How a Michigan hospital is acting to save lives of Black pregnant women
- Henry Ford Health in Detroit is trying to reduce pregnancy-related deaths through visits to homes of vulnerable new moms
- Hypertension in pregnancy is a key driver of maternal mortality, and one that often goes undiagnosed
- Ensuring new mothers get their vitals checked after they return home will hopefully reduce preventable deaths
DETROIT—On a recent afternoon, Rob Barron, a paramedic, stepped into the Detroit home that Kayla Sturkey, 20, shares with her mother, teenage brother and the home’s newest resident: Kayla’s week-old son, Abel.
The room is filled with the evidence of new life: a baby blue mylar balloon, a tidy bassinet and baby clothes with price tags still attached. Next to Sturkey on the living room couch is Abel, gurgling softly in his sleep.
Barron works efficiently to unpack his equipment and introduce himself to Sturkey’s mother, who’s making spaghetti in the kitchen. The dining table is stacked with baby formula. He turns to Kayla.
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“I’m going to check your blood pressure. Can I have your left arm?” he asks Sturkey, clipping a pulse oximeter to her finger.
She nods, and he slips the cuff on her arm.
Nationally and in Michigan, Black women like Kayla Sturkey are up to three times more likely than white women to die of pregnancy-related causes. Of particular concern is hypertension, which is a leading cause of maternal deaths in Michigan, and a condition that often goes undiagnosed.
Which is why Henry Ford Health has begun deploying paramedics like Barron in a mobile medical unit to visit new moms at home, take their blood pressure and other vitals. It’s a basic precaution to head off a vexing problem that is also widely preventable: maternal mortality.
“Sometimes the best answer is the simplest one,” Barron says.
The paramedic chats with the young mother as he goes about his work.
“What would you be doing today if you weren’t here?” he asks. He pinches Sturkey’s arm and checks her tongue, searching for evidence of dehydration.
“Probably hanging out with friends and watching movies,” she responds.
He suggests she might want to try compression socks for the occasional swelling in her legs. It would be good for her to drink more, too, he said.
The maroon blood pressure cuff is releasing its pressure.
“No medications?” he continues.
“No,” she says.
“Have you been checking your blood pressure since you’ve been home?” he asks.
But her blood pressure numbers are worrisome.
Barron tries two more blood pressure readings after several minutes. No significant change.
He then punches in numbers to his cell phone, texting a Henry Ford doctor who, in turn, orders medication to control Sturkey’s high pressure.
A tough job, more dangerous for some
Being a new mom is tough, whatever their background. Tired, overwhelmed, it’s not uncommon for new mothers to miss crucial follow-up appointments that would detect hidden perils like high blood pressure or an infection after birth.
“You're recovering from a delivery, whether it's a vaginal delivery or a C-section, so this makes life easier,” Dr. D’Angela Pitts, director of maternal health equity at Henry Ford, said of the home visits, which began this year.
“And as new moms we tend to, of course, put everyone first. You may not think about the symptoms that you have.”
As tough as new motherhood can be, it is demonstrably more dangerous for women of color. The data is stark and has been for decades.
In Michigan, 29.8 Black women died per 100,000 live births between 2015-2019, compared to a rate of 10.7 per 100,000 for white women over a five-year period ending in 2019, the most recent state data available. American Indian and Alaska Native women were 1.8 times more likely than whites to die of pregnancy-related causes.
National numbers and trends are no less worrisome. Indeed, between 2018 and 2020, maternal mortality among all women in the U.S. actually worsened — from 17.4 to 23.8 per 100,000. Again, it was worse for Black women, who died at 2.6 times the rate of whites.
Think the differences are related more to poverty than race? Think again. Experts at the Stanford University’s Institute for Economic Policy Research found that, among Californians, the wealthiest Black women are more likely to die from pregnancy-related causes than the poorest white women.
These broad disparities have been magnified by a few high-profile tragedies, and near misses, in recent years, lending credence to the role unconscious bias can play in the treatment of Black patients.
In 2017, Shalon Irving, an accomplished Black researcher of health inequities, died of cardiac arrest following childbirth after her distress was dismissed again and again by doctors.
“It didn't even matter that Shalon had two master's degrees, one of them a master's in public health from Johns Hopkins,” her mother, Wanda Irving, said in a Ted Talk entitled “How the U.S. medical community fails Black mothers,” or that she was a highly respected epidemiologist at the Centers for Disease Control and Prevention.
“She was still a Black woman — a Black woman accessing a system that saw her as a stereotype and responded to her as such.”
In May, three-time Olympic medalist Tori Bowie, 32, was found dead at her home in Florida. She was eight months pregnant. The medical examiner cited possible complications from respiratory distress and eclampsia, a condition of high blood pressure during pregnancy.
Tennis superstar Serena Williams wrote in 2022 about a nurse dismissing her complaints of sharp pain during labor, telling her, “I think all this medicine is making you talk crazy.” Williams had to repeatedly insist that doctors perform more testing, which revealed a life-threatening blood clot in her lung.
Dr. Joneigh Khaldun, Michigan’s former chief medical executive and an emergency department physician, shared her own experience of feeling ignored when she complained of terrible headaches after giving birth: “I felt brushed off and did not know what to do,” she said in 2018.
A CT scan revealed the life-threatening brain bleed. Doctors had to drill holes in Khaldun’s skull to release the blood, she told Crain’s Detroit in 2020.
Unconscious bias can play a factor in a clinician being more likely to dismiss a pregnant Black woman who complains of something like a headache, said Pitts, the Henry Ford doctor.
“We want to treat everyone the same, and unfortunately it’s not just happening,” she said.
Instead, she said, too many patients of color are dismissed with assurances that “it’s normal in pregnancy.” “You're going to be fine.” Or “there’s no need to come in.’”
To be sure, deaths among pregnant women and new moms are a tiny sliver of overall deaths. Fewer than 100 people die each year from pregnancy-related causes in Michigan.
But among 11 developed nations, women in the U.S. are the most likely to die from complications related to pregnancy or childbirth, according to a review by the Commonwealth Fund, a New York-based health care research organization.
Each death leaves a wake of misery, and children who are sometimes left without a parent. But Pitts notes another maddening fact: Maternal deaths are most often preventable.
In a review of 996 maternal deaths in the U.S. from 2017 to 2019, the Centers for Disease Control and Prevention concluded 84 percent were preventable. In Michigan, one review of deaths between 2015 and 2019 found 64 percent of pregnancy-related deaths could have been avoided.
A push to save Michigan lives
So a mobile medical unit that performs basic checks on a new mom’s vitals has the potential to save lives.
Moms qualify for the Henry Ford program if they have been diagnosed with gestational hypertension, chronic hypertension or preeclampsia, if they have had little to no prenatal care prior to delivery, or face other obstacles — say, a lack of transportation — in making a follow-up office visit.
The Michigan Department of Health and Human Services is also stepping up outreach efforts. Through its Healthy Moms, Healthy Babies initiative that began in 2021, the state has extended Medicaid coverage for low-income mothers to cover postpartum care for up to a year after delivery, rather than just 60 days — a $20 million line item that will cover an estimated 35,000 pregnant and postpartum people in Michigan each year.
The Whitmer administration’s 2024 budget proposal also seeks to expand programs that focus on health inequities. And there is more help coming from Washington. In January, Medicaid coverage was expanded to pay for doulas, trained professionals who help support women during and after delivery.
‘It was easy’
Sixty-five minutes after Barron arrived at Sturkey’s apartment, he reloads his equipment into the mobile unit’s Ford Explorer, leaving with a promise that he will return again.
And he did, as did another paramedic, Sturkey later told Bridge Michigan.
Meanwhile, little Abel is growing fast. She said she adores his tiny, gummy smiles when she speaks to him.
Sturkey is now in the habit of taking her blood pressure medicine, nifedipine. Her most recent reading was a more manageable 122 over 84. She said she’s planning to find a customer service job in the coming months.
Sturkey said she never thought about blood pressure until her pregnancy — a pregnancy she didn’t discover until she was six months along.
That makes her thankful for Henry Ford’s mobile program.
“It was easy, and everything is really good now,” she said.
“They told me the stuff I needed to be concerned about. They told me that, if anything feels out of hand, to call the doctor,” she said.
“And they told me that everything was going to be okay.”
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