American Heart Month, observed throughout February, promotes heart health and raises awareness about high blood pressure as a leading risk factor for heart disease and stroke. Go Red for Women Day on February 4 is a campaign sponsored by the American Heart Association dedicated to raising awareness about how cardiovascular disease disproportionately affects women. Heart disease especially impacts new and expecting mothers and is the number one killer of new moms in the U.S. Those most affected, and often least aware of their risks, are Black women.

Due to a number of factors including heart health, obstetric racism, and social determinants of health, the maternal death rate for Black women is higher than any other race and three times that of white women. While the American Heart Association offers great resources to help women understand their heart health risks and make healthy lifestyle changes, the maternal mortality rates for Black women cannot be solved by individual actions alone. Improving these rates for Black women, and thus all women, will also require addressing systemic racism and bias in health care at all levels.

Maternal Mortality is Preventable

According to the American Heart Association, cardiovascular conditions are the leading cause of death during and immediately following pregnancy. Nearly two-thirds of these deaths could be prevented. To improve wellness prior to pregnancy and lower the risks of heart issues, doctors recommend:

  • Finding a good provider who can assist with pregnancy questions and concerns and staying up to date on routine checkups.
  • Knowing the risk factors for heart problems or existing conditions that can increase the likelihood of heart problems.
  • Making healthy lifestyle choices such as quitting smoking, managing stress, and eating a nutritious diet.
  • Managing medical conditions before pregnancy, such as controlling high blood pressure or losing weight if necessary.

During prenatal visits, women are encouraged to ask about what to expect at each stage of pregnancy, labor, and delivery, as well as expectations for any upcoming tests or appointments. This includes learning what the purpose of each test is and what the results mean. Typical testing includes checking for signs of diabetes, infections, or any heart issues.

It’s important to mention any family history of major heart health diagnoses or complications. Any changes or irregularities in heart functions should also be reported as soon as they occur. Previous pregnancy complications and some fertility treatments may also lead to higher risk. Warning a doctor of these early on in pregnancy can help them identify potential problems and intervene early if trouble occurs.

Pregnancy brings a wave of symptoms and changes to the body, many of which are normal and expected. However, a number of symptoms may be warning signs of heart health complications or other potential problems. Symptoms that should immediately be reported to a provider include:

  • Bleeding.
  • Difficulty breathing or shortness of breath.
  • Heart palpitations, increased heart rate, or irregular pulse.
  • Chest pain.
  • Fever.
  • Severe nausea or abdominal pain.
  • Persistent and intense headaches.
  • Bloody cough or coughing at night.
  • Vision problems.
  • Changes in mental health.

Even after delivery, it’s important for moms to continue to monitor their health as many heart-related problems can arise from a few days up to a year after birth. Heart rate and blood pressure normally decrease within 48 hours postpartum and increase again in the days or weeks following.

Mothers can care for themselves by following the same healthy lifestyle changes they made during pregnancy and continuing regular medical care to monitor their health and any changes. Symptoms that call for urgent medical care include vision changes, dizziness, fever, chest pain, severe swelling, and any warning signs of complications during pregnancy.

Black Mothers Need Better Care

Though knowing the risks and warning signs of maternal health complications and making healthy behavioral changes is important, access to and quality of care can be the difference between life or death for Black mothers. Poor quality of care and failure to recognize social determinants of health and their role in women’s ability to prioritize their health has directly impacted Black maternal mortality rates.

The disparities in health care and social service support for Black women are often rooted in racism, often intersecting with sexism. A recent webinar series titled “The Intersection of Misogynoir, Obstetric Racism, and HIV,” explored how obstetric racism and misogynoir — the intersection of racism and sexism expressed towards Black women — drives higher rates of deaths and near-deaths of Black girls, women, and birthing bodies.

To combat Black maternal mortality, providers have a responsibility to acknowledge how social determinants of health may affect mothers’ ability to invest in their health outside hospital walls. A nutritious diet helps improve heart health but may not be realistic for a mother living in a food desert, especially if she doesn’t have reliable transportation. Regular prenatal appointments are crucial but may be out of reach for expecting mothers who don’t have affordable health insurance.

Health systems also have a responsibility to address structural racism and implicit bias at all levels from individual providers to the facility as a whole. Numerous accounts exist of Black women being mistreated or denied equitable care due to personal bias from their providers. Black women are frequently denied pain medication, even following childbirth, due to stereotypes regarding them as drug users. Tennis player Serena Williams famously spoke up about her near-death experience following childbirth. She correctly identified warning signs of blood clots in her lungs, coupled with chest pain and gasping breaths, but her nurse thought the pain medicine was just confusing her.

Williams is an international and beloved celebrity with access to top-of-the-line care, and even she had to navigate structural racism. Had she not repeatedly insisted her concerns be addressed and advocated for herself, she fears she may not have survived. Many Black women struggle to feel heard or have their wishes respected, especially throughout pregnancy and during delivery, and aren’t as fortunate as Williams.

Because of this, it’s necessary for Black women to understand their rights as patients and build a care team that advocates for them. Black doulas and midwives are an invaluable support to new or expecting Black mothers. Though they assist with childbirth and not necessarily with complications that can arise, they do serve as a powerful medical advocate to ensure that the mother’s pain and concerns are believed and addressed. This in turn allows swift intervention and can help prevent prolonged issues, future complications, and death.

Doulas and midwives also offer emotional support. They sometimes help women navigate maternal depression, postpartum depression, and suicidal thoughts — another high risk for new mothers, especially those affected by social determinants of health.

One of the risk factors for women’s heart health issues, especially pregnant and recently postpartum women, is stress. New and expecting mothers are encouraged to manage stress to keep both their physical and mental health under control. However, for Black women, shaking off stress is easier said than done.

Stress and trauma caused by racism is lifelong. Black Americans experience racism and racial bias from the day they are born to the day they die. It’s also transgenerational, as Black children are raised learning how their family has been discriminated against and will eventually grow to see their own children and grandchildren being affected. Stress can even be passed on physically. High cortisol levels built up over time from racial stress and trauma can be passed down from Black mothers to their children.

This transgenerational and lifelong span of racism compounds any existing physical and mental health concerns. Any additional risks similarly compound, such as family history of heart conditions or social determinants of health that prevent a healthy lifestyle. Any bias or racism experienced throughout prenatal visits and childbirth only adds to the problem, culminating in the overwhelming Black maternal mortality rate present today.

Working Together to Improve Black Maternal Mortality

Supporting new and expecting Black mothers requires ensuring not only proper physical care, but emotional and social support as well. Black women need to be shown that they are valued, respected, and autonomous of their own bodies and their babies. Some may need social support to ensure that they can access affordable quality care, including an advocate such as a doula or midwife. They need reliable transportation to health appointments and pharmacies, affordable medication, and nutritious food.

A study on the racial disparities of Black maternal and infant mortality outlined five recommendations for policy strategies to help address the ongoing threat to Black mothers. These recommendations are:

  • Improve access to critical services. This includes strengthening existing programs and support services, eliminating maternity care deserts, and offering Black women tools to navigate the health care system.
  •  Improve the quality of care provided to pregnant women. This includes training providers to address racism, building a more diverse health care workforce, creating standardized assessments for mothers and infants, and adopting new models of care.
  • Address maternal and infant mental health. This includes identifying barriers to accessing maternal mental health services, dismantling these barriers, and screening for and addressing infant and early childhood mental health issues.
  • Enhance supports for families before and after birth. This includes investing in and expanding access to policies and programs that support families’ basic needs, including community support services.
  • Improve data collection and oversight. This includes standardizing birth and death certificate data, mandating and funding fetal and infant mortality review committees, and ensuring equity in the review process.

Though structural change is needed within the American health care system, it’s still important for women to know what the risks for heart health issues are. Risk factors include race, age, weight, and blood pressure. Black, American Indian, Alaskan Native, and Hispanic women are more likely to have complications during pregnancy due to structural racism and social determinants of health affecting their ability to receive quality care.

Older women of all races are at higher risk of pregnancy-related death. Women 40 and older are nearly eight times more at risk of pregnancy-related death than women 25 and younger. Women 35 and older are at increased risk of conditions that make pregnancy complications more likely, such as chronic high blood pressure, preeclampsia, and gestational diabetes. Increasing age can also amplify racial inequities.

Obesity, defined as a body mass index (BMI) of 30 or higher, can also increase the risk of pregnancy complications. Women who are obese prior to or at the start of pregnancy are at higher risk of sleep apnea, which can increase the risk of gestational diabetes, and stillbirth. Preeclampsia, a high blood pressure disorder, is also more likely.

Issues contributing to high blood pressure such as preeclampsia greatly increase the risk of heart attack and heart failure. Women with high blood pressure are more likely to have pregnancy complications and should work with a provider to lower it before getting pregnant if possible. Some birth control medications and prenatal supplements have been linked to heart complications and should also be discussed with a doctor.

The American Heart Association’s annual Go Red for Women campaign helps raise awareness about heart health issues in women and encourages them to share their stories. Each year, the association highlights a class of Real Women and their lived experiences with heart complications. Reading and sharing conversations from women about their real-life experiences builds community, and spreads awareness about women’s heart health while underscoring the need for more compassionate, whole-person health care practices.