An Olympian’s death from childbirth complications connects with a local concern on maternal death

The majority of those pregnancy-related deaths took pace in Montgomery County, which had 29 deaths, according to state data. Butler County was next with 12 deaths.

U.S. Olympic champion sprinter Tori Bowie died from complications of childbirth, an autopsy report confirmed on June 13. Bowie, who won three medals at the 2016 Rio de Janeiro Games, was found dead last month. She was 32. The report from the office of the medical examiner in Orlando, Florida, said Bowie was estimated to be eight months pregnant and showing signs of undergoing labor when she was found dead on May 2, according to the Associated Press.

Bowie’s death resulted from possible complications including respiratory distress and eclampsia, according to the autopsy report.

Eclampsia falls on a spectrum of blood pressure problems than can occur within a pregnancy, said Dr. Yangshu Linda Pan, an obstetrician-gynecologist with Premier Health’s Life Stages Centers for Women’s Health. This range includes normal blood pressure and then gestational hypertension where blood pressure is slightly elevated. The conditions can then lead into preeclampsia, preeclampsia with severe features, and eclampsia.

“Then you get to preeclampsia, which is where you have elevated blood pressures and protein in your urine, which means there could be a little bit of an issue with the kidneys now,” Pan said. Preeclampsia with severe features includes elevated blood pressure, protein in urine, and more concerning symptoms, one of which could be seizures.

“The seizures would then bump you to eclampsia,” Pan said. “It’s on the very severe end of a blood pressure problem in pregnancy.”

Preeclampsia can also occur postpartum, so while delivery can help, it doesn’t always remove the risk. Additional ways pregnancy can be life-threatening is if there is hemorrhaging, an infection, or blood clots.

What the numbers show

In an analysis on pregnancy-related deaths in the U.S. between 2017 and 2019, the Centers for Disease Control found four out of five pregnancy-related deaths could have been avoided, with 23% of those deaths being associated with mental health conditions, including deaths to suicide and overdose/poisoning related to substance use disorder.

In Ohio, pregnancy-related deaths increased from 2008 to 2018, according to the Ohio Department of Health’s Pregnancy-Associated Mortality Review program. The pregnancy-related mortality ratio for 2008 was 10.8 maternal deaths per 100,000 live births. That eventually increased to 29.2 in 2017 and 23.7 in 2018. Approximately 33% of the maternal deaths between 2008-2018 occurred during pregnancy, and 67% occurred within the year after the pregnancy.

A disparity persists

In 2021, the maternal mortality rate for Black women was 69.9 deaths per 100,000 live births, 2.6 times the rate for white women, according to the CDC.

“We definitely can correlate rates of infant and maternal mortality to race,” said Olivia Dixon, a certified nurse midwife with Fiver Rivers Health Centers.

Statistics show that even if you remove variables like income and education, the disparity for Black women still persists, she said.

“We still see higher rates of infant and maternal mortality in Black women,” Dixon said. “We can kind of make an assumption that that is largely associated with systemic risk factors, systemic racism, creating disadvantages, and stress.”

Nationally, Black women have reported not feeling heard by doctors when they express a concern, which has even led to the CDC’s Hear Her campaign, which seeks to encourage partners, friends, family, coworkers, and providers—anyone who supports pregnant and postpartum people—to listen if a pregnant person says something doesn’t feel right.

Access to care is important, as well as establishing a continuity of care and a relationship between providers and patients. It is helpful for patients to see the same provider throughout their pregnancy, Dixon said.

“I think it comes down to the ability to provide continuity of care. If somebody can create a relationship, whether that is with a physician or a midwife, they can build trust and can feel more heard,” Dixon said.

One thing Dixon has incorporated into the care she provides her patients is shared decision making.

“If it doesn’t work for the patient, it’s not going to work,” Dixon said. Whether it is a decision involving transportation or medication, the patient is involved in developing the care plan after that visit.

The CDC also encourages patients to know the signs of urgent maternal warning signs, including severe headache, extreme swelling of hands or face, trouble breathing, heavy vaginal bleeding or discharge, overwhelming tiredness, and more. These symptoms could indicate a potentially life-threatening complication. When a patient is being seen by a health care provider, they should also disclose their recent pregnancy history during each medical care visit for up to one year after delivery.

Health care providers can also ask questions to better understand their patient and things that may be affecting their lives, the CDC says, as well as working to recognize and eliminate unconscious bias, responding to concerns patients have, and helping patients understand urgent maternal warning signs.

“We have to acknowledge the fact that there is a disparity in access to health care, as well as the fact that maternal mortality rates are higher in Black women,” Pan said. “We don’t know completely why this is.” Whether it’s discrimination or other determinants, Pan said this is a reality Black women face.

“Definitely when we take care of our Black patients, we all, as providers, have to know this, that Black women are at a higher rate of dying than any other race,” Pan said.

The Associated Press contributed to this story.