Since COVID-19 is an infection that can also impact one’s cardiovascular system, there’s a concern for heart attacks and blood clots—and particularly so for Black women who are pregnant.
Renee Davis didn’t enter 2020 with any assumptions. But like many Americans, Davis—who asked to use a pseudonym so she could speak candidly about her medical experiences—wishes that someone could have told her that this year would be emotionally taxing on all fronts, especially while pregnant.
“I’ve had to limit the amount of media I consume because the constant reporting of [COVID-19] cases and fatal stories were causing me to live in constant fear,” said Davis, who was 39 weeks pregnant at the time of this interview.
Davis, 28, hasn’t contracted the novel coronavirus, but she’s already been sick several times this year. The care she received in those interactions left her feeling under-informed, under-supported, and often untreated.
As confirmed cases continue to soar across the U.S., it’s clear that precautions decrease but don’t necessarily eradicate the risks. And when you’re a first-time Black mother with pre-existing conditions, protections intended to reduce infections—such as limiting the number of support individuals in hospitals and wearing masks during labor—might actually increase fears and risks during pregnancy and birth.
The Centers for Disease Control and Prevention recently updated its list of at-risk factors for severe complications related to COVID-19 to include pregnancy—validating the fears of many. But the agency still hasn’t added racism as a risk factor for serious illness, despite overwhelming evidence of racial health disparities.
Jaleen Sims, an OB/GYN in Jackson, Mississippi, told COURIER that since COVID-19 is an infection that can also impact one’s cardiovascular system, there’s a concern for heart attacks and blood clots—and particularly so for Black women who are pregnant. They are three times more likely to die from pregnancy-related complications, and the top causes, including excessive blood clots, infections, and high blood pressure, all impact the cardiovascular system.
The “downgraded” immunity the body initiates to maintain pregnancy, Sims explained, also means “illnesses are typically more serious and prolonged in pregnancy.”
Recent data published in the CDC’s Morbidity and Mortality Weekly Report (MMWR) found that pregnancy increases one’s risk for being hospitalized, being admitted into the intensive care unit, and needing a ventilator. It also found that Black and Hispanic individuals were disproportionately impacted during pregnancy.
Sims said this information is consistent with what is known about other illnesses, like the flu. She also notes that information must be paired with the data that continues to show that Black and Hispanic individuals are more disproportionately affected by COVID-19.
“We ask all pregnant individuals to call their doctors as soon as cold/flu-like symptoms, even the mildest symptoms like cough, congestion, and sore throat develop so that COVID-19 testing can be complete and the patient can remain under close observation by the care team.”
Seeking Personalized Care
Davis, who lives in Dallas, Texas—which has recently been described as having experienced “a Tsunami-like wave” of COVID—has had more interaction with the healthcare system in the last few months than many have over a couple of years.
Medical professionals don’t always provide quality care to Black women, and Davis suggested the pandemic may be making it worse. Now that appointments are even more expedited, she feels that her providers don’t have the time to give her the personalized care she needs to feel comfortable—and that has intensified her existing concerns.
Davis is sandwiched between numerous health risks—the maternal mortality crisis (of which six of every 10 maternal deaths that occur could be prevented), the coronavirus pandemic, and the pervasive impact of exposure to stress on Black health outcomes—and her struggle to find comprehensive care worries her. Nor does she feel her OB takes her pre-existing health conditions, which include chronic migraines and heart arrhythmia, seriously.
From January to February, Davis sought assistance from three different physicians hoping to get her cold-like symptoms under control. The first two providers—one she met virtually via telehealth and another who was an urgent care provider—each told her that there were no medications that were safe to take during pregnancy. Finally, the third provider—who happened to be a Black woman—prescribed something that would help with her symptoms safely. That doctor was also the only one to contact her afterwards to see how she was doing, she said.
Not long after her cold symptoms subsided, Davis started having migraines and noticed that her heart issues had resurfaced. Unable to take her regular medication because she was pregnant, she decided to check in with the neurologist and cardiologist she’d been seeing for years.
“My doctors told me the same thing,” Davis recalled. “There was nothing I could take and they hoped I felt better.”
Meanwhile, Davis was in near constant pain with migraines. Even the most mundane of tasks had become uncomfortable. Although she was taking time to care for herself, missing work also became a stressor of its own: She worried about her job security after being out for a month.
Finally, Davis decided to advocate for herself. “I took it upon myself to research medications and noninvasive treatments safe for me and baby,” she said. “I asked my neurologist and OB for permission to begin taking them and they approved. It made me wonder why all this time, they couldn’t have done the research to try to help me. I also worried if these medications were truly safe for my baby. I knew I was taking a risk, but had to get some relief and also get back to work for income.”
Her migraines, however, persisted, and she ended up having to go to an emergency headache clinic for an infusion treatment.
“That same day, I began having cardiac issues due to my heart condition,” Davis said. “That caused me to have to see my cardiologist and begin taking another prescription and over the counter medication.”
While her migraines have subsided, Davis continues to manage her heart issues with daily medication.
Providing Vigilant Care
Davis’ experiences as well as stories like that of Amber Rose Issacs—who died earlier this year after an emergency Cesarean-section related to HELLP syndrome, an urgent pregnancy complication that affects the blood and liver—illustrate the importance of being mindful in the way we streamline care while reducing COVID risks. Had Issacs had access to the intentional individualized care that she repeatedly requested from her healthcare provider, she might still be alive.
Earlier this month, another woman, 26-year-old Sha-Asia Washington, went into cardiac arrest while her baby was delivered via an emergency C-section following a routine stress test that discovered high blood pressure. Her death has prompted protests and further discussion into the ways the maternal health care system fails Black mothers.
Sims, the OB/GYN, notes that medical professionals must be attentive to all, especially Black mothers, in these times.
“We have to maintain our vigilance for Black mothers, especially if they are affected by the coronavirus. If they end up with a pregnancy complication on top of the coronavirus, they now have two significant ‘hits’ to the cardiovascular system that could lead to poor outcomes or even their demise if systems aren’t in place to be watchful for these things.”
Many hospitals are already following the guidelines developed by The American Colleges of Obstetricians and Gynecologists (ACOG). ACOG advises that medical facilities consider giving testing priority to pregnant individuals with symptoms as well as routine testing for those being admitted to labor and delivery, even if they are asymptomatic.
“We have to maintain our vigilance for Black mothers, especially if they are affected by the coronavirus.”
Davis understands the restrictions are in place to protect her and others. However, she worries many of these measures could make an already nerve-wracking process even more challenging.
Because she is high risk, the limits on support worry her.
“My plan for delivery was to have my boyfriend and mom present. Now, I am being forced to choose one even though they both support me in different ways.”
Naturally, she’s most concerned with how well these efforts will protect her baby after delivery.
All pregnant individuals, regardless of race and health status, should take COVID seriously, Sims said, advising they avoid crowds, wear face coverings, wash hands regularly, and stay home unless absolutely necessary.
And that’s what Davis has been doing: taking every precaution she can to stay safe. She’s working from home and social distancing. Her family even surprised her with a drive-by baby shower instead of a traditional celebration to minimize potential exposure.
But in these difficult times, her biggest wish is to make it through labor safely so she can meet and raise her baby boy. To do that, Davis said we need to create the systems that nurture Black women through birth and beyond.
“Black expectant mothers need more support, better and more affordable health care, education, and advocacy on their behalf. I feel like this group is forgotten. People think that expectant mothers will just figure it out, but it is a huge task to grow another human and that’s only the beginning.”
This story has been updated to reflect a clarification on the risk factors for maternal health.