Not even tennis dynamo Serena Williams is immune from the complications and challenges new mothers face during and after childbirth.
In a Vogue cover story published online Wednesday, Williams, who holds 23 Grand Slam titles — some call her a superhero, others a queen — shared her agonizing postnatal experience, including an episode in which hospital employees did not act on her concern that she was experiencing a pulmonary embolism, a sudden blockage of an artery in the lung by a blood clot. She is prone to such clots, a condition that nearly killed her in 2011.
“Serena lives in fear of blood clots,” the Vogue article said.
On Sept. 2, the day after giving birth to her daughter via cesarean section, Williams was having trouble breathing and “immediately assumed she was having another pulmonary embolism,” the article says.
She alerted a nurse to what she felt was happening in her body and asked for a CT scan and a blood thinner, but the nurse suggested that pain medication had perhaps left Williams confused, according to Vogue. Williams insisted, but a doctor instead performed an ultrasound of her legs.
“I was like, a Doppler? I told you, I need a CT scan and a heparin drip,” Williams, 36, said she told the medical team.
When the ultrasound revealed nothing, she underwent a CT scan, which showed several small blood clots in her lungs. She was immediately put on the heparin drip. “I was like, listen to Dr. Williams!” she told the doctors.
A spokeswoman for Williams declined to comment beyond the Vogue article.
The need to ensure that medical professionals are responsive to new mothers’ concerns has gained attention in recent years. The “Stop. Look. Listen!” campaign, for example, which was introduced in 2012, aims to empower women to report pregnancy-related medical issues and to increase awareness and responsiveness among health care practitioners.
About 700 women die each year in the United States as a result of pregnancy or delivery complications, according to the Centers for Disease Control and Prevention. Complications affect more than 50,000 women annually. And the risk of pregnancy-related death is three to four times as high for black women as it is for white women, the CDC says.
Even more troubling, the numbers have increased steadily from 7.2 deaths per 100,000 live births in 1987 to a high of 17.8 deaths per 100,000 live births in 2009 and 2011, according to the CDC.
The “Stop. Look. Listen!” campaign — a collaboration between the Tara Hansen Foundation and the Robert Wood Johnson Medical School at Rutgers — was developed to honor the life of Tara Hansen, a young mother who was sent home after delivery despite raising concerns about how she felt. She died six days later from an undiagnosed infection.
The campaign has prompted New Jersey to designate Jan. 23 as Maternal Health Awareness Day, the first state to designate a day to the cause.
For Williams, the clots were only the beginning of her complications. In the days after she gave birth, bouts of severe coughing — a result of the embolism — caused her C-section wound to open. She returned to surgery, during which doctors found a large hematoma, a collection of blood outside the blood vessels, in her abdomen. She was then back in the operating room for a procedure to help prevent more clots from dislodging and traveling to her lungs.
Williams was bedridden for her first six weeks of motherhood.
Life-threatening complications in the delivery room, and during recovery, are all too common — particularly for black and Hispanic women.
A series last year by the nonprofit investigative journalism organization ProPublica explored why black women disproportionately suffer complications around pregnancy and childbirth.
ProPublica analyzed how different medical facilities in New York, Illinois and Florida treated women who experienced hemorrhages during childbirth. It found, as has other research, that women who hemorrhage at disproportionately black-serving hospitals are significantly more likely to experience severe complications like birth-related embolisms and emergency hysterectomies.
Poverty, access to care, culture, communication and decision-making all contribute to disparities, Dr. Elizabeth Howell, professor and director of the Women’s Health Research Institute at the Icahn School of Medicine in New York, said Wednesday. Still, the problem is often attributed incorrectly solely to poverty, she said.
“Everyone always wants to say that it’s just about access to care and it’s just about insurance, but that alone doesn’t explain it,” said Howell, whose research focuses on quality of care and racial and ethnic disparities in maternal and child health.
Howell and ProPublica both pointed to a 2016 analysis that found that black college-educated mothers who gave birth in New York City hospitals were more likely to suffer severe complications during pregnancy and childbirth than uneducated white women.
New York City is increasingly confronting the role that racism plays in health outcomes, Howell said. “There’s more and more emphasis to thinking about the ways bias shapes the way we hear our patients,” she said.