Awareness, advocacy, action to save our Black mothers
Dr. Chaniece B. Wallace, like many other women, was enjoying her pregnancy. She and her husband were preparing for the arrival of their firstborn child.
She was a pediatrician. She died.
Wallace, the pediatric chief resident at Indiana University School of Medicine, passed away on Oct. 22 after giving birth two days earlier to a daughter, Charlotte, via an emergency cesarean section at one of the top medical institutions in this country.
Wallace, like many other Black women, became part of a horrible, yet very common statistic — which urgently needs to change.
Wallace is not the first Black woman to die due to complications of childbirth. Too many babies and children have lost their mothers in childbirth, with their fathers, grandmothers or other family members left to raise them. This should have been the happiest day for their family. Sadly, there is a common thread between Wallace and all of these mothers: No matter how old they were, where they delivered or the gender of their babies, they all were Black.
In Virginia, the maternal mortality rate for Black women is more than twice as high as for white women, according to the Virginia Department of Health’s Office of the Chief Medical Examiner. The data is clear around our country and our commonwealth that while many of these deaths are preventable, they are occurring regardless of socioeconomic status, education or ZIP code of these Black women.
After years of outcry, this public health crisis finally transcended to the elite rooms of mortality and morbidity rounds, peer review, and now has reached the halls of our legislative bodies into the ears of elected officials, social media and magazines where it belongs. In fact, beginning in 2018, legislators in Virginia finally were asking questions about how to best combat this crisis in the commonwealth.
Those conversations led to funding for the Virginia Neonatal Perinatal Collaborative (VNPC) for community engagement, training and education around decreasing maternal mortality and morbidity. That was followed by Gov. Ralph Northam establishing an aggressive goal to eliminate the racial disparity in the maternal mortality rate in Virginia by 2025, which included millions of dollars to dramatically expand Medicaid coverage for new moms, with increased home visiting, and a study for Medicaid reimbursement for doula support services.
In addition, the General Assembly passed new laws to recognize a statecertified doula, develop a doula registry and annually designate July as Maternal Health Awareness Month in Virginia. These efforts have now cemented Virginia as a leader in combating maternal mortality throughout the country.
However, the loss of Wallace — and many women like her — serves as a somber reminder of the work that remains to be done.
To truly upend those structures, practices and behaviors that led to this crisis, awareness, advocacy and action must continue. Our commitment to look deep within our systems to strive for equitable pregnancy, birth experiences and outcomes for all women must go on.
Awareness of the racism and bias in health care are real issues that need to be addressed at the early stages of those entering health care. This includes timeliness of response to patient concerns, education of staff and patients on the effects of implicit bias on health outcomes, advocacy and mentorship.
With these collective approaches, hospital systems, private practices and medical schools can create safety measures to support Black mothers, and keep them safe during pregnancy and the postpartum period.
Even with increased awareness, policy is what changes lives. Advocacy and action on maternal mortality policies is what will save lives. The American College of Obstetricians and Gynecologists states, and evidence suggests, that in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor and up to one year postpartum.
At the end of this year, a report will be released to the General Assembly proposing some of the most competitive rates in the country to reimburse Virginia state-certified doulas, expanding access to Black mothers and women who need this support. It will be up to policymakers to adopt and prioritize this proposal.
This commonwealth and our country can and should want better for the birthing experience of women. These are the first steps in a long journey to improving Black maternal health outcomes; and Dr. Chaniece B. Wallace will continue to remind us of the sense of urgency that still exists. We owe it to her and to so many women just like her to act.