This story is part of SELF's ongoing series exploring black maternal mortality. You can find the rest of the series here.
As a black woman who hopes to become pregnant someday, statistics are scaring me into second-guessing my desires. Black women have three to four times higher risk of dying from pregnancy or childbirth-related complications than white women in the United States. Given this fact, I regularly swing between excitement about the prospect of being a mother and fear that I wouldn’t survive childbirth.
Despite spending more per capita on health care than any other industrialized nation, the United States has the highest maternal mortality rate of the industrialized world, according to the Centers for Disease Control and Prevention (CDC). Around 700 people in the United States die from pregnancy-related complications each year, the CDC says. Another crushing statistic: About 60 percent of these pregnancy-related deaths are preventable.
People who are black and pregnant or postpartum are most vulnerable to dying at this time regardless of factors like their income level and education. The maternal mortality rate for black non-Hispanic people is 42.8 deaths per 100,000 live births, according to the most recent CDC data. White non-Hispanic people experience a much lower (yet still far too high) maternal mortality rate of around 13 deaths per 100,000 live births. (From this point on, when we use the terms “black” and “white,” we mean people of those races who are non-Hispanic.)
Much of the work in preventing these deaths comes down to identifying and treating potentially dangerous health conditions before they have a chance to become lethal. Of those who die due to pregnancy-related complications, “a third of people die during actual childbirth, about a third die within a week of having the baby, and the rest die up to a year later,” Joia Crear-Perry, M.D., founder and president of the National Birth Equity Collaborative, tells SELF. “So we're trying to ensure that people know about symptoms and signs before they get to the hospital.”
With that said, it’s impossible to talk about the health of black pregnant and postpartum people without addressing racism in health care settings. It shouldn’t be on us to save ourselves. The onus really should be on health care providers to keep us safe, Sara Brubaker, M.D., assistant professor of the department of obstetrics and gynecology and associate director of Maternal-Fetal Medicine Program at NYU Langone Health, tells SELF. But discrimination in health care is a clear factor in racial maternal mortality disparities.
Advocating for our health and safety as black people in the health care system doesn’t always work, but I do believe that knowing early warning signs of health issues can only help us in the fight to protect ourselves. We did not create the health inequities that plague us, but the more we understand the circumstances, the more equipped we are to navigate the unfair landscape in which we find ourselves.
If you’re black and pregnant, hoping to one day become pregnant, or have recently had a baby, I hope this list of conditions you should know helps you feel a bit more in tune with your body, mind, and overall wellbeing. I know it can be scary to read through this, but the ultimate goal is to help empower you to advocate for yourself. If you’re experiencing any of the symptoms we mention or just don’t feel right, it’s important to seek medical help as soon as possible.
1. Hypertension
Hypertension is another term for high blood pressure. Your blood pressure is a measure of the amount of blood your heart pumps and the amount of resistance in your arteries, according to the Mayo Clinic. The more blood your heart shunts around your body and the narrower your arteries, the higher your blood pressure climbs. Overall, black American women over the age of 20 are around one and a half times as likely to have hypertension than their white counterparts, according to the CDC.
Hypertension can be broken down into two other categories. There’s chronic hypertension, which occurs either before or within the first 20 weeks of pregnancy, and there’s gestational hypertension, which occurs after the first 20 weeks of pregnancy, according to the American College of Obstetricians and Gynecologists (ACOG). When you’re pregnant, your body’s already going through a roller coaster of changes that can put more stress on various critical systems. High blood pressure in pregnancy just exacerbates that, placing even more strain on organs like your heart and kidneys, ACOG says. If left unmanaged, this can eventually lead to some of the life-threatening conditions on this list.
In addition to being black, hypertension risk factors include a family history of high blood pressure, being overweight or obese, a lack of physical activity, stress (as well as dealing with stress by using tobacco or drinking alcohol), and chronic conditions such as kidney disease and diabetes, the Mayo Clinic says.
Signs to look for: The tricky thing about high blood pressure is that it typically doesn’t have noticeable symptoms, according to the Mayo Clinic. When it comes to pregnancy, it’s most important to ask your ob/gyn how often you need to see them for check-ups so they can keep an eye on your blood pressure, especially if you already have hypertension or a cluster of the above risk factors. “Throughout pregnancy, you want to keep your regular prenatal appointments,” Dr. Brubaker says.
We know that can be easier said than done. A lot of things can make it difficult to see your doctor regularly when you’re pregnant, like issues with transportation and getting time off of work. But voicing that concern can help your doctor try to come up with a manageable pregnancy care plan that actually makes sense for your life, like having you monitor your blood pressure at home, for instance.
2. Preeclampsia
When left untreated, either type of hypertension can lead to preeclampsia, though it’s more likely to happen with the chronic form, the CDC says. This potentially dangerous condition involves high blood pressure along with damage to essential organs like the kidneys, ACOG explains. Preeclampsia usually begins after 20 weeks of pregnancy, though it can occur at any time, and black women are three times more likely to die from preeclampsia complications than white women. As such, it’s really important for any black woman who is considering pregnancy or is currently pregnant to be aware of this condition, Dr. Brubaker says. Since preeclampsia can also happen in the postpartum period, it helps for anyone who’s recently given birth to be aware of it as well.
Preeclampsia risk factors include being pregnant for the first time, having a family history of preeclampsia, having experienced preeclampsia in an earlier pregnancy, being obese, being over 40, and having chronic hypertension, kidney disease, or diabetes, according to ACOG.
In severe cases, preeclampsia can devolve into HELLP syndrome, which ACOG explains stands for hemolysis (damage to red blood cells), elevated liver enzymes (a sign of liver damage), and low platelet count (cells that help your blood clot). HELLP syndrome can be deadly. So can eclampsia, another condition that preeclampsia can cause if it’s not quickly discovered and treated.
Signs to look for: See your doctor immediately if you’re dealing with symptoms like unusual facial or hand swelling, a persistent and severe headache, eyesight changes like spotty or blurred vision, abdominal pain (particularly under your ribs on the right side), shoulder pain, shortness of breath, and decreased urination. Also be on the lookout for foamy pee—in some cases it can signal excess protein in your urine, which can be a sign of kidney damage.
3. Eclampsia
Around one in 200 pregnant people with untreated preeclampsia will develop eclampsia, according to the U.S. Library of Medicine. This is essentially preeclampsia with seizures, and it can lead to coma or even death.
You can develop eclampsia without any obvious signs of preeclampsia, and even if you do show symptoms, you can progress from preeclampsia to eclampsia very quickly, often within a few days, Dr. Brubaker says. Additionally, while preeclampsia symptoms tend to lessen after delivery, about one-third of eclampsia cases actually happen after people give birth, according to the National Institute of Child Health and Human Development.
Signs to look for: Unfortunately, as the Mayo Clinic notes, there aren’t really specific signs someone is in eclampsia territory besides seizures. Otherwise, eclampsia can cause similar symptoms as preeclampsia. Since those symptoms don’t always show up with either condition, this is another example of how important ongoing prenatal care is—especially if you’re black.
4. Fibroids
Fibroids are benign tumors that form in or on the uterus, according to the Mayo Clinic. The fact that fibroids are non-cancerous is pretty much the only remotely good thing about them.
Fibroids can cause issues like intense pain and worryingly heavy periods. Sometimes (although this isn’t common), fibroids can even contribute to trouble getting pregnant or miscarriage, according to the Mayo Clinic. And if someone with fibroids gets pregnant, they might be at higher risk of complications such as premature birth, smaller fetus size, and placental abruption (when the placenta, which provides nutrients to the fetus, separates from the wall of the uterus). Pregnancy hormones seem to encourage fibroids to get larger, the Merck Manual says, which could put you at higher risk of complications.
These tumors are more prevalent in black women; about half develop symptomatic fibroids at some point compared with a quarter of white women, according to the Merck Manual. On top of that, black women tend to show more severe symptoms of fibroids and have them at younger ages than white women, Dr. Crear-Perry says.
Signs to look for: Many people don’t realize that they have fibroids. Even if you do have them, they won’t necessarily cause problems with pregnancy or childbirth. With that said, if you experience symptoms like heavy bleeding, intense cramping, a persistent urge to pee but also trouble fully emptying your bladder, and even a feeling of heaviness in your pelvis, you might want to talk to your doctor.
5. Gestational diabetes
As you might have guessed, gestational diabetes is when someone who didn’t previously have diabetes develops it during pregnancy. This happens when your body has trouble making or using insulin, a hormone from your pancreas that helps you properly draw energy from glucose (sugar) in the foods you eat. It typically shows up around the 24th week of pregnancy, according to the CDC. People of color—including black people—have a higher risk of developing gestational diabetes than white people do, according to the Mayo Clinic.
For some people, gestational diabetes goes away after pregnancy without causing any issues. For others, it can contribute to pregnancy complications like high blood pressure, the CDC says. Gestational diabetes can also increase your odds of having a baby that’s 9 pounds or more, which can then boost your risk of needing a C-section, and of having a baby that’s born too early.
Even if your gestational diabetes recedes after you give birth, it can raise both your and your baby’s risk of developing type 2 diabetes and prediabetes (when blood sugar levels are higher than average but not yet high enough to be considered type 2 diabetes, the CDC explains).
Signs to look for: Much like the above conditions, gestational diabetes doesn’t typically cause any symptoms, the Mayo Clinic says. The best thing you can do is talk to your doctor about it during routine prenatal visits and, if recommended, monitor your blood sugar levels throughout pregnancy, according to the Mayo Clinic. Regular contact with your doctor can help you catch any abnormalities before they turn into serious complications.
6. Peripartum cardiomyopathy
Also called PPCM, this is a relatively rare form of heart failure that can set in between the last month of pregnancy and up to five months postpartum, according to the American Heart Association (AHA). It happens when the heart becomes too weak to pump enough blood throughout the body, which taxes organs like the lungs that need sufficient oxygen to do their jobs, the AHA explains.
Black pregnant people seem more vulnerable to this condition and also often fare worse if they develop it. A 2016 review in Circulation summarized much of the evidence on the subject, finding that over 40 percent of PPCM cases in nationwide studies happened in black people. Population studies in California and North Carolina showed PPCM incidence rates about three and four times higher in black people than in white people, respectively.
It isn’t really known what causes peripartum cardiomyopathy, but some of the risk factors include being pregnant over the age of 30, a history of heart conditions, high blood pressure, obesity, excessive alcohol use, and smoking, according to the AHA.
Signs to look for: Symptoms include fatigue, heart palpitations, peeing more at night, shortness of breath even when you’re lying down, feeling faint when you stand up, swollen ankles, and swollen neck veins, the AHA says. If you’re thinking that a lot of that just sounds like regular pregnancy symptoms, you’re absolutely right. But it’s important to see a doctor anyway if these symptoms are worrying you. Your doctor can check your breathing to see if there are signs of fluid in your lungs, which could indicate that your symptoms extend beyond normal pregnancy woes, the AHA says.
7. Stroke
Stroke can be lethal because it interrupts blood supply to the brain, according to the Mayo Clinic. This causes brain cells to die within minutes.
While stroke alone is not overwhelmingly common during pregnancy, according to the CDC, many of the conditions on this list put black pregnant people at greater risk for having a stroke. In fact, high blood pressure is the leading cause of stroke in pregnant and postpartum people, the CDC says. Since black people are more susceptible to high blood pressure during pregnancy, it’s important to be aware that this can nudge up the risk of stroke, too.
Signs to look for: If your face, arms, or legs suddenly go numb or weak—especially if it only happens on one side of the body—you might be having a stroke, the CDC says. Other symptoms include confusion, dizziness, trouble walking, severe headaches, and trouble speaking, understanding, or seeing.
8. Postpartum hemorrhage
This potentially deadly complication happens when someone suffers severe blood loss after giving birth.
“Anybody, even without certain conditions, can have a hemorrhage,” Dr. Brubaker says. “Even a young woman who has had a vaginal birth that seemed uncomplicated can have a life-threatening hemorrhage.” With that said, a 2018 study in the American Journal of Obstetrics and Gynecology points to black people being most at risk. The study, which analyzed 360,370 people who experienced postpartum hemorrhage from 2012 to 2014, found that 121.8 black people out of every 100,000 who gave birth died due to postpartum hemorrhage, compared with 24.1 white people per 100,000 who gave birth dying from the same cause.
The most common reason for postpartum hemorrhage is uterine atony, according to the American Academy of Family Physicians (AAFP). This is when the uterus doesn’t contract enough after labor, the Mayo Clinic explains. Other issues like long, complicated labor, uterine tearing, and uterine inversion (when the uterus actually turns upside down) can also cause hemorrhaging, the Merck Manual says.
Signs to look for: Because most postpartum hemorrhage happens during or right after delivery, there aren’t many symptoms for you to look for. Diagnosis and treatment hinge on your care team realizing that you’re bleeding too much and taking immediate steps to solve the problem.
There are, however, rare instances of a condition called delayed postpartum hemorrhage, Dr. Brubaker says, which can cause bleeding within the first 12 weeks after delivery. When we say rare, we mean estimated to occur in 0.23 to 3 percent of all pregnancies. Some bleeding after childbirth is completely normal, but if you go through more than one pad in an hour, call your doctor or go back to the hospital, Dr. Crear-Perry says.
9. Venous thromboembolism
Venous thromboembolism describes the dangerous phenomenon of having blood clots in your veins, the CDC explains. When these blood clots happen in one of the veins deeper in the body (typically in the legs or arms), it’s called deep vein thrombosis. In what’s known as pulmonary embolism, this type of clot can break off and travel into the lungs, where it can block off blood supply. This can be life-threatening. What’s more, some research on the subject suggests that black people are most vulnerable to venous thromboembolism, with a 30 to 60 percent higher risk of this potentially dire health issue than white people.
Getting pregnant can make you around five times more likely to wind up with a blood clot, the CDC says. This is because during pregnancy and delivery, your blood clots more easily to lessen blood loss and the risk of conditions like postpartum hemorrhage, the CDC explains. Your growing uterus can also compress blood vessels that would normally help keep blood flowing from your lower legs up through your body, which gives that blood more of a chance to pool in your limbs. This blood clot risk is heightened through pregnancy and into the first three months after delivery.
Other blood clot risk factors include a personal or family history of blood clots or a blood clotting disorder, having a C-section or any other major surgery, and limited physical activity (like when you’re on bed rest or in recovery from a C-section), according to the CDC. Chronic medical conditions that are more likely to impact black people, like heart disease and diabetes, can also play a role.
Signs to look for: Symptoms of deep vein thrombosis show up in the affected limb, like your arm or leg, the CDC says. They include swelling, pain, warmth, redness, and discoloration, according to the CDC. If you have a pulmonary embolism, you might be dealing with trouble breathing, pain that gets worse when you take a deep breath or cough, a racing or irregular heartbeat, and even coughing up blood.
10. Preterm birth
Any birth that occurs before 37 weeks is considered preterm, the CDC explains. Preterm birth can be deadly for babies, and those who survive are at higher risk of issues like respiratory problems and developmental delays. This is a prevalent and worrisome health issue; around 1 in 10 babies were born too early in 2017, according to the CDC. Black people are a shocking 50 percent more likely to have a preterm birth than white people are, according to CDC data.
Preterm birth can happen for a number of reasons, like a history of going into labor too early, being pregnant with multiples, smoking, substance use disorder, and having less than 18 months between pregnancies, the CDC says. Some of the health issues on this list can also contribute to preterm birth, including preeclampsia and gestational diabetes.
A 2019 study published in The Journal of Maternal-Fetal & Neonatal Medicine aimed to explore the relationship between maternal morbidity and preterm birth. Using birth rate data from the California Office of Statewide Planning, researchers looked at rates of preterm birth (876 per 10,000 births) and severe maternal health complications (140 per 10,000 births), finding that 1 in 270 births had both preterm delivery and severe maternal health issues.
The researchers also emphasize that, just as with the other conditions on this list, racism has to be part of the conversation here. “The weathering hypothesis posits that there's accumulative stress on the body from exposure to structural factors like racism and discrimination,” Audrey Lyndon, Ph.D., R.C.N., lead author on the preterm birth and maternal complication study and assistant dean of clinical research at NYU Rory Myers College of Nursing, tells SELF. “There [are] a lot of folks that see that as a strong factor in the patterning that we see in preterm birth and other health outcomes in the black population in particular.”
Signs to look for: Preterm labor is the same as regular labor, it just starts before 37 weeks. Signs include contractions every 10 minutes or more, leaking a lot of fluid or blood from the vagina, and the sensation that the baby is pushing down. People in preterm labor may also experience a dull ache in their lower back and abdominal cramping that may or may not include diarrhea, the CDC says.
11. Postpartum depression, anxiety, and other mental health conditions
There is rightfully a lot of focus on making sure that black pregnant people can have physically safe and healthy birthing experiences. But that can make it easy to sideline mental health in this space, even though it’s just as crucial for wellbeing. And with all the changes a new baby can bring, it can be even easier to miss the signs of serious mental health conditions like postpartum depression and anxiety, along with less common conditions like postpartum bipolar disorder.
According to a 2017 CDC analysis of 27 states, around one in nine people experience symptoms of postpartum depression. Data on postpartum anxiety isn’t as robust, but what research does exist suggests it may actually be more common than postpartum depression. A 2013 study in Pediatrics found that 17 percent of the 1,123 postpartum people studied showed signs of postpartum anxiety compared to 6 percent who exhibited symptoms of postpartum depression (and 3.7 percent who showed signs of both). More research is necessary to confirm just how common both of these conditions may be. (This study also had limitations, like only looking at people who intended to breastfeed.)
According to the National Institute of Mental Health (NIMH), black people aren’t inherently more likely to experience mental disorders than other populations, but they can be more vulnerable to barriers to care, which can make it harder to seek help, such as a lack of insurance or culturally competent providers, and community mental health stigma, according to the American Psychological Association (APA).
The stress of a new baby, a lack of support, and logistical challenges in seeking care can contribute to issues like postpartum depression and anxiety, Dr. Crear-Perry says.
Signs to look for: “[It] can be hard for women to sort out what's normal from what's a real problem,” Dr. Brubaker says. How are you supposed to separate regular mood shifts or worries that can come with caring for a baby from something that might be more serious?
Let’s start with postpartum depression. The symptoms can involve those of non-postpartum depression, like a sad mood that lasts for over two weeks, feelings of hopelessness, and a loss of interest in things that would typically bring you joy, according to the NIMH. On top of that, postpartum depression can lead to crying more than usual, being angry, feeling disconnected from your baby, doubting your ability to take care of your baby, and thinking about causing harm to yourself or the baby, according to the CDC. Most importantly, you don’t need to have all of these symptoms to justify getting help. Worrying can also be a feature of postpartum depression, but it’s the hallmark of postpartum anxiety. If you’re experiencing such an intense level of worry or fear after having a baby that it’s hard for you to go about life as normal (or as close to normal as possible as a new parent), that could be a sign of postpartum anxiety.
Ultimately, if you’re feeling any of these emotions (or any of the above physical symptoms we mentioned) reach out to your doctor to talk through what you’re feeling. All pregnant people and new parents deserve to be safe, happy, and healthy—black ones included.
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