Black Maternal Health of New York City

Part: 1

NYC's Rising Black Maternal Mortality Unexplained

Sunday, April 18, 2010

New York City statistics include the troubling finding that black women here are nearly eight times more likely to die from pregnancy-related complications than white mothers. Efforts to explain the trend appear nonexistent.

Page 2 of 2

Greater Risk for Some Black Women

Data indicate that black Caribbean and African women living in New York City in particular have negative maternity experiences. Mothers from Guyana, Haiti, Trinidad, Jamaica and Nigeria are more likely to lose an infant than African American women. The stress of working-class immigrant life contributes to poor maternal health, as do fears of encountering a complicated hospital system, say some health leaders in New York City.

An income-strapped woman can obtain low-cost insurance in New York State and apply for a special Medicaid package once she is pregnant. But eight weeks after her delivery, that insurance stops and this may contribute to a mother's health complications between pregnancies.

Setting aside the issues of limited access to medical care, low socio-economic status and inadequate-to-nonexistent health insurance, poor maternal health outcomes are still more common among black women, said Nereida Correa, medical director of MIC-Women's Health Services, a community health program of Public Health Solutions in New York City.

Correa works with six women's health centers in New York City that care for about 12,000 clients a year. Staff at these centers help women enroll in medical insurance, provide prenatal care and educate mothers before they go into labor about the symptoms of preeclampsia and high blood pressure.

"We have access to so much prenatal care and so many programs and we still have some of the biggest maternal health problems," Correa said.

C-Sections a Factor

Health leaders point to the rise of Cesarean sections to help explain the country's increase in maternal mortality.

One-third of births are now by C-sections. Ten years ago that figure was 20 percent, almost double the level the World Health Organization recommends industrialized countries should not exceed, lest they cause more harm to mothers than good. Among Manhattan hospitals, 22 to 40 percent of births in were by C-section in 2007.

A C-section can take anywhere from two to 30 minutes and carries the risk of causing deadly blood clots, said Dr. Aaron Caughey, a perinatologist and the medical director for the Diabetes and Pregnancy Program at the University of California, San Francisco. Caughey led a 2008 report about "labor arrest," which found that most C-sections can be avoided if doctors wait a few more hours for a stalled labor to turn around.

"The proportion of women who actually ask for a C-section is in the 3-to-5 percent range," he said. But many health institutions, fearing liabilities, train obstetricians that if a woman doesn't keep dilating after two hours of stalled labor, then it's best to do a C-section.

We need to be wide open about maternal mortality, said Correa of MIC-Women's Health Services, who also stressed the value of community-level health services that target women long before they enter a hospital.

"Most hospitals are worried that they would have to face liabilities. But we shouldn't be worried about liabilities when it comes to protecting our women against dying in childbirth," she said.

Malena Amusa is a New York-based reporter completing a book about her adventures in New Delhi.

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NYC's Rising Black Maternal Mortality Unexplained