Every woman deserves to deliver a baby how she wants and in a safe way, said Dr. Maya Dominique, a Northwest Indiana obstetrician and gynecologist.
However, Black women have a more difficult time getting what they need out of labor, which can lead to grave consequences.
“Black babies have a higher risk of pre-term birth,” Dominique said. “But, it’s a really complex issue, and we can’t point to one thing and say, ‘That’s the reason.’”
Black women and children have greater risks of maternal and infant mortality, Dominique said, with the infant mortality rate being nearly double the numbers for white infants.
In 2023, in Indiana, 524 babies died before their first birthday, Dominique said, which is about 44 babies every month and 10 each week.
According to a 2023 report from the Indiana Maternal Mortality Review Committee, the state had 80 pregnancy-associated deaths in 2021, with the three top causes of death being substance use disorder, continuity of care and knowledge.
Per 100,000 live births, 156.3 Black women experienced pregnancy-associated deaths, while 90.7 white women experienced pregnancy-associated deaths, according to the Indiana Maternal Mortality Review Committee.
The experience of Dolton woman at a Crown Point hospital more than a week ago has put a spotlight on Indiana hospitals’ maternal and infant health policies.
On Nov. 16, Mercedes Wells and her family were driving through Northwest Indiana around midnight when she went into labor. After six hours at Franciscan Health Crown Point, she said she was told to leave the hospital as she was dilated 3 cm and her labor wasn’t progressing to the satisfaction of a nurse; Wells was never examined by a doctor, she said. Wells, 38, and her family drove to Community Hospital in Munster, but they had to pull over about eight minutes later and she gave birth to her fourth child, Alina, in the car, according to Post-Tribune archives. Wells told the Post-Tribune that she feared for her life during the incident.
Franciscan announced on Nov. 21 that it fired the nurse and doctor assigned to Wells and was retraining staff to adhere to protocols requiring every maternity patient be examined by both a doctor and a nurse.
Wells was readmitted to Community on Nov. 23 with post-birth complications, including hemorrhaging. She and her husband Leon appeared with U.S. Rep. Robin Kelly, D-Lynwood, at a Tuesday press conference where Kelly introduced legislation that will urge hospitals and birthing centers to develop and implement a safe discharge plan.
“I’ll live with this experience for the rest of my life,” Mercedes Wells said in a news release from Kelly’s office. “No expecting mother should be visited by this kind of horror. I’m ready to join Congresswoman Kelly in advocating for women like me. I’m ready to speak up and speak out so that one day, substandard medical care is a thing of the past.”
Mary Pell Abernathy, chair of the Indiana Maternal Mortality Committee, said that the committee has consistently seen a disparity between the rates for white and Black women throughout the course of five years.
“That being said, in Indiana, our numbers for (Black) maternal deaths is somewhat unstable, meaning it’s a lower number,” she said. “It’s sometimes hard or a little uncomfortable making sweeping generalizations from that data when the numbers are low.”
The committee doesn’t track mortality rates based on counties, but instead looks at districts. Lake, Porter, LaPorte, Newton and Jasper counties are part of District 1, Pell Abernathy said, which has about 10% of pregnancy-associated deaths.
“We probably won’t ever have something for the counties,” she said. “It’s just simply because there’s a lot fewer maternal mortalities than there are infant deaths (per county).”
Jill Inderstrodt, assistant professor in the Indiana University Richard M. Fairbanks School of Public Health, said the leading cause of pregnancy-related death among Black women is cardiovascular complications, including preeclampsia and eclampsia, which occurs when a woman suffers from high blood pressure.
Because Black women might die because of those complications, Black infants are also at a greater risk of death, Inderstrodt said.
“If Black women are dying more frequently or if the babies of Black women are dying more frequently, that isn’t necessarily an indicator that something is wrong with Black women genetically or physiologically,” Inderstrodt said.
To change differences in Black and white maternal mortality rates, Inderstrodt said it’s important for providers to understand their patients and not place the burden of care on their patients.
“Doctors and clinicians in general often perceive Black women’s pain as different or less than white women’s pain,” she said. “Studies show that Black women might actually rate their pain higher than white women when they’re in labor, but they’re less likely to be prescribed the requisite painkillers that will temper their pain. I think one of the major talking points with maternal mortality in particular is that we need to believe Black women when they’re in pain.”
That stigma exists because of historical stereotypes that Black women have a higher pain tolerance than white women, Inderstrodt said, and that unconscious bias can make its way into medical school cohorts.
“Sometimes it’s not pain, sometimes it’s dizziness or lightheadedness or things that would indicate a higher blood pressure,” Inderstrodt said. “Not responding to warning signs in Black women … that can all be reasons (for a higher mortality rate).”
The Indiana Maternal Mortality Review Committee strives to help women get care to prevent any risks to them or their babies, Pell Abernathy said, including working with county and state departments to provide help.
According to a statement from the Indiana Department of Health, multiple initiatives are in place to decrease maternal and infant mortality statewide.
“IDOH is committed to using data-driven and evidence-based strategies to reduce maternal and infant mortality,” Lisa Welch, media relations coordinator, said in an email. “IDOH has initiatives focused on improving maternal and infant mortality at all levels…”
Initiatives include: connecting with and supporting community-based programs through Health First Indiana; providing home visiting, breastfeeding resources and infant safe sleep education; conducting comprehensive reviews of maternal and infant deaths; ensuring mothers and infants receive care at the best facilities; partnering with external stakeholders to bring care across the state; and running the Indiana Pregnancy Promise Program to offer support during the prenatal phase and first 12 months after birth.
In Lake County, Health First Indiana funds have been directed to strengthen maternal and child health, said Dr. Chandana Vavilala, health officer for the Lake County Department of Health.
“That includes expanding prenatal assistance programs to help pregnant residents navigate appointments, insurance, transportation and social needs,” Vavilala said in a statement.
The Department of Health has partnered with Dominique to create Early Connect: Community-Based Prenatal Safety Net Program in Merrillville, which Dominique said is part of the ZIP code that has the most infant deaths in Lake County.
The program aims to meet pregnant women where they are, Dominique said, because it’s easier to bring resources to them.
Doctors can refer patients to the program, Dominique said.
“Once we find out that a patient is pregnant from their ultrasound, we then surround them with the resources they need to have a successful pregnancy,” she said. “We contact the patient, we do our initial intake within 24 to 72 hours, and once that intake occurs, we connect them to prenatal care right away.”
The program provides expecting mothers with a maternal advocate, Dominique said, and they can call a hotline to get help when needed.
“Of course, we’re not their physician, but we can intervene and advocate for patients when needed,” she added.
In addition to its program with Dominique, the health department works to connect pregnant and postpartum mothers with necessary support, including hygiene items, baby formula, safe-sleep essentials, pregnancy and post-partum education, breastfeeding support and infection-prevention resources.
The department also expands HIV and sexually transmitted infections testing to pregnant women and provides access to maternal and infant food boxes to those struggling with food insecurity, Vavilala said.
“Together, these investments can help remove barriers, meet families where they are, and ensure that every pregnant person and infant in Lake County can access consistent, safe, and supportive care,” Vavilala said.
Beyond Lake County, women are working to make pregnancy safer for Black women, including Keyonna Tompkins, the Southside Health Community Organization’s program manager for maternal health. Tompkins’ organization helps provide Black mothers with free doulas on the south side of Chicago.
Tompkins said it was important for her to provide resources to Black expecting mothers because they deal with consistent prenatal care, which can be due to implicit bias in the health care system or medical conditions, including hypertension and diabetes.
“That particularly leads to delayed treatment, and it’s very important for our maternal patients to get to those appointments and be seen sooner,” Tompkins said. “These delayed treatments and missing warning signs can be very detrimental.”
Although the organization serves Chicago, Tompkins said seeing Mercedes Wells being denied care while in active labor in Crown Point, upset her.
Knowing a woman just across state lines was suffering made Tompkins upset, she said, and she’s worried about the future of Black maternal health if help is not provided.
“Everyone I’ve spoken to in my circle has the same concerns,” Tompkins said. “I just want to advocate and help be a key factor in closing those gaps to traditional care so we can have some improved birth outcomes.”