Q As a labor and delivery nurse, I’ve witnessed some of my Black obstetric patients suffer negative outcomes during their birthing experiences from what I believe were unnecessary and preventable complications. I’m not sure how to assist my patients properly without fear of consequences. What can I do to help my patients—both mothers and babies—experience better outcomes?

A Thank you for your concern. This public health crisis for Black mothers urgently needs further action and research. According to the Centers for Disease Control and Prevention, the Black maternal mortality rate in 2021 was 89% higher than in 2019. Also, more than 80% of pregnancy-related complications are preventable and non-Hispanic Black women account for 31.4% of these complications. Additionally, Black women are two times more likely to experience maternal mental health conditions but less likely to receive care than other pregnant people.

Factors contributing to these disparities—often external to our patients—include systemic racism, lack of access to quality healthcare, socioeconomic disadvantages, and inadequate support systems.

Implicit racial bias and financial incentives may contribute to other disparities, such as C-sections being 25% more common in Black women than in White women. This finding calls out the vital need for further investigation.

Practical challenges such as obtaining time off work, arranging transportation, and securing childcare may contribute to still other disparities. For example, pregnant women covered by Medicaid are less likely to receive a crucial 20-week ultrasound, considered essential for diagnosing potential prenatal heart defects. Addressing these obstacles is crucial to ensure that all pregnant people have equitable access to necessary prenatal care, regardless of their insurance status.

So, how can you help? First, keep in mind that the American Nurses Association position statement, The Ethical Responsibility to Manage Pain and the Suffering it Causes, reminds us that nurses must intentionally set their biases aside when caring for their patients. Provision 3.5 of the Code of Ethics for Nurses with Interpretive Statements also states that “nurses must be alert to and must take appropriate action in all instances of incompetent, unethical, illegal, or impaired practice or actions that place the rights or best interests of the patient in jeopardy.”

This means it’s our ethical duty, as nurses, to take appropriate action in all such instances of practice or actions that occur against our patients. If we ever want to root out bias and structural racism, we must say something when we see something. Acting in the moment of a patient’s distress or mistreatment could involve raising the issue with the treatment team and escalating our concerns to appropriate leaders in the absence of an adequate, appropriate, or timely response.

In addition to our direct efforts on behalf of our patients, we should take every opportunity to see more research funded and programs implemented that aim to address the maternal health crisis. The American Nurses Association is among more than 200 organizations that support the Black Maternal Health Momnibus Act. This collection of 13 individual bills, sponsored by the Black Maternal Health Caucus, aims to address the maternal health crisis. Association members who voice support of Momnibus through RNAction.org will add momentum toward passing these beneficial policies (p2a.co/fhWBAgz).

With many Black women feeling unheard, undervalued, and harmed by the healthcare system, we should act—whenever and wherever possible—to effect real change.

— Response by Tracy Wilson, DNP, MBe, MSN-Ed., FNP-C, RN, a member of the American Nurses Association Ethics and Human Rights Advisory Board

American Nurse Journal. 2025; 20(1). Doi: 10.51256/ANJ012526

References

American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. 2015. nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/

American Nurses Association. Position statement: The ethical responsibility to manage pain and the suffering it causes. 2018. nursingworld.org/globalassets/docs/ana/ethics/theethicalresponsibilitytomanagepainandthesufferingitcauses2018.pdf

Hoyert DL. Maternal mortality rates in the United States, 2022. Centers for Disease Control and Prevention. May 2024. cdc.gov/nchs/data/hestat/maternal-mortality/2022/maternal-mortality-rates-2022.pdf

Hoyert DL, Miniño AM. Maternal mortality in the United States: Changes in coding, publication, and data release, 2018. Natl Vital Stat Rep. 2020;69(2):1-18.