Hey Sis, 

This week is Black Women's Maternal Health Week. 

I keep thinking about Summer's baby shower. 

She was beautiful that day. Glowing in a way that only a woman who is genuinely excited to become a mother can glow. She was the kind of woman who showed up for her community, who people called on, who made every room feel warmer just by being in it. She was so ready to be a mother. And everyone in that room could feel it. 

Six months after her baby arrived, Summer was gone. 

She died of eclampsia. A complication of uncontrolled high blood pressure developed during pregnancy. A condition that is serious, that is dangerous, and that is also treatable when it is caught and when a woman is believed. Summer was overweight during her pregnancy. She had elevated blood pressure throughout. And she had doctors who saw both of those things in her chart and did not respond with the urgency her body was demanding. 

She told them something was wrong. She was not believed. And she left behind a six-month-old daughter who grew up without her mother. 

I have asked myself many times what might have been different. And the honest answer is: so much. 

Because what happened to Summer did not begin on the day she went into crisis. It began in prenatal appointments where the weight she was gaining was noted but never fully explained to her with urgency. It began in a system that saw the numbers and said nothing meaningful. No nutritional guidance. No conversation about what the pregnancy or weight meant for her blood pressure, her heart, or her risk of complications in the months after delivery. 

And I know this pattern intimately because I have seen it in my own family. 

A family member of mine attended every prenatal appointment during her first pregnancy. She was in her mid-twenties, doing everything she believed she was supposed to do. Over the course of that pregnancy she gained over  eighty pounds. And she left every single one of those appointments without being told what that weight gain meant for her body, her blood pressure, or her long-term health. 

She'd grown up hearing what many hear. Eat for two. A bigger baby is a healthy baby. The weight comes off after. When she wanted to know more, she turned to where most of us turn when the doctor's office stays quiet. She asked her girlfriends and her family.  She found fragments of information on social media. She pieced together what she could from the women around her who were also doing their best with what they knew. 

The medical system, the one place with both the authority and the obligation to give her accurate information, gave her none. 

She survived. Her baby was born healthy. But most of the weight stayed. The system that was silent throughout her pregnancy remained silent after it. No follow-up conversation about what eighty pounds of gestational weight gain meant for her metabolic health going forward.

Although she hasn't been diagnosed with disease, the foundation for it, elevated blood pressure, insulin resistance, cardiovascular risk, was set during that pregnancy, in the space where education should have been. That foundation is still there. And it is still building. 

Two women. Different ages. Different outcomes. The same failure threaded through both of their stories. A system that withheld information when it could have protected them. A system that stayed silent when it should have educated them. A system that failed to act when their lives, and their long-term health, depended on it. 

Black women have higher mortality and morbidity rates during and after pregnancy than any other group of women in the United States. Mortality means death. Morbidity means serious illness and complication. Too many women are passing away from complications of pregnancy within the first year of giving birth. Too many women are holding two existences at the same time. The joy of a new baby. And the fear that their body might not survive what it is being asked to carry. 

The system failed both of these women. And until we close the gap between what the system withholds and what Black women deserve to know, it will keep failing us. 

 We can advocate for better care!  

 We are in this together,

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The Numbers Behind the Reality

When we talk about maternal mortality and morbidity, it helps to understand what is actually being counted, because the measurement itself tells part of the story. 

The CDC defines a maternal death as one that occurs while pregnant or within 42 days of the end of pregnancy from causes related to or aggravated by the pregnancy. That is the official maternal mortality rate. But the CDC also tracks pregnancy-related mortality, which extends that window to one full year after delivery. More than half of all pregnancy-related deaths among Black women occur after the birth, in the weeks and months that follow. A significant portion happen in the late postpartum period, between six weeks and twelve months after delivery. 

Summer's death at six months postpartum falls inside that window. She is counted in those numbers. And so are too many others whose names we do not know. 

What the Data Shows 

According to the most recent CDC data released in March 2026: 

Perhaps the most sobering finding across this body of research: wealth and education do not erase this disparity. Studies consistently show that the most educated and highest-earning Black women still face greater maternal mortality risk than the least wealthy white women. This is a structural racism story. 

What Is Killing Black Women and Why It Is Preventable 

The leading causes of maternal death among Black women are concentrated in conditions that respond to timely medical intervention. These are conditions that, when recognized and addressed promptly, do not have to be fatal. Summer had one of them. 

•        Preeclampsia and eclampsia are severe hypertensive disorders of pregnancy and the postpartum period. Black women are approximately 60 percent more likely to develop preeclampsia, and their risk of dying from it is about five times greater than that of white women. Eclampsia, the more advanced form that causes seizures and organ damage, is what took Summer's life. 

•        Postpartum cardiomyopathy is a form of heart failure that develops in the final weeks of pregnancy or months after delivery. Black women die from this condition at five times the rate of white women, and are more likely to present with more advanced disease by the time they receive a diagnosis. 

•        Obstetric embolism includes blood vessel blockages such as pulmonary embolism. Black women experience mortality from this cause at more than twice the rate of white women. 

•        Obstetric hemorrhage, or severe bleeding, also occurs at more than twice the mortality rate for Black women compared to white women. 

The Pain Myth That Gets Women Killed 

There is a belief embedded in medical culture that has been traced back to the founding of American gynecology. The belief that Black people feel less pain than white people. That our skin is thicker. That our bodies are hardier. That our distress is less urgent. 

This is not science. It has never been science. It is a myth rooted in the dehumanization of enslaved Black people, used to justify performing procedures on Black women without anesthesia. Research published in the Journal of Pain in 2024 found that observers still disproportionately underestimate pain in women of color compared to all other groups.

A landmark 2016 study found that roughly half of medical students and residents endorsed at least one false belief about biological differences between Black and white patients. 

These beliefs shape clinical decisions. How seriously a complaint is investigated. How quickly a symptom is treated. Whether a woman who says something is wrong is believed. 

Summer said something was wrong. She was not believed quickly enough. And she died. 

This is what medical dismissal looks like in real life. It doesn't always look like cruelty. Sometimes it looks like a provider who is busy, working within a system that has taught them, implicitly or explicitly, that Black women's pain and distress carry less clinical urgency. The outcome is the same regardless of the intent.

Many of us are having children later. The average age of perimenopause onset for Black women is 37. A Black woman delivering in her late thirties may be doing so during early hormonal transition, in a body that has already been carrying elevated allostatic load for decades. 

The concept of weathering, introduced by Dr. Arline Geronimus, describes how the cumulative physiological burden of racism and chronic stress accelerates biological aging in Black women. By the time many of us arrive in the delivery room, our cardiovascular systems have been working harder for longer. Our inflammatory burden is greater. Our blood pressure baselines may already run higher than what standard charts consider normal for our age. 

Pregnancy is an extraordinary stress test on the cardiovascular system. For a body already carrying high allostatic load, that stress test is more demanding. And the complications that emerge do not simply resolve at discharge. They leave biological marks. 

Women who experience preeclampsia carry a significantly elevated risk of cardiovascular disease later in life. Women with gestational diabetes carry a seven-fold increased risk of developing Type 2 Diabetes. The postpartum period is recovery. And it is trajectory. It is the beginning of the next chapter of a woman's health story. 

This is why Black maternal health belongs inside the conversation about Black women's midlife health. These are the same chapters. The same story, told across different decades of the same life.

_______________________________________________

Holistic Wellness Toolkit

What Every Black Woman Deserves to Know Before, During, and After Pregnancy 

Before pregnancy or during preconception: 

•        Establish baseline cardiovascular markers including blood pressure, lipid panel, and fasting glucose. These numbers become your reference points for the entire journey. 

•        Know your family history around hypertension, diabetes, and heart disease. These are independent risk factors for pregnancy complications. 

•        Ask your provider directly about healthy gestational weight gain ranges for your body before you become pregnant. This conversation should happen before you need it. 

•        If you are in your mid-to-late thirties, ask your provider about both preconception readiness and early perimenopause. These conversations can and should happen at the same time. 

During pregnancy: 

•        Track your symptoms and bring documentation to every appointment, including dates, frequency, severity, and how symptoms are affecting your daily life. 

•        Ask for nutritional guidance at your first prenatal visit. If it is not offered, request a referral to a registered dietitian who has experience with maternal health. 

•        Know the warning signs of preeclampsia: severe headaches, visual changes, upper abdominal pain, sudden swelling in the face or hands. Do not wait to see if these resolve on their own. 

•        If a provider dismisses your concern, ask them to document in your chart that they are not providing treatment for the symptom you have described. That request changes the dynamic in the room. 

In the postpartum period, through one full year: 

•        Do not wait until your six-week appointment if something feels wrong. The highest risk window for Black women extends well beyond six weeks. 

•        Know the warning signs of postpartum preeclampsia and eclampsia, which can develop even after a healthy delivery: severe headache, blurred vision, upper abdominal pain, sudden severe swelling. 

•        Know the warning signs of postpartum cardiomyopathy: shortness of breath, difficulty lying flat, rapid heart rate, swelling in the legs or feet. 

•        Postpartum depression and anxiety are real, common, and treatable. Black women are less likely to be screened and less likely to receive treatment. Name it if you are experiencing it. 

•        Medicaid now covers twelve months postpartum in most states. Schedule follow-up appointments before you need them urgently. 

Advocate for Your Whole Self

Building Your Care Team: Questions, Scripts, and the Support You Deserve

Advocacy in maternal health is not only about what happens inside the exam room. It is also about who is with you before you get there, while you are navigating it, and in the months after you leave.

The Role of Doulas, Midwives, and Community Health Workers

Research is clear that continuous support during pregnancy and birth improves outcomes for Black women. Doulas, midwives, and community health workers are not luxuries. They are evidence-based interventions that the standard medical system has historically failed to make accessible to Black women. Here is what each of them offers across the continuum of care.

Doulas

• A doula provides continuous emotional, physical, and informational support before, during, and after birth. They do not replace medical care. They strengthen a woman's ability to navigate it.
• Studies show that Black women who have doula support experience lower rates of cesarean delivery, lower rates of preterm birth, and greater satisfaction with their birth experience.
• A doula can help you prepare questions for appointments, be present with you during labor and delivery, advocate alongside you when you feel dismissed, and support your postpartum recovery.
• Community-based doula programs exist specifically to serve Black women. The National Black Doulas Association and local birth justice organizations are good starting places for finding culturally aligned support.

Midwives

• Certified nurse midwives and certified midwives are trained clinicians who provide prenatal, birth, and postpartum care. They are licensed to practice in all 50 states and are covered by most insurance plans including Medicaid.
• Midwifery care tends to involve longer appointments, more personalized attention, and a greater emphasis on education and shared decision-making. These are exactly the elements most often missing from the care Black women describe receiving in standard obstetric settings.
• Ask your provider or insurance company about midwifery options in your area. Freestanding birth centers staffed by midwives are another option worth researching, particularly those led by or centered on Black women.

Community Health Workers and Patient Navigators

• Community health workers are trained members of the community who serve as a bridge between women and the healthcare system. They help with appointment scheduling, insurance navigation, transportation barriers, and connecting women to local resources.
• Patient navigators can help you understand your diagnosis, your options, and your rights as a patient. Many hospital systems have patient navigator programs. Ask for one by name.
• These roles are especially important in the postpartum period, when the risk window for Black women is highest and the system's follow-up tends to be most sparse.

Questions to Bring to Your Appointments

During pregnancy:

• Given my family history and my background, what are my specific risk factors for hypertensive disorders of pregnancy?
• What blood pressure readings should prompt me to contact you immediately, at any hour?
• Can you refer me to a registered dietitian to support healthy nutrition and weight management during this pregnancy?
• What does my postpartum follow-up plan look like beyond six weeks, and can we schedule that care now?

In the postpartum period:

• I am experiencing [specific symptom]. I want this documented in my chart and I want to discuss next steps today.
• I had a complication during my pregnancy or delivery. What does that mean for my long-term cardiovascular health?
• I would like to be screened for postpartum depression and anxiety at this visit.

For women in their late thirties:

• Given my age and my postpartum recovery, what should we monitor as I move toward perimenopause?
• Are there lifestyle foundations I should be building now to support both my postpartum recovery and my long-term hormonal health?

Pass It On, Because Information Is Protection

Summer did not have to die. Her daughter did not have to grow up without her mother. And neither of those things had to be true if the right information had reached the right people at the right time.

That is what this newsletter is trying to do.

If you know a Black woman who is pregnant, trying to conceive, or in her first year postpartum, please share this with her today. If you know a woman in her late thirties navigating fertility decisions alongside early perimenopause symptoms, share this with her too. If you know a mother, a sister, a daughter who has never heard the words weathering or allostatic load but has lived the experience of both, send her this.

Because when one woman's health literacy improves, the women in her sphere of influence benefit. Questions become more precise. Advocacy becomes possible for women who did not know they had the right to ask.

In honor of Summer. And every woman whose name we carry with us.

That is how we Build Generational Health.

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