Thread by @DrDGrossman

Beyoncé and Serena have spoken out about the potentially fatal complications they experienced during their pregnancies, and the toll it took on their bodies. Sadly, this is quite common, particularly for Black women, as I explained to @_allysonchiu.
washingtonpost.com/news/morning-m…

People tend to think about pregnancy as a universally happy experience, but the reality is that pregnancy is inherently risky, Black women face significantly higher risks during pregnancy, and Beyoncé and Serena have helped put a very well-known face to these risks.

Beyoncé shared that she had toxemia, or preeclampsia, which means she had high blood pressure during pregnancy accompanied by protein in the urine. Patients my have symptoms like headache, visual changes, abdominal pain, and swelling.

If untreated, preeclampsia can develop into eclampsia, which involves having seizures. The treatment for preeclampsia—especially near term—is delivery of the baby. Usually it’s possible to have a vaginal delivery, but sometimes a c-section is needed.

If preeclampsia is severe early in pregnancy, it may be necessary to deliver the baby even if it is very premature. The pregnant person is always the most important patient.

An emergency c-section is done when the fetus is in distress or when the pregnant patient is having a complication that requires immediate delivery—for example, in the case of heavy bleeding when the placenta covers the cervix.

Obstetricians are trained to do an emergency c-section quickly and safely, but there may still be an increased risk of complications. General anesthesia is often used for emergency c-sections, and there may be higher risks of infection and damage to surrounding organs.

The average recovery time after pregnancy is 4-6 weeks and even longer if there were complications. This is why we need a paid leave system to allow parents time off of work to recover from pregnancy. This is also why it's amazing Serena came back to Wimbledon the way she did.

Serena was open about coming back from pregnancy on her HBO special Being Serena, and how hard it was to train again, particularly while breastfeeding. She talked a lot about missing the connection with her daughter, and posts on Instagram about her post-partum depression.

It's wonderful that Beyoncé is open about taking time to recover from the birth of her twins, and the impact performing after giving birth to Blue Ivy took on her ability to breastfeed and recover. Rapper Cardi B recently cancelled her tour for similar reasons. Rest is important.

The pregnancy complications Beyoncé and Serena experienced can be fatal if patients don't have access to medical care. In Serena's case, her health care providers refused to believe her when she thought she was having a blood clot in her lung, which led to a delay in diagnosis.

Recently, Crystal Galloway in Florida had symptoms of a postpartum stroke. Rather than take her immediately to the hospital, paramedics allegedly asked if she could afford the ambulance bill. Her mother eventually drove her to the hospital, where she died. abcnews.go.com/US/video/mom-b…

We should be appalled that we live in a nation where Black women are dying because they don't have access to healthcare during their pregnancy, or because doctors and paramedics aren't giving them basic respect.

My colleague @mclemoremr studied the impact racism and discrimination in healthcare settings has on pregnancy and preterm birth. The women of color in the study "perceived their prenatal healthcare as a largely disrespectful and stressful experience."
sciencedirect.com/science/articl…

There is a lot being done by the medical and nursing community to try to better identify patients’ medical risk factors, recognize early signs of complications, and treat the conditions quickly using the best available evidence.

But doctors and nurses have been slow to acknowledge the role that racism plays in poor outcomes—from placing unnecessary barriers to care to dismissing symptoms to making unwarranted assumptions about our patients.

Until we address the problem of racism in the health care system, we will not be able to fully address the problem of maternal mortality among Black women.