few people understand this alarming issue as well as Monifa Bandele, vice president and chief partnership and equity officer at MomsRising, so Bitch spoke with her about Williams’s terrifying ordeal, how we can lower maternal morbidity rates, and how the healthcare system continuously fails Black women.
Why was so it important for Serena Williams to share her postpartum medical emergency publicly?
It was really critically important. About a year ago, MomsRising launched “Maternal Justice,” a campaign to look at maternal mortality, because no one really knew that the United States has one of the highest rates of maternal mortality in the developed world and that maternal death among Black women is really driving those high rates. If Texas were its own nation, it would have the highest maternal mortality rate in the developed world. When we would tell people that, they’d think we were lying, so we’ve been collecting stories from moms all over the country about their birth experiences and launching petitions with families who’ve experienced maternal death due to hospital neglect, racism, and incompetence.
Those stories really picked up over the course of 2017, and we found that more and more people were learning about maternal mortality. ProPublica and NPR are running a series about maternal death. And what we see is that, by and large, there are a lot of Black mothers dying. Serena Williams is using her platform to shed light on what happens to Black mothers. In general, women are not believed. If a man comes to the hospital and says, “I think I’m having a heart attack,” there are protocols in place to save them. That happened to my husband, and three hours later, they told him he had gas.
Women die a lot more because their symptoms aren’t recognized and they’re not believed. There’s a doubling down for Black women who aren’t believed, are being stereotyped, and aren’t getting pain medication. It’s a converging at the intersections of racism and sexism, which makes it so important for Black women to advocate for themselves. Serena Williams is the GOAT, so she was able to get herself up and tell a nurse that she needed a CT scan. She needed that nurse to save her life. But a lot of people, myself included, aren’t in that position. We’re not in that state of mind after giving birth.
You can have all of the training and talks in the world, but when you’re actually in the hospital and going through labor, all of that goes out of the window. Hospitals need to do better. Doctors need to do better. We need policies that put hospital protocols in place that protect women. Also, and this is a big piece of it, we need to make sure we have equitable access to healthcare. Black women are showing up to give birth without knowing that they have gestational hypertension or diabetes. Not having access to healthcare puts us at even higher risk.
Can you talk a bit about Kyira Johnson, a Black woman in California who died after a C-section? How does she fit into the context of the conversation we’re having about Black maternal mortality?
Kyira’s Johnson death is really painful, and we’ve been working with her husband to get the story out. She had a C-section, and basically bled out. Johnson wasn’t clotting, and in a state of neglecting her, she bled out too much and died. It’s so tragic, and her death highlights that neglect isn’t just happening to poor Black women. Johnson’s mother-in-law is Judge Glenda Hatchett, so this is happening across socioeconomic status. Her husband is really helping us focus on the issues around race. Black women are really neglected and not taken seriously when they say there’s something wrong.
Kyira Johnson’s story is really key because California, the state where she died, has really great hospital protocols. The state’s commissioner handed down recommendations for hospitals, but they’re not laws. Legislate it. Make it so that hospitals can’t just say, “That’s nice. Maybe we can do this checklist when people come in.” Legislate it, so that everyone has the same experience as my husband, who had a chest pain and was believed, even though it was gas. That level of procedure needs to be in place.
Data collection also needs to be improved. From state to state, hospitals aren’t collecting information about maternal mortality in the same way. Did they die three months after giving birth? How soon did they go back to work after having a C-section? We really need to make sure there are state by state measures and metrics that are consistently collected. We’ve found that there are a lot of inconsistencies. Besides Johnson’s case, we’re also zeroing in on the death of Erica Garner. She passed away just three months after giving birth. She went into labor, had a heart attack, survived, and then three months later, had another heart attack. In some states, that’s considered maternal morbidity, and in other states, it’s considered an unrelated heart attack. We have to really get the data together.
So many women, particularly women of color, are encouraged to have C-sections. Why do some many hospitals pressure women to have C-sections? How does that lack of agency fit into the conversation about maternal justice?
America has the highest rate of C-sections in the developed world. It’s dumbfounding how many babies are delivered via C-section. It’s all part of the medical-industrial complex. C-sections are driving dollars to hospitals. I know because I’ve had two of them. Patients pay more for a C-sections than they would if they gave birth vaginally or gave birth at home. It’s not just with pregnancies: Across the board, hospitals are pushing patients toward these expensive procedures. With C-sections, in particular, we’ve found that workplace policies impact people’s pregnancies and their ability to stay home and recover. Nationwide, the United States does not have maternity leave. Just this month, New York became the fifth state to have paid family leave. A lot of people, my friends included, are saying, “When this kid comes, I need to be back at the office in five days.”
Americans, more than people in other countries, schedule their C-sections. So, there are all of these different levers driving up C-sections: Sometimes it’s hospitals pressuring people to have C-sections. Other times, people are scheduling them because they don’t have maternity leave. When I talk to people in other countries, they say our system is archaic, but that’s the reality here. When moms are experiencing labor, it’s hard for them to advocate for themselves. You almost need another person, like a doula or a midwife, to do that kind of advocacy. We’re seeing a lot of birthing projects popping up nationally that are helping moms, particularly moms of color, have those advocates in place.
What Williams did was like equivalent to her winning Wimbledon. After I gave birth, I didn’t get out of the bed for days. Serena Williams argued with a nurse [and] snuck out so her mom didn’t see her [laughs]. We’re really up to the mercy of the healthcare providers around us.
Most people don’t have the resources or the power that Williams has, so how can pregnant Black women advocate for themselves at the doctor?
We must emphasize prenatal care. Not having access to prenatal care is driving America’s maternal mortality rates up. Texas, for instance, closed down tons of reproductive health clinics. Prenatal care will detect problems that you may have before you go into labor, such as pregnancy-induced hypertension, gestational diabetes, or some kind of heart condition. All of these things are really important.
We really have to stress the importance of prenatal care in our communities. Encourage women to go to the doctor and get everything checked out before they’re in the hospital to labor. That’s why the gutting of Medicaid is so scary. Half of all births in the United States are covered by Medicaid. While we’re telling women to make sure that they’re getting more prenatal care, there’s also less access to it. It’s critical though. Serena Williams knew things about her health that allowed her to save own life. For instance, if you have pregnancy-induced hypertension and you haven’t had prenatal care, you don’t know that you can potentially have a stroke. The information that you need about your health starts early on in the pregnancy.
While we inform moms, we also have to organize and fight to change our system and policies. We need to have maternity leave. We have to stop driving C-sections and other dangerous procedures when they’re unnecessary. When we talk about maternal morbidity, there are people who have C-sections, go to work a few days later, and have issues that are causing them to bleed internally. More often than not, women of color are finding themselves in that position. If we center Black women and Black women’s stories, we’ll get at the heart of the different things we need to end racism in the healthcare delivery system.
What state and federal policies have to be passed to protect pregnant women?
MomsRising has thrown our weight behind the Prevent Maternal Death Act. It has a number of hospital protocols that would cut down on a lot of these deaths. The bill would make sure doctors are collecting data, and really quantifying problems in their hospitals. It would ensure that hospitals are doing self-assessments and improving, but also guarantee that hospitals follow specific guidelines when women go into labor to make sure they’re stable and not bleeding out. There’s a protocol that’s taken very seriously when men have chest pains; that should happen for women in labor and delivery as well. The Prevent Maternal Death Act is new. It has a few sponsors, but we plan to launch a very robust campaign in April to get more sponsors on the bill.
We need to go into states, like Texas, where the rates are high, and strengthen access to prenatal care, so we can stop some of these maternal deaths. From state to state, lowering the rate would require different things. The main piece is to mobilize and share these stories. A year ago, people would say I was lying when I talked about maternal mortality. The beauty in Serena Williams’s story is that people are now saying, “What the fuck? Why are pregnant women are dying in the hospitals?” Kyira Johnson was in a hospital; there’s no reason why she bled out.
We really have to build an awareness campaign that puts maternal mortality on the map alongside other deadly phenomenons in America.