Race, sex, bias
complications of high blood pressure identified by signs of damage to her heart and hypertension. 12 She had died just a few weeks after giving birth to her first child. During her pregnancy it was noted that she had experienced multiple spikes in her blood pressure but also complications due to the c- section that was carried out in order to deliver her child; she was diagnosed with a post-caesarean haematoma, that is, blood trapped in layers of healing skin (extremely rare, occurring in only 1% of c- sections). Her persistent high blood pressure took a great toll on her health throughout her post-partum period, constantly fluctuating, reaching a dangerous blood pressure reading of 174/118 indicating hypertension stage 3. Under correct protocol and ACOG guidelines, her alarmingly severe blood pressure should have warranted an assessment on the day of the reading to then receive the adequate care required especially for someone like Shalomwho had a history of hypertension and other multiple risks. However, she was scheduled for a later appointment, by which time her blood pressure had reduced to a reading of 130/85; it was concluded by her doctor that her spikes had been due to ‘poor pain control’. It was later revealed after her death that on her medical records there was a clear lack of care or awareness for her need of a heightened level of attention, despite the complexity of her pregnancy and health during her post-partumperiod. Nevertheless, it would be erroneous to imply that her overall treatment was completely due to her race. However, could there have been an adequate post-partum care put in place by her health providers in response to the risks she possessed? Yes. Could her healthcare providers have acted sooner to her health problems relating to her history with hypertension and therefore identified something was wrong? Yes. It is evident that there was a lack of concern and urgency for the health problem and risks she possessed even up until her death.
It is imperative that conditions like pregnancy-induced hypertension are recognized as it continues to disproportionally affect black women like Shalom, influencing co-morbidities in black women and overall affecting the course of their pregnancies.
Biological weathering
Through emerging research, the term ‘biological weathering’ is becoming a widening explanation regarding the racial disparities in maternal mortalities of black women.
Hypothesized by Arline Geronimus, the theory explains the biological effects racial bias has on the body causing premature decline of health and a greater allostatic load 13 in Black women due to a greater exposure to the stresses of racism, susceptibility to social disadvantages and dangerous environments. Although there is a great emphasis on the health of black people and their susceptibility to certain diseases and challenges, it should be known that the disparities in health are not due to inherent genes within the ‘black race’ but instead heavily influenced by the social environmental factors due to DNA methylation. DNAmethylation is a common epigenetics signalling tool that is used to lock genes in the ‘off’ position. 14 It occurs when a group of molecules attach methyl groups to specific areas of a gene’s promoter region (e.g. to the C-5 position of the cytosine ring) by DNA methyltransferases (DMNTs). 15 The understanding of this process helps refute the idea certain races are more susceptible to certain diseases due to the DNA one possesses; it also helps accentuate the idea that race is a social construct 12 NPR, Black Mothers Keep Dying After Giving Birth , 2017. 13 ELSEVIER, Racial differences in weathering and its associations with psychosocial stress , 2019. 14 Pediatric research, DNAmethylation, early life environment, and health outcomes, 2015. 15 PMC, DNAMethylation and Its Basic Function , 2013. 16 PMC, ‘ Weathering ’ and Age Patterns of Allostatic Load Scores Among Blacks and Whites in the United States, 2006.
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