Why It Matters
"[My mother] had good reasons to think women dying in childbirth or because of pregnancy-related complications was a thing of the past. It should be."
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Maternal Mortality Should Be a Thing of the Past

By Kimberlydawn Wisdom | Thursday, May 23, 2019

Kimberlydawn Wisdom, MD, MS, serves at Henry Ford Health System as Senior Vice President of Community Health and Equity, and the Chief Wellness and Diversity Officer. IHI is partnering with Henry Ford and the community in Detroit to co-design and test interventions to improve maternal outcomes and experience of care for women of color. In the following interview, she describes what it will take to improve maternal mortality and shares her professional and personal reasons for committing to this work.

Why do you think maternal health inequities in the US has been getting more attention recently?

The problem of maternal death has been there for a long time, particularly for women of color. It’s getting more attention in part because the media has helped to raise awareness.

Many people think maternal mortality is something of the past. “That doesn’t happen anymore. That happened back in the Dark Ages.” They don’t realize that it’s still prevalent today and is a significant health care and public health issue that affects families in many communities. Many members of the mainstream media were surprised by the data. For example, in the United States we see about 700 to 800 women per year die from either childbirth or pregnancy-related complications. It’s appalling for so many women to die from conditions that are largely preventable.

Some of the media attention has come because celebrities have been affected by complications related to pregnancy or childbirth. There’s also been media coverage about individuals like Shalon Irving. She was an epidemiologist at the Centers for Disease Control and Prevention. She had a double PhD. She passed away from childbirth-related complications a few weeks after giving birth to her daughter.

Women with resources, education, access to health care, food, and transportation are dying. The factors that we would think are protectors are not particularly helpful for women of color, particularly among African American women. Some of these women — like Serena Williams or Beyoncé — have tremendous means, and yet are still suffering from the same conditions that people of color without resources have experienced for generations.

Despite the increase in mainstream media attention, what do many people misunderstand about the maternal mortality problem in the US?

Women of color may have challenges psychologically and physiologically in ways that white women don’t. The data show that African American women who have completed college, even graduate school, are much more likely to have a poor birth outcome than a white woman who is a high school dropout.

There’s a phenomena called “weathering” that people of color experience. It refers to the chronic social and environmental stressors of everyday life that people of color experience. This includes not only the major contributing factors we often think of when we think of racism, discrimination, and prejudice.

For example, if you’re followed around a store because people think you may shoplift, that’s a small thing. If you’re not greeted professionally when you go for an appointment, that’s a small thing. If you’re going into a restaurant and somebody overlooks you and serves somebody else, that’s a small thing. But these daily microaggressions begin to add up. It’s like one or two cuts aren’t a big deal. If you have a thousand cuts, that becomes life threatening.

What will it take to eliminate inequities in maternal health?

One way is to raise awareness. I know that sounds like a cliché, but it’s important that not only the provider side of the equation understand [maternal health and maternal mortality], but women who are pregnant and their advocates — their significant others, their mothers, their girlfriends — need to know more because oftentimes the pregnant woman [during pregnancy, labor, and delivery] is not in the best position to advocate for herself.

If her husband, significant other, mother, best friend, or community health worker knows about maternal health risks, then those people can help. They can say things like, “I don’t think this headache you’ve had for three days is typical of a pregnancy or for you. Let’s call your doctor.” Raising awareness among the people who make up women’s support teams is critical.

We also need providers to understand that the prevalence of maternal mortality is much greater in certain communities, so you cannot treat everyone the same. As a provider, I need to recognize that I may need to respond differently if an African American woman presents with the same symptoms as a white woman because there are conditions that affect communities of color in greater prevalence than they do the white community, such as preeclampsia.

Every provider wants to provide high-quality care for all their patients. They also need to realize that sometimes what constitutes a quality intervention may vary depending on who they’re serving.

What would it mean to co-design ways to prevent maternal mortality?

We need a community-based participatory approach to this work. You have to involve the people who have been most affected. We know about 50,000 women experience life-threatening or co-morbid complications related to pregnancy or childbirth. They’ve had experiences that they can share with us. They can help co-design better ways to reach and support pregnant women. We need those family members, colleagues, friends, and girlfriends to be part of that co-design. It’s a very diverse, heterogeneous group of people that need to be involved in co-designed efforts to achieve greater health equity.

Why are you committed to this work?

I practiced emergency medicine physician for 20 years in a busy free-standing emergency department that saw 60,000 patients a year. In the emergency department, you realize that pregnancy is not a benign condition. It can have very serious complications if it’s not managed well.

I also have personal reasons that drive my commitment to this work. My mother was one of 11 siblings. She had a younger sister who passed away from pregnancy-related complications. I didn’t learn this until I was 19 or 20 years old.

My mother was devastated that her younger sister had passed away. She was newly married and wanted to further her nursing career. She had her whole life ahead of her and didn’t expect to be a mom for a while, but her sister’s death meant becoming an instant mother of her sister’s older children, one-year-old twins. She and my dad adopted, embraced, and loved them. Then I came along, and my brother came many years thereafter.

I knew I was doing this interview, so I called my mother to ask if I could share our family’s story. Until now, I’ve only ever talked about maternal health and maternal mortality on a professional level.

When I explained what I was going to be talking about, my mother said, “You’re welcome to share the story.” She’s 91 years old, very sharp, and her memory is great. She said, “I’m glad women don’t die in childbirth anymore.” It broke my heart to have to tell her this still happens. She was stunned. She had good reasons to think women dying in childbirth or because of pregnancy-related complications was a thing of the past. It should be.

As a physician, I’ve seen death related to complications of pregnancy and death related to complications of childbirth. On a personal level, my family was transformed because of my aunt’s maternal death. In my mind, these issues are very real.

Editor’s note: This interview has been edited for length and clarity.

You may also be interested in:

Behind the Headlines about Maternal Mortality

How Can You Address Maternal Mortality Inequities?

Why Race Matters in End-of-Life Conversations

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