Washington, DC Is #4 for Fetal Deaths

For the past 15 years, fetal deaths, also known as stillbirths, have declined in the United States. However, stillbirths in the District of Columbia have exceeded the national average for the last 10+ years.

According to the 2022 DC Health Infant Mortality Report, non-Hispanic Black babies were three to five times more likely to die in infancy than Hispanic and non-Hispanic White children. Here are some other findings from the Infant Mortality report:

• The leading cause of infant deaths are birth defects or congenital abnormalities.
• Although the causes of birth defects aren’t known, in some cases they can be connected to genetics or poor prenatal care.
• The highest number of infant fatalities in the District of Columbia are born to Black mothers and persons who live in Wards 5, 7, or 8.
• Infants who died were either born premature (prior to 37 weeks’ gestation) or had a low birth weight (under 5.5 pounds).
• The infant mortality rate of babies born to women on Medicaid was more than triple the rate of births covered by private insurance.

March of Dimes, a national advocacy group dedicated to ending preventable maternal and infant deaths, released a report in 2022 stating that D.C. mothers with one or more chronic health conditions were 69 percent more likely to have a preterm birth. According to the CDC data, 54 sudden unexpected infant deaths (SUID) occurred in D.C. between 2016 to 2020, or approximately 116 per 100,000 live births. SUIDS and accidental deaths can be challenging to predict; however, it is possible to prevent them.

What causes fetal death?

Various factors can lead to fetal death. These include:

• Maternal health ailments. Conditions present in the mother, including diabetes, high blood pressure, infection, autoimmune disorders, and thyroid problems can increase the risk of stillbirth.
• Placental problems. Issues with the placenta, including placental abruption (detachment of the placenta from the uterus), placenta previa (placenta covering the cervix), or inadequate blood flow through the placenta, can lead to fetal death.
• Growth restriction. Inadequate growth of the fetus can lead to stillbirth, often due to problems with the placenta or other factors that negatively impact nutrient and oxygen delivery to the fetus.
• Umbilical cord issues. Compression, prolapse, or knots in the umbilical cord can restrict blood flow and oxygen to the fetus, resulting in a stillbirth.
• Infections. CMV, toxoplasmosis, syphilis, and other infections transmitted from the mother to the fetus during pregnancy can lead to fetal death.
• Trauma. If the mother sustains trauma in a car accident or physical assault, this can result in fetal death.
• Drug or alcohol use. Substance abuse during pregnancy, including smoking, alcohol consumption, and illicit drug use, can increase the risk of stillbirth.
• Environmental factors. Exposure to environmental toxins, pollutants, or radiation can pose a risk to fetal health and may result in stillbirth.

Pregnant individuals must receive regular prenatal care to monitor for any potential risk factors to reduce the risk of stillbirth. When a mother receives inadequate prenatal care or none at all, preterm birth and neonatal death can be the result.Bottom of Form

Black and low-income D.C. families encounter numerous birthing challenges

According to a USC Center for Health Journalism report, limited access to resources is a major roadblock for many Black and low-income D.C. families seeking prenatal care:

Lack of resources

• Two of D.C.’s OB wards normally serving numerous Black and low-income patients in the city have been closed for over five years. Ward 8’s United Medical Center permanently shuttered its obstetrics ward in 2017 after medical errors harmed its reputation and its patient load plummeted.
• Also in 2017, Providence Hospital in Ward 5 closed its obstetrics ward. Although construction of a new medical center in Ward 8 is in progress, but it won’t be completed until 2025.
• Those who live east of the Anacostia River are required to travel over six miles (an average of 25 minutes) to a birthing hospital. In Ward 8, where some of the highest rates of infant mortality in D.C. exist, just 56 percent of the residents have access to a vehicle, compared to 64 percent in D.C. as a whole. Absent a vehicle, they are forced to rely on costly rideshares and the C. Metro, widely known for delays, disruption, and unreliability.

Racism

In 2020, The Georgetown University Center for Child and Human Development released a report, Uncovering the Role of Racism in DC Reproductive Inequities. The report outlines several roadblocks to prenatal care in the District, including how “culturally incompetent care and institutional racism” can damage the provider-patient relationship and negatively impact health outcomes for mothers and infants. Further, women who detect discrimination while trying to access health care might be more likely to delay prenatal care or not seek it at all.

Racial and ethnic bias

A review of 15 studies on the ways racial and ethnic bias impacts patient care concluded that hidden discrimination and institutional bias toward racial minority groups can become evident in several ways, including:

• Extended wait times for evaluation and treatment
• Hurrying patients through consultations
• Assigning the wrong gender
• Treating patients in a condescending manner
• Less collaboration with the patient regarding treatment options

Stillbirths in D.C.: A grim picture

According to the 2022 National Vital Statistics Report, Black families nationwide were at the greatest risk of experiencing a stillbirth in 2020 (10.34 per 100,000) compared to non-Hispanic Asian families (3.93 per 100,000) and non-Hispanic White families (4.73 per 100,000). From 2019 to 2021, the District of Columbia had the fourth-highest fetal mortality rate nationwide at 5.38 deaths per 1,000 babies, compared to the national rate of 3.66. Despite these troubling statistics, the District is not attempting to educate parents about infant death, including stillbirth.

Unfortunately, medical malpractice can also contribute to stillbirth. A physician’s mistake, lapse of judgment, or poor decision-making can lead to the preventable death of an infant before or during labor. You may be able to sue a doctor or hospital for a stillbirth if medical negligence resulted in the death of your child.

Please contact Paulson & Nace, PLLC through this contact form or by calling our office.