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Lawmakers Act to Correct Racial Disparity in Maternal Mortality Rates

Two women sit with an infant
Theresa Steele, her 1-year-old daughter Harlem, and Stephanie Spencer from Urban Baby Beginnings. (Photo: Crixell Matthews/VPM)

The governor and lawmakers are working to address racial disparities in Virginia’s maternal mortality rate. Right now, Black women in the commonwealth are three times more likely to die from pregnancy complications than white women.

Some moms and advocates say they’re off to a good start, but much more is needed. One of those moms, Monica Hutchinson, says the birth of her youngest son was really traumatic. Hutchinson is African American and was 26 at the time.

“As soon as my bottom hit the bed, my water broke and my son's head popped out,” Hutchinson said. 

That was when she says she was finally brought into the delivery room at a Roanoke hospital, three hours after pleading with hospital staff to fully evaluate her condition from another hospital bed, in what she called a ‘delivery waiting room.’  

She was in labor, and in a lot of pain. She’d requested an epidural, which she never received. To make matters worse, she feared for the life of her baby, who was born in distress.

“The fear that my baby is not going to make it, or I’m not going to make it…no mom should have to feel like that,” Hutchinson said.

Woman looking at camera
Monica Hutchinson. (Photo: Crixell Matthews/VPM)

At first, Hutchinson thought it was an isolated incident but soon realized that other Black women and women of color had similar stories about doctors who didn’t listen to them. 

Another woman, Teresa Steele, said she asked her Richmond-area doctor to change her medication because she was feeling tired and sick during her pregnancy a year ago. 

“I felt they didn't understand me being African American. ‘Oh, you’re drama, oh you’re dramatic,’ or ‘it’s ok just brush it off.’ That I took really seriously, and I felt like oh my God, no I’m really hurting, and they didn’t understand me,” Steele said.

Stephanie Spencer, who runs pregnancy support-services group Urban Baby Beginnings, says she helped Steele find a new doctor after she received a noncompliance label in her medical file, which Spencer views as just one example of the racial disparities in maternal healthcare. VPM did not name or contact Steele’s former doctor at Steele’s request because she said she feared retaliation.

“You can be easily labeled noncompliant for something just simply because you're trying to get information,” Spencer said. “My moms who really heavily advocate for themselves are immediately placed on this list where, you know, it is either non compliant with care or they don't care about what's going on with them.”

Lawmakers, like Del. Cia Price (D- Newport News), know these disparities are real. When introducing a resolution to make July Maternal Health Awareness Month, she pointed to a University of Virginia study that found racial bias played a role in the treatment of Black patients. 

“Physicians that were practicing in 2016 believe that African Americans experienced pain in different ways than their white counterparts which is scientifically proven to not be [true],” Price recently told a House Rules committee. 

Some lawmakers like Del. Barry Knight (R- Virginia Beach) wanted to remove a line in Price’s resolution stating that the root cause of these racial disparities is structural racism.

“Sometimes it looks to me like you’re trying to stick a knife in there, and twist it a little bit,” Knight said. “We’re talking about ladies that are having babies from this point moving forward.”

That struck a nerve with Price and Del. Charniele Herring (D - Alexandria) who shot back at Knight.

“I want you to understand that we have had family members not too long ago die because our grandmothers were not admitted to hospitals,” Herring said. “It is real, and it’s something that we have to come to terms with. And I know it's painful, but so is the pain the African American women have experienced, and not having that kind of access to healthcare based simply on the color of their skin.”

There are a few big funding proposals being finalized this week to help address these disparities, including ramping up community-based services for pregnant women and extending Medicaid coverage to women for one year postpartum. New research suggests that Medicaid expansion is associated with lower rates of maternal mortality. But right now, even with Medicaid expansion, single women with an income between about $18,000 and $25,000 (or between about $25,000 and $35,000 for a family of two) only receive healthcare for 60 days postpartum.

“Women between 138% and 205% of the federal poverty level, those women still have their coverage terminated at 60 days postpartum,” said Rachel Pryor, deputy director of administration for Virginia’s Medicaid agency. “If anyone's ever had a baby, they'll tell you it's the postpartum part that's hard. So losing your health insurance during that time period can be really stressful and can lead to gaps in coverage.”

A recent state report found that of all pregnant women who died within a year of childbirth from 1999 to 2012, over half died beyond 60 days postpartum. The report was part of Virginia’s first ever comprehensive look at the connection between maternal mortality rates and chronic health conditions. It found that African American women with at least one chronic health condition, like diabetes or mental illness, were more than twice as likely to die around the time of their pregnancy. And of all of the women who died, few were referred to a specialist.

The state’s also studying how to come up with a Medicaid reimbursement model to help fund doula services. Del. Lashrecse Aird (D- Petersburg) sponsored legislation clearing the General Assembly that would establish a registry for state-certified doulas.

“Everyone deserves a doula,” Spencer said. “And it should be something that if you feel like you want and need should be accessible to you.”

Teresa Steele says her doula, along with support from Spencer, was essential in helping her through a difficult pregnancy. “Being my ears to listen to the nurses about what's going on,” Steele said.

As for Hutchinson, both she and her son are OK. She says after her traumatic birth, the head OBGYN did apologize. But Hutchinson said the apology came too late. She wants doctors and nurses to receive more training in medical school about implicit bias. 

“Black women are having conversations with their husbands of saying, you know, when I go into labor, if this happens, save the baby,” Hutchinson said. “I never thought to have that conversation with my husband.”

Senior VP for Carilion Clinic Nathaniel Bishop called Hutchinson’s incident “truly regrettable” but also “surprising” in a phone interview with VPM. He was the hospital administrator of the Carilion Roanoke Community Hospital in 2007 when Hutchinson’s son was born. 

“I don't recall it because I was always very proud of the equity of care that we provided to everyone who presented at the hospital,” Bishop said.

Bishop says the health network has offered training for providers on cultural awareness and implicit and explicit bias for the past three years. And, Bishop says, these topics are also part of the Carilion medical school program at Virginia Tech where Bishop is Senior Dean for Diversity and Inclusion.

“It is more and more widely understood the importance of implicit bias, and for physicians and medical workers and nurses to be well versed in issues of implicit bias and diversity and inclusion,” Bishop said.

Eight state hospitals are part of a new pilot, among other efforts, to help enhance the identification of chronic diseases during delivery-age patient assessments, according to Julian Walker, a spokesperson for the Virginia Healthcare and Hospital Association.

“[Maternal mortality] is a complex issue that is influenced by a number of external factors,” Walker said in a statement to VPM. “And hospitals are on the frontlines by investing in, and focusing on, improvement efforts as part of the broader mission to make Virginia the healthiest state in the nation.”

According to Gena Berger, Virginia’s Deputy Secretary of Health and Human Resources, VDH has been working with VHHA to crunch data on pregnancy-associated deaths in order to select hospitals to participate “in a quality collaborative around maternal health.”

Originally, they planned to look at 10 hospitals with the highest incidence of pregnancy-associated deaths, Berger said. But according to Walker, hospitals “don’t collect pregnancy data on all people of childbearing age,” making it “challenging to develop a comprehensive sense of how many women are dying due to pregnancy-related factors.” 

Berger says they’ve adjusted criteria for the program, and are instead focusing their efforts to improve care in hospitals that account for the largest number of births: Sentara CarePlex Hospital in Hampton, Sentara Norfolk General Hospital, Sentara Obici Hospital in Suffolk,  Sentara Princess Anne Hospital in Virginia Beach, Carilion Roanoke Memorial Hospital, Bon Secours St. Francis Medical Center in Richmond, Sentara Northern Virginia Medical Center, and the Inova Women’s Hospital, as well as the corporate team from Sentara Health System.

Berger says the pilot will help hospitals “identify disparities in the incidence of chronic disease or onset of pregnancy-related illness among their delivering patient populations and supporting hospital participants in better understanding, demographically, who they serve.”