Women and STEM: Birth and inequality in Pittsburgh

Childbirth is incredibly complicated biological mechanism. Most of us take for granted how safe it is nowadays compared to the days of yesteryear, when mothers had no access to antibiotics and children were somehow always dying between the ages of zero and five. Modern medicine provides us not only with more knowledge about birthing, but also, like, painkillers. We can monitor vital signs and take ultrasounds and it all feels so comforting. The reality, though, is that many mothers and babies still die before, during, and after labor for a variety of reasons.

I would like to start generally: this issue has the potential to impact anyone. Mistakes and complications happen all the time, and some fatalities are due to genetics or missed signs. However, women of color are statistically more likely to die during childbirth in the U.S. And Pittsburgh has one of the highest death rates for women of color in the country.

In 2019, the City of Pittsburgh’s Gender Equity Commission released a report entitled “Pittsburgh’s Inequality Across Gender and Race” which included a number of birth statistics for women of color in Pittsburgh. Here are a few:

• Fetal deaths are two times more likely among black women than white women
• Pittsburgh’s maternal mortality rates are higher than 97 percent of similar cities
• Black mothers are three times more than likely than white mothers to give birth to underweight babies

So what accounts for these deaths? A report from 2022 on maternal deaths in Pennsylvania noted drug-related accidental poisoning and obstetric complications as leading causes. Pennsylvania has certainly not avoided the effects of the opioid epidemic, with our next-door neighbor Ohio leading the nation in opioid-related fatalities. Communities of color and low-income communities have been disproportionately impacted by addiction, which certainly takes a toll on the body.

In fact, there are a number of systemic problems that can detract from the health of a pregnancy. Lack of access to food, mental health care, and prenatal care all lurk in the background of the medical terminology typically used when talking about childbirth. Many complications can be avoided with prior knowledge and care, which may be absent if a patient has less ability to see a doctor prior to giving birth.

However, there are some risk factors that can be foreseen. For example, an enormous number of birthing complications fall under the cardiovascular umbrella: preeclampsia (restriction of blood delivery to the placenta), hemorrhage (the rupture of a blood vessel), and cardiomyopathy (a form of heart failure) are all results of hypertension or high stress on the heart. You better bet giving birth to a child puts high stress on the heart. What might make that stress more likely to lead to a fatality, though, is diabetes. Diabetes raises the blood pressure by increasing blood sugar, and is much more commonly seen in black patients for a variety of biological reasons.

This is something that a doctor could reasonably check for, as are other pitfalls like sepsis, issues with anesthesia, or a variety of embolisms (the entrance of blood in the lungs or matter from the fetus into the bloodstream). So why are these fatalities still so prevalent, especially in Pittsburgh, the home of Magee Women’s Hospital?

A lot of attention has recently been brought to medical bias and the role of the patient in identifying problems in a medical context. There are certainly things to be said about racism in medicine and medical education. Also, though, I believe we have reached the point in medicine and technology where patients can take more control over their care, especially when they feel they may be at risk for bias. After nearly dying from a birth-related pulmonary embolism, Serena Williams spoke out about standing up for yourself to your doctors, something that saved her life. Her story is a great example of the birthing experiences of Black women and the dangers they face. For the many who did not survive their complications, though, justice has yet to be brought — and the medical community has a long way to go to make birthing safe for all.

Addendum

Addendum to last week’s “Period apps: tracking you or your period?” from social technologist and Carnegie Mellon Human-Computer Interaction Institute Ph.D. student Kimi Wenzel:

“The focus on period tracking apps has been sensationalized by the media. While I don't want to minimize concerns about privacy and period tracking apps, because they are legitimate, it's important to remember that (1) the menstrual data is not robust evidence, especially compared to the other types of information typically used in a prosecution and (2) the surveillance of pregnant individuals is simply not new. This surveillance, however, typically centers on women of color from low-income communities, which frankly is a group that many tech writers ignore.”