Chelsi West Ohueri, PhD, is a sociocultural anthropologist at the University of Texas at Austin. Her research is closely related to the work at The Blavatnik Family Women’s Health Research Institute, and her personal story underscores the importance of bringing evidence-based research to the public. We are privileged to honor her powerful perspective as a guest contributor. – Teresa Janevic, PhD, Member of the Institute, Assistant Professor of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Sciences at the Icahn School of Medicine at Mount Sinai
It was Christmas Eve. I was in the hospital emergency room, just four days after what had been a normal delivery of my second child. As I lay on the bed moving in and out of the CT scanner, I tried to remain still and slow the panic in my mind. My left breast was full of breast milk that had just come in. The pain in my head was wrenching. I worried whether I would ever hold my newborn daughter and her sister again.
I had good reason to be concerned.
I am a cultural anthropologist and I research race, belonging, and inequality. One of my research areas includes health disparities, specifically the social and root causes of racial and ethnic inequities. As a social force, racism dehumanizes and assigns value, and as a result, there are varying health impacts. My research and scholarship examine how structural and systemic racism in particular impacts Black people and people of color.
It was during this period in 2018 that numerous news outlets – ProPublica, NPR, USA Today – were discussing the increasing maternal mortality rate in the United States. And Black women were dying at even higher rates.
Also, I had had complications during my first delivery three years earlier.
My first pregnancy included quite a bit of nausea and vomiting, but aside from this, it was pretty typical. My child however, was not quite ready to make her appearance until almost 42 weeks. The labor was slow and onerous, lasting 33 hours. After an additional three hours of pushing, my baby was yet to be born.
At some point I began to shiver, my palms were sweaty, and my heart rate was more rapid. I was extremely fatigued from the labor but in that moment, I felt very different. The nurse, however, delayed contacting the doctor. She kept insisting that I was experiencing side effects from the anesthesia. Then the nurse became unresponsive, maintaining that there was no need to contact the physician. When I asked if she could take my vitals she did, and got a high temperature read but then kept wondering if something was wrong with her thermometer. She kept reiterating that everything was fine and that she just needed to check her equipment. I asked again if she could contact the physician and my husband did as well.
Finally, at the urging of my mother, who is a physician, the nurse eventually went to get my doctor, who, upon seeing me and my temperature reading, said we needed to act quickly because I had more than likely developed an infection. A second doctor came into the room and said they had to quickly get me to the OR for an emergency C-section. My temperature was 103.9. The diagnosis was chorioamnioitis, an infection of the placenta and the amniotic fluid. My baby was delivered and had to spend a week in the Newborn Intensive Care Unit. We were both treated with antibiotics. Though we were both able to be healthily discharged after a week, the feelings of not being listened to, of being dismissed and devalued, remained with me.
As a result, my first doctor’s visit during my second pregnancy in 2018 began with the retelling of the first delivery story. I had a new doctor, a Black woman, mostly because we had moved to a new part of the city. After my previous experience, it was important for me to build a trusting relationship with my medical care team.
Throughout my second pregnancy I worked on multiple research projects about race and health disparities. Between my own pregnancy and my work, it was difficult to escape the issue of maternal mortality. People would often tell me not to worry about “those bad things” while I was pregnant, but as a Black woman in the United States and as a researcher, I was unsure how someone could not worry about potential problems, especially in a moment of such urgency. Compared to white women, Black women in the United States are 243 percent more likely to die from pregnancy or childbirth-related causes.
I often thought about Shalon Irving, a Black woman with a PhD who worked for the Centers for Disease Control. Like me, she was a health disparities researcher. Only weeks after giving birth to her first child, she died from complications of high blood pressure, even though she was seen by multiple medical professionals during the early postpartum period. I also thought about Kira Johnson, a second-time mother who died just ten hours after giving birth because of excessive bleeding. Her husband told stories about delayed attention from health care providers, even though his wife complained of severe pain as her catheter filled with blood.
My second C-section was scheduled at 39 weeks, and the procedure went smoothly and according to plan. At discharge my baby and I were both healthy, and my doctor noted that recovery from a second C-section is often easier than the first. We were discharged on December 20 and made our way home to adjust to our new life as a family of four.
On Christmas Eve night I was sitting on the couch and watching television with my mother. I began having abdominal pain on my right side. The pain was sharp, but I assumed it was gas, a common symptom after delivery. I mentioned the pain to my mother who suggested that I look for some gas medication in the bathroom. At that point my head began to hurt as well. But I suffer from migraines and was exhausted from the initial days of sleeplessness with a toddler and newborn. When I stood to go look for medicine, however, it felt as if my skull was being seared, and the pain rushed down the back of my neck. Then my vision went blurry and I could not see. I stumbled back to the couch. My mother jumped up, grabbed my robe, put some socks on my feet, and walked me to the car. She put the baby in the car seat just as my husband and daughter were returning home from a Christmas Eve service. We all immediately drove to the hospital.
When I arrived at the ER, I was quickly wheeled to triage, and the nurse took my blood pressure. It was 198/95. It would actually increase to over 200/100 before the medicine fully kicked in. The staff at the hospital acted quickly, sending me for a CT scan to check for brain bleeds, giving medication for the pain, drawing blood, and beginning a magnesium sulfate bag, all standard care for what I learned was postpartum preeclampsia, a complication of pregnancy that results in high blood pressure. I had never had any symptoms of preeclampsia, never had even a slightly elevated blood pressure reading during pregnancy, or in my life for that matter. Prior to this, I did not even know that preeclampsia could occur after delivery. Yet there I was, Christmas Eve night, in a hospital bed, unable to move, full of worry.
Fortunately, my health care providers acted swiftly. I was admitted immediately and received excellent care. But this is not the case for many other Black women.
Since 1996, researchers have known that the top reasons for maternal mortality among Black women are hemorrhage, pregnancy-induced hypertension, and embolism. Oftentimes, the conversation about these areas quickly turns to patients’ lifestyles and behavior, but this conversation needs to be refocused. First, there needs to be an examination of what happens when patients present with symptoms during and after birth, and the ways that Black women of many backgrounds, are often dismissed and not believed, as was shown in the case of the Serena Williams story. Second, there is a need for more research about the impact of racism on the physical body throughout the life course. Third, it is time for the health care field to reckon with systemic racial inequities. The current system is failing Black mothers.
As a research fellow at a medical school I had the opportunity to talk with many health care providers, and have even facilitated discussions around race and equity. I would regularly hear from people who felt that they respected all patients, but our current state of racial health disparities is not simply about a matter of respect. A health care provider may believe that they are offering the same level of care for all patients but still carry out practices that are shaped by deeply imbedded forms of racism. Health care is considered a helping profession, but if that help is not equitable and is steeped in unexamined racism, then it can harm more than it helps.
Chelsi West Ohueri, PhD, is a sociocultural anthropologist with research interests in race, structural inequality, marginalization, and health disparities in Eastern Europe and the United States. She is an assistant professor in the Department of Slavic and Eurasian Studies at the University of Texas at Austin. She is currently working on a book project that examines racialization and belonging in Albania and Southeastern Europe.