Late last year, 30-year-old Christine Fields died after giving birth at a Brooklyn public hospital. Within weeks, New York State Department of Health inspectors arrived, retrieved her medical file and began interviewing her doctors and nurses, the department said.
This is not the first time government officials have investigated the delivery department at Woodhull Medical Center Hospital. In 2020, medical examiners determined that a series of failed epidurals by the same Woodhull anesthesiologist led to the death of a 26-year-old first-time mother named Sha Asia Semple.
Both Mr. Fields and Mr. Semple were black. Their deaths made Ms. Woodhull the most prominent symbol of racial disparity in New York. In New York City, black women are nine times more likely to die during pregnancy and childbirth than white women, which is much more pronounced than the national disparity.
New York state’s alarming maternal health record has drawn attention from lawmakers, health officials, activists and even filmmakers. In recent years, new laws and programs have been introduced one after another. Government funding for doulas is increasing. A state commission investigates all maternal deaths. A survey was conducted among new mothers about their childbirth experience, including questions regarding racial discrimination.
On Thursday, Gov. Kathy Hochul proposed her own six-point plan to address the issue. The plan includes paid maternity leave, no out-of-pocket costs for prenatal visits, and a monitoring system for unnecessary C-sections.
But it remains to be seen whether attention and intervention will have a significant effect. In fact, New York state’s maternal health is worsening, according to several indicators.
State Department of Health spokesman Daniel de Sousa said the department could not comment on the details of what may have happened at Woodhull because it is a public investigation.
“While we cannot comment on individual cases, the department has strong policies in place to keep parents and babies healthy and safe and protect them from potential illegal activity,” De Souza said in a statement. said.
Dr. Wendy Wilcox, chief of women’s health for the city’s public hospital system, said she had no particular concerns about Ms. Woodhull. “We strive to improve quality and safety, and we certainly believe that our hospitals are safe places to deliver babies,” Dr. Wilcox said.
There were 29 maternal deaths related to pregnancy and childbirth in 2020, according to the latest citywide data available from. New York City Department of Health and Mental Hygiene. Of the women who died, 12 were black, nine were Latino, four were Asian, and four were white.
Experts say the reasons for racial disparities are complex and diverse. Chronic conditions such as diabetes and high blood pressure that can increase the risk of pregnancy occur in New York City. more widespread There are more black and Hispanic residents than white residents.
The coronavirus pandemic has also led to poor overall health for many people, including pregnant women, and is contributing to a growing shortage of doctors and nurses. Interviews with doctors and nurses show that understaffing on delivery floors in some poorer areas can lead to poor safety conditions and contribute to infant deaths and serious injuries. Black mothers also often face racism in the form of unconscious bias, refusal of medication, and verbal abuse that can make childbirth more dangerous, the study found.
Maternal deaths nationwide surged in 2020 and 2021 as the coronavirus disease (Covid-19) created dangerous health conditions for pregnant women. According to the Centers for Disease Control and Prevention, New York state’s maternal mortality rate actually decreased in 2020, but rose significantly in 2021.
Doctors say the pandemic has increased the number of problems that interact in alarming ways. Conditions such as uncontrolled high blood pressure and anemia can increase the likelihood of a caesarean section and the risk of postpartum hemorrhage. And due to staffing shortages and high physician turnover, some workplaces have become unaccustomed to dealing with such emergencies.
Staffing shortages are also being felt at clinics where many pregnant women on Medicaid and without insurance receive prenatal care. This kind of care, the centerpiece of the governor’s new initiative, lowers the risk of various complications during pregnancy.
But in the Bronx, Less than 60% of pregnant women The rate of receiving prenatal care during the first trimester is the lowest in the city. The percentage of women in the Bronx who receive adequate prenatal care or better care during pregnancy is It went down a little Although it is a trend in recent years, Saw it in Brooklyn.
In some cases, the reason may not be women not seeking care, but a lack of appointments.
At Montefiore Medical Center, a private hospital system and the Bronx’s largest health care provider, 20% of pregnant patients currently have follow-up appointments, according to PowerPoint slides obtained by The New York Times. He says he hasn’t. Doctors said in interviews that the number of calls the hospital receives from people seeking prenatal care has significantly reduced the number of available appointments.
Most patients who give birth at Montefiore in the Bronx are Hispanic or black. The majority have Medicaid. The Bronx has the highest poverty rate of any borough in the city.
In August 2022, a recent black immigrant from Jamaica showed up at Montefiore’s Wakefield campus in the Bronx. The 28-year-old woman was in her third trimester of pregnancy and wanted to become a Montefiore patient. She and her baby had high blood pressure, but she was considered stable.
She was told to call the clinic in Montefiore for her next prenatal appointment. But when she got there, she learned her first available window wasn’t until November — two months after her due date in September, she said in an interview. The woman asked to reveal only Razanaha, recalled.
She had no further prenatal appointments. A few nights before her due date, she felt that her baby was moving less. When she arrived at the hospital, Razanaha recalled that she was told that she had “had a very busy day.” A simple fetal heart rate check appeared normal enough, according to a four-page summary of the incident by Montefiore’s quality control department obtained by the Times. The nurse asked Razanaha to count her kicks. Then the nurse went to take care of another patient.
There were no kicks to count. However, it was a while before anyone checked on her again. According to her case review, Razanaha was not fitted with a continuous fetal heart rate monitor, a standard step for mothers reporting decreased fetal movements, until nearly 90 minutes after her initial arrival.
“As they were tying me up, they finally realized he was dying,” Razanaha recalled. An emergency caesarean section was performed shortly thereafter.
“He appeared without crying,” the case report states.
At a subsequent internal meeting, doctors discussed whether there was an “opportunity to put this patient on a fetal monitor sooner,” according to “discussion points” listed in the case review, and whether staffing levels affected the outcome. I was encouraged to consider whether I had given it.
At the time, many high-risk pregnancy specialists left Montefiore, making it difficult for the hospital to staff its two main delivery floors in the Bronx, including Wakefield, Montefiore doctors said. one person said in a recording of a department meeting in January. 2023, obtained by The Times.
“We do not have enough faculty to safely staff two separate inpatient obstetric OB services,” the doctor said in the recording.
In the recording, a doctor was also heard blaming “burnout” among doctors for a “huge increase” in serious complications associated with increased night shift work.
At Montefiore, potentially life-threatening complications occurred in about 10% of births on the main labor and delivery floor in 2022, according to internal hospital documents. This is a staggering 66 percent increase from pre-pandemic, when the rate of severe complications was nearly 6 percent. Already twice the citywide average.
In 2022, an Ecuadorian immigrant who suffered from preeclampsia, a dangerous pregnancy condition, died of a stroke at Montefiore Hospital in the Bronx, according to her sister Gabriela Waraca. Ms. Waraka is currently nursing her sister’s baby, which she delivered by emergency caesarean section.
Dr. Andrew Racine, Montefiore’s chief medical officer, said women who give birth in Montefiore tend to have higher rates of underlying risk factors, such as obesity and diabetes, than pregnant women in other parts of the city. He pointed out that there is.
Still, the maternal mortality rate associated with Montefiore was well below the Bronx’s overall mortality rate, and even the city’s overall mortality rate for many years, Dr. Racine said.
“If you want a safe birth, this is the place to be,” he said in an interview last year.
In September 2022, Mayor Eric Adams signed seven bills aimed at solving the city’s maternal mortality problem. The new law promised more education and more doulas.
These bills were promoted as a turning point. It is the first city legislation to address maternal mortality disparities and, as City Council President Adrian E. Adams said, “an important step in our city’s efforts.” Start addressing this long-pending problem”
But at Woodhull, the deaths of Ms. Semple and Ms. Fields have spotlighted another factor in racial disparities in childbirth that may be more difficult to address: hospital quality.
A 2016 study estimated that differences in hospital performance could be responsible for nearly all of this. half of the racial gap Severe maternal morbidity.
white women in new york Probability is high than for Black women to give birth at top academic medical centers.black woman Probability is high Giving birth in public hospitals or struggling private “safety net” hospitals where staffing shortages and safety records are more problematic. tends to be lower.
What happened after Ms. Fields, a 30-year-old mother of two, arrived at Woodhull Medical Center on a Sunday in November, and whether her death could or could have been prevented by the staff there. It is still unclear whether there is. If she had given birth elsewhere, the outcome would have been different.
According to her family, she told an employee there that she did not want a C-section. Doctors insisted on doing so when her baby’s heart rate began to drop, her fiancé Jose Perez recalled in an interview outside the hospital later that week.
After giving birth to her son, Fields “felt weird,” Perez said. Perez said her hospital staff immediately performed CPR on her. The coroner gave her cause of death as bleeding after a Caesarean section.
Four days later, standing outside Woodhull, Perez said she still hasn’t told her two older children, ages 5 and 2, what happened. “They’re expecting mom to come home,” he said with tears on his face.
Kirsten Noyes and Lyceto Cruz Contributed to the report.
audio producer Patricia Zurbaran.