Recently I've been reminiscing about my tennis days. I had the privilege of playing on the varsity team while in high school as well as through college before I started medical school. I had so many people to look up to -- Steffi Graf, Billie Jean King, and Martina Hingis. And then came Serena Williams. Little did I know that my tennis hero would become my hero in such a different and more substantial way.
Unless you've been living under a rock for the past few weeks, you're probably aware that Serena Williams made it to the Wimbledon finals. And despite her upsetting defeat, Serena's loss was still such a huge victory.
If we can remember, it was only a mere 10 months ago when she was fighting for her life after giving birth to her beautiful daughter, Alexis Olympia. As a black woman, this already placed Serena at an excess predisposition for peripartum events. Hence it came as no surprise when 24 hours after her emergency cesarean section, she suffered an acute pulmonary embolism. This was further complicated by postpartum hemorrhage (PPH), requiring surgery after surgery to the point she couldn't even keep track, as she later relayed. This elite athlete was in an unfamiliar place: Even after extensive rehab, she found it difficult to walk to her mailbox and back.
How would she respond? Like a champion.
Fast forward to less than a year later. Serena Williams is in the Wimbledon finals, and she serves as an inspiration and true phenomenon to all physicians and patients who are dealing with postpartum and women's health issues. Bearing in mind that this international superstar -- who eloquently stated at the Wimbledon final that she's "just getting started" -- for all her status, is still a black woman in America. And as such, her maternal-health complications can't be separated from those of so many other black women who have been in her shoes.
It should be shocking to many that U.S. rates of maternal mortality are substantially higher when compared with those of other developed nations. The sad news is that these rates continue to rise. Outcomes for black women have led the way to try to make sense of what may be driving this, because women of color remain disproportionality susceptible to these pregnancy-related complications.
Each year in the U.S. alone, about 700 to 1,200 women die from pregnancy or childbirth complications. And black women are roughly three to four times more likely to die from such complications when compared with their white counterparts. Additionally, there has also been a steady rise in maternal morbidity. Indeed, for every woman who dies, dozens more experience such severe complications, affecting more than 50,000 women annually. Sadly, half of these conditions are preventable, according to the CDC.
The more common preventable complications include two that Serena Williams had: pulmonary embolism and PPH. The rates of both have steadily increased over the past decade, with pulmonary embolism doubling over time, from 1.1 in 1993 to 2.2 in 2014, and the PPH rates with procedures to control hemorrhage increasing from 4.3 in 1993 to 21.2 in 2014, with even sharper increases in later years.
Added to this list is high blood pressure and cardiovascular disease, which are two of the leading causes of maternal death, according to the CDC. Hypertensive disorders in pregnancy -- including gestational hypertension, pre-eclampsia, and eclampsia -- increase the maternal risk for future cardiovascular disease in the next 8 to 10 years and have been on the rise over the past 2 decades. These disorders .
In 2017, a Department of Health and Human Services report found that pre-eclampsia and eclampsia were and are also more severe. In addition, peripartum cardiomyopathy has been shown to affect black women at a younger age (median 27.6) than non-black women (31.7), later in the postpartum period, and with worse outcomes after initial diagnosis. Moreover, despite similar rates of treatment in black and non-black women, the recovery time for African-American women remains .
The cause for this racial divide in maternal deaths and morbidity remains controversial. Researchers and physicians have varying hypotheses about what factors could be driving these long-standing disparities. Some point to the differences in overall health and chronic illnesses among black and white women as a driving factor with higher rates of obesity and hypertension among the former. Others point to socioeconomic status (SES). These factors include access to good healthcare, education, insurance coverage, and housing, as well as levels of stress and community health among black and white women.
SES shouldn't be the strongest variable, however, as studies have shown that black women are more likely to have severe maternal morbidity regardless of their level of education or income. In fact, 2016 Department of Health data show that black college-educated women were more likely than white women who had not completed high school to .
There is more and more emphasis on understanding the ways that implicit bias and variations in the ways in which healthcare is delivered to black versus white women shape the way we hear our patients, and when discussing Serena's case, this couldn't be more apparent: Her initial concerns about her own body were dismissed, delaying her diagnosis and management. Ultimately, she diagnosed herself with a pulmonary embolism.
With all this being said, little research has been done to understand these health differences in severity. It is imperative to get to the root of the problem. What also is imperative is educating patients and healthcare providers alike on the potential risks. For me, as an avid tennis fan, black woman, and cardiologist who focuses on women's health, Serena's story is a major eye-opener. In shedding light on this subject, Serena Williams is a true heroine.
With all due respect to Angelique Kerber on her Wimbledon triumph, Serena Williams is the true victor. Not simply for the mere fact that she is the greatest of all time, but also for the many women who are realizing that they are not alone in their fights and that there's a light at the end of the tunnel. Her accomplishment at Wimbledon is the most remarkable thing I've seen an athlete do in my entire life. She shows the courage and determination that inspires us in the fight against peripartum complications.
And just as we will soon see Serena Williams hoisting another Grand Slam trophy, you will see us celebrating a major victory in women's health. I can't wait for the next serve.
, is the associate director of the Women's Heart Health Program at Northwell Health, Lenox Hill Hospital, in New York, and assistant professor of cardiology at Hofstra Northwell School of Medicine. She is a women's heart health and prevention specialist and spokesperson for the American Heart Association's "Go Red for Women" campaign. She wrote this piece for ľֱ.