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Olympic sprinter's death highlights rise in maternal mortality

AYESHA RASCOE, HOST:

Olympian Tori Bowie sprinted into the hearts of many.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON: ...But it's Tori Bowie who's going to get away with this one. Tori Bowie, who's got the joint lead, gets it. Tori Bowie...

RASCOE: The track and field star wowed fans internationally and at home with her fierce performances on the track and her megawatt smile. Tori Bowie was also an expectant mother, but the 32-year-old was found dead in her home in Florida on May 2. An autopsy report released last week cites childbirth complications as the cause of death, highlighting the spike in maternal mortality among Black women in the U.S. Laura Riley is OB-GYN in chief at New York Presbyterian Weill Cornell Medical Center. She joins us now. Welcome to the program.

LAURA RILEY: Thank you. Thank you for having me.

RASCOE: The CDC has published data showing that the rate of maternal mortality has increased each year for the last three years. More pregnant American women like Tori Bowie are dying. This is something that we've been reporting on for years at NPR. People are talking about it. But it's actually gotten worse and not better. So do we know what is driving the rise?

RILEY: Cardiovascular disease tends to be a very common cause of death for these women - infection, hypertensive disorders of pregnancy also have been shown to be increasing causes. I think something that we haven't been willing to answer in the past or acknowledge in the past is the impact of structural racism on maternal mortality, like the patient's knowledge, their health behaviors, how they act within their social network and the information that they gain from that or their beliefs based on that. And then their neighborhood - poverty, crime, insecure housing - that's going to have an impact on your health as well. And then there's the provider factors, meaning there is just sort of this sense of just not listening and not hearing what people have to say.

RASCOE: I've had three kids. I've had OBs that I, you know, liked and felt like I - cared for me. And then I had OBs who I felt like treated me like I was stupid. Often Black patients - their pain is ignored. They're expected to be able to take more, et cetera. Is that a part of this, that their symptoms are not being listened to?

RILEY: I always use the example of Serena Williams telling them that she had a blood clot. She knew what the diagnosis was. She knew why she was short of breath, but she was told it was because she had just had a baby and she was tired. That's not listening. You won't have confidence in people who you think aren't listening to you or who you think are judging you.

Where we have focused in the past is creating a standard of care for certain high-risk complications. So it used to be that hemorrhage, excessive bleeding after delivery, was the most common cause for maternal death. And we've seen a slight decrease in that. And I think that that reflects that we've done a lot of work to educate physicians and set standards for hospitals that every single patient with a hemorrhage has to have these - you know, this set of minimum things done in order to handle it.

And that kind of standardization can help with some of the - you know, the bias issues. Oh, she doesn't need it. No. Every person who bleeds X amount needs this. And it has nothing to do with race, ethnicity, whatever.

RASCOE: Can I ask you - Tori Bowie's specific cause of death hasn't been determined yet, but her autopsy does list eclampsia as a possibility. What should a pregnant person do if they suspect they may have eclampsia?

RILEY: You know, eclampsia is having a seizure, or many, related to high blood pressure. It is kind of the worst thing that can happen as part of the pre-eclampsia condition. And most women will complain of headache, visual symptoms like I'm seeing spots in front of my eyes or I'm seeing things blink - you know, bright lights. Some women will have severe upper abdominal pain. And I tell my patients, if you think there's an elephant standing on your chest, you need to call and come in.

The other thing that sometimes can be a clue is that there's swelling. And when the face is swollen, that's when I tell patients, just get on the phone, tell me you're coming in. We'll check your blood pressure.

RASCOE: With the information that we have now, what are the specific steps that communities can take to lower maternal mortality rates, you know, especially among Black expectant parents?

RILEY: Parents themselves can make sure that they are seeing people who are listening. And I always tell my patients, if it seems like I'm not listening, then just ask me the question again. People need to be empowered to do that. We saw this play out with COVID. Black women did not get vaccinated. Many did not get vaccinated. And I think that there is - definitely part of that hesitancy is not having trust in the health care system.

You know, there was an increase in maternal deaths across all populations and significantly amongst Black women. And I think what we don't know yet is how much of that was related to COVID.

RASCOE: That's Dr. Riley, OB-GYN in chief at New York Presbyterian Weill Cornell Medical Center. Thank you so much for joining us.

RILEY: My pleasure. Transcript provided by NPR, Copyright NPR.

Ayesha Rascoe is a White House correspondent for NPR. She is currently covering her third presidential administration. Rascoe's White House coverage has included a number of high profile foreign trips, including President Trump's 2019 summit with North Korean leader Kim Jong Un in Hanoi, Vietnam, and President Obama's final NATO summit in Warsaw, Poland in 2016. As a part of the White House team, she's also a regular on the NPR Politics Podcast.
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