Why are black mothers at higher risk of miscarriage?
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NeCara McClendon was 19 weeks pregnant and at home after work on a Tuesday night in August 2022 when she started bleeding — profusely.
At the nearest emergency room in Fredericksburg, VA, where she lives, medical staff told her her cervix had dilated. Your baby and the amniotic sac moved into the birth canal too soon.
One doctor told her there was no hope, a second doctor said she needed expert advice, and a third doctor recommended, via telemedicine, a transfer and a technique where the mother is placed head-down in a hospital bed to avoid miscarriage.
The mixed messages are discouraging, Mclendon said. “It felt like they kept giving me a little hope and then taking it away.”
After the transfer, McClendon found that the new hospital did not offer Tilt treatment. Instead, they gave her medicine and told her to wait. And she did – for 3 days – before an ultrasound showed her son’s legs in the birth canal.
The doctor said nothing could be done. McClendon gave birth to her son the next morning at 19 weeks and 5 days, too young to survive outside her womb.
“The days after were non-stop crying – questions [myself] why did this happen to me I started to feel like a failure.”
why it happens
Miscarriages are more common than many think. It roughly happens 1 out of 4 Pregnancies, mostly in the first trimester. It is often not clear why it happens.
Still, some things increase the risk of miscarriage. Weight is one of them, and McClendon is slightly overweight. She also has polycystic ovary syndrome (PCOS), which means her ovaries produce too many male sex hormones called androgens. PCOS can increase the risk of early miscarriage in the first 3 months of pregnancy. (McClendon didn’t lose her son until he was almost five months old.)
But there’s another factor: McClendon is black.
Black women in the United States are 43% more likely than white women to miscarry, according to a 2021 study that examined more than half a million US women. (A black mother is also more likely than a white mother to lose her baby at 20 weeks or in childbirth (stillbirth), or her life, according to the CDC.)
“The scandal is that we really don’t know [why]said study lead author Siobhan Quenby, MD. “We urgently need more research. It is not acceptable in 2022 not to know.”
Doctors know that health risk factors for miscarriage, such as diabetes, obesity, and high blood pressure, are more common in black women than in white women.
But again the question why? Factors include differences in biology, society, culture, lifestyle, and medical care, among others. And those can be pretty hard to separate, according to experts.
Other less studied biological factors may also play a role. For example, fibroids — muscular tumors that grow on the wall of the uterus — can sometimes cause a miscarriage. Almost 25% of black women ages 18 to 30 have them, compared to 6% of white women. Black women are also two to three times more likely to have recurring fibroids or complications, which could compound the problem.
The difference in vaginal microbiota between black and white women may play a role, as the vaginal microbiome has been linked to recurrent miscarriage.
But it’s disparities in access and use of health care that could make the biggest difference, said Ana Langer, MD, director of the Women’s Health Initiative at Harvard’s TH Chan School of Public Health.
Black women are less likely to seek proper prenatal care for a variety of reasons, Langer said. These can include lack of insurance, lack of financial and educational resources, lack of nearby healthcare facilities, fear of abuse, and more. Even perceptions of racial discrimination in society at large can delay prenatal care, according to some research.
The implications of race in medical facilities can be difficult to unpack. In one remarkable study, the mortality rate of black newborns, which is three times higher than that of white newborns in the US, was halved when cared for by a black doctor. But oddly enough, doctors’ race didn’t affect the mother’s results, the study found. Researchers continue to grapple with these questions.
After the miscarriage
Since August, McClendon and her partner have been trying to find a personal grief counselor to see as a couple. But so far they haven’t had any luck. So they made their way on their own – with some success. “I’m not going to say it’s getting better, but you’re dealing with it better,” she said.
Grief comes in waves, she says. Some days they are fine and other days the pain returns unexpectedly. Approaching the baby’s due date was particularly difficult.
“My baby shower was supposed to be last Saturday,” McClendon said. A day to celebrate McClendon and her son-to-be turned into a day to remember what she had lost. It was a hard day. But she got over it. “It started out sad, but eventually got good,” she said.
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