New Jersey, pioneers of Maternal Health Awareness on the statewide level
By Lisa Gittens-Williams, MD
In obstetrics there are two patients: baby and mother. Like a pilot, the provider must navigate that pair through the clear skies of a normal pregnancy or the foggy turbulence of a pregnancy fraught with the perils of chronic illnesses such as obesity, hypertension, diabetes and heart disease. Providers must remain vigilant and acutely aware that split second decisions can make the difference between life and death in the delivery room and in early postpartum care. Even more importantly, we must go back to basics and develop a keen and sensitive ear for both mother and baby before, during and after delivery.
With this in mind, New Jersey is poised to celebrate the first ever Maternal Health Awareness Day in the nation, on Tuesday, January 23, 2018. With fearless honesty, the Chair of New Jersey’s Maternal Mortality Review Committee, Dr. Joseph Apuzzio, marshaled the support of the leadership of ACOG (The American College of Obstetrics Gynecology), and joined other health care professional stakeholders to testify before the New Jersey Senate — bringing clear-eyed attention to the epidemic of avoidable maternal deaths in the state. Upon learning that with collective, sustained commitment, maternal fatalities could be reduced, the New Jersey Legislature stopped and listened.
And so, as pioneers of Maternal Health Awareness on the statewide level, New Jersey is bringing attention to the Stop. Look. Listen! campaign developed by the Tara Hansen Foundation. This campaign, born of the tragedy of a mother’s avoidable death during the postpartum period, highlights the critical importance of all providers actively and respectfully listening to mothers’ concerns before, during and after childbirth.
The statistics are dire and the tragedies are piling up. Every year in the United States between 700–1200 mothers die before they can love and raise the children they have just birthed. And, as is the case for almost every measure of wellbeing, black newborns are 3–4 times more likely to have to navigate the world without ever having known their moms. The outpouring of stories about women who suffered life threatening events or who died during childbirth should sound a clarion call for providers: Stop. Look. Listen!
Serena Williams’ recently publicized personal childbirth story drives home the importance of listening to the voice of the mother, and highlights the perilous path of invisibility and voicelessness that Black women tread during childbirth and the postpartum period. Serena reports that she told her medical team that she felt she was having a pulmonary embolism — a life threatening blood clot in the lungs. But her voice was not heard. With keen attention to the signals her body was providing, Serena clearly articulated her condition and the interventions she knew could save her life. Serena was acutely aware that in her postpartum journey, she was having a more than a mere bumpy landing. She was in danger of being a passenger in a fatal crash. But the flight team was willfully oblivious to the danger signs. They almost rendered voiceless this black mother — this celebrity.
Serena thankfully survived due to her unrelenting self-advocacy. However, the maternal mortality statistics worldwide and in the U.S. are staggering. The 3–4 fold rate of death among African American women at all educational and economic levels requires a deep dive into problems of access to quality care and even more importantly, problems of systemic bias. In her exploration of higher rates of maternal morbidity among African American women in NYC, Dr. Elizabeth Howell has opened Pandora’s box on maternal health equity: questioning the systems, cultures and behaviors that make health care delivery systems separate but not equal. Dr. Howell has now asked the broad question, “How much does bias influence care?”
My own lesson in “Stop. Look. Listen! “ speaks to the nuance of implicit bias and the irreversibility of the outcomes when these biases lead to subconscious action. As a young physician in a suburban hospital, I was called to the emergency room to evaluate a pregnant woman who had come from a black tie event saying, “I was dancing and I felt dizzy and almost fainted.” Here we had a young lady in a gown, accompanied by a young man in tux, coupled with my long night on call. “Send her home, she doesn’t need to see you,” her private doctor told me on the phone, “I’ve already done an ultrasound and the baby is fine.” I thought, “She has a private doctor, a husband, a dream dress; she’s probably fine, I’ve nothing to offer.” But I couldn’t get her voice out of my head; “I almost fainted.”
I ordered a repeat ultrasound, which showed an ectopic pregnancy — a life threatening condition where the pregnancy is in the fallopian tube. This simple diagnostic test also revealed an abdomen full of blood secondary to internal bleeding. Off with the dress! I called her doctor and we admitted her for life saving surgery. I was shaken. I had come close to sending this woman home to die. That day, I vowed to listen, really listen to my patients — without bias.
In my last diagnosis of a postpartum pulmonary embolism (the condition that Serena Williams had self-diagnosed), my patient did not have the insight of “Dr. Serena Williams”. She saw me passing in the hallway just outside her room, and called out weakly, “ Doctor, I just don’t feel right.” That vow made early in my career, to listen with an open heart, lead to the diagnosis and life saving treatment of a massive pulmonary embolism in that patient.
For this Maternal Health Awareness Day let’s create a positive legacy for the children of Tara Hansen, Shalon Irving and the thousands of victims of avoidable maternal deaths. Let’s join Every Mother Counts in understanding that the consequences of a mother’s death reverberate through families and communities. Let’s empower mothers to hold fast to what their bodies are telling them. Let’s empower their self-advocacy by listening keenly and respectfully. Mothers! Pierce the veil of invisibility and voicelessness! Stop. Look. Listen! may be the compass that your healthcare team needs to take you safely home.
About the author, Lisa Gittens-Williams, MD:
New Jersey Medical School
Division of Maternal Fetal Medicine
Rutgers New Jersey Medical School
Director Obstetrical Services
University Hospital, Newark NJ
Chair Patient Safety and Quality Improvement Committee
ACOG District III