For her college thesis, Alex Boatwright researched an issue ripped from the headlines—that Black women in America are three to four times more likely to die during childbirth than their white counterparts.
“That’s a major problem and there’s not a whole lot of explanations for it,” she said. “What I found is that racism is a key driver of this crisis. There are so many examples of it, unfortunately, it has pervaded maternal health.”
The 21-year-old, who graduated from Colonial Forge High School in Stafford County in 2018, defended her thesis and earned an “A-” for the project, required as part of an honors program at the University of Lynchburg.
But even though she recently turned the tassel on college, Boatwright’s not about to put her concerns behind her. She’ll start her career in July as a labor and delivery nurse at Mary Washington Hospital.
Ashley Simms, a registered nurse who supervised the 120 hours Boatwright spent in the department during her nursing rotations, looks forward to her joining the team.
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“Her positive attitude, combined with her passion in this specialty area is refreshing,” Simms said. “She always arrived for our shifts with the biggest, brightest smile, so eager to learn and was ready to be part of any patient scenario and be as hands-on as we could be.”
Simms also helped Boatwright deal with the normal nerves. The recent graduate is bubbling with excitement at the thought of being at the bedside during such emotional moments. She’ll work the night shift, when there will be fewer visitors on the floor, giving her more chances to interact with moms and babies.
“I’m definitely a night owl,” she said. “I don’t have much problem staying up through the night, but I hate waking up early.”
Alexandra Boatwright is the oldest of three daughters of William and Lisa Boatwright, who both work for Stafford County Public Schools. She’ll spend part of her summer as she’s done in the past, helping Jennifer Spindle, the school’s systems facility assessment supervisor, by moving desks, textbooks or other materials.
“Alex is amazing,” Spindle said. “She is a hard worker, a team player and will literally do anything asked of her. She is a total rock star.”
At one point, Boatwright considered a career in biology or biomedical science. Her mother suggested nursing, and Boatwright liked the idea. She observed different specialties as she pursued her degree, and things clicked during the obstetrics rotation.
“I saw my first live birth and I was like, I want to be doing this,” she said. “Honestly, I was super emotional, just as the mom was. It’s just a beautiful thing watching a baby being born.”
As her studies continued, Boatwright—a field hockey player and president of the Student Athletic Advisory Committee—needed a topic for a thesis as a student in the Westover Honors College at the Lynchburg university. When she came across a report from the Centers for Disease Control and Prevention about the high incidence of maternal deaths in the United States—and that rates were three to four times higher for Blacks than whites—her amazement at seeing a birth turned to shock at the disparity.
During research, she compared rates to those in other developed countries, such as Canada, Germany, France, Sweden and the United Kingdom—and found “the United States markedly surpasses them all as the leader,” she said. “That is insane. That absolutely blew me away.”
Even worse, American death rates have worsened. For each 100,000 live births, there were 17.4 women who died in 2018, then 20.1 fatalities the next year and 23.8 maternal deaths in 2020, the CDC reported.
In other countries with similar economic status, the average is 4.72 maternal deaths per 100,000 live births, according to a 2020 study by the Commonwealth Fund that Boatwright cited.
“That is the reality, pregnancy is still something that is dangerous in the United States and that is mind boggling,” she said.
The bar charts Boatwright examined showed the number of pregnancy deaths among Black women towered over every other category—far higher than rates for the total population, whites and Hispanics. There were 55.3 deaths among Black women per 100,000 births in 2020 compared to 18.2 for Hispanics and 19.1 for whites, according to the CDC.
As other health officials have noted in published reports, “social determinants” don’t seem to matter in the rate of Black deaths during pregnancy, birth or postpartum, she discovered. Regardless of their health, wealth, education or socioeconomic status, “they didn’t feel as though their words were being heard,” Boatwright said.
“There were repeated examples of women talking about how they didn’t feel listened to by their providers, they felt as though they were being dismissed, ignored, undervalued and that they just weren’t treated fairly,” she said.
She cited the experience of tennis star Serena Williams, who had a history of pulmonary embolisms—blood clots in the lungs. When she exhibited similar symptoms after giving birth in 2017, Williams told her nurse she needed a CT scan and a blood thinner to counter the problem.
In several published accounts, Williams said she was ignored, until she kept pressing the point and the test was finally ordered. It showed blood clots, just as Williams suspected.
“She’s a celebrity. You’d think with all the money and influence that she has people would listen to her, but obviously it doesn’t matter,” Boatwright said in a story on the university website.
SHAPING THE CARE
Boatwright wondered if health care providers were required to take training on implicit bias—a form of bias that can occur automatically and unintentionally but nevertheless can impair judgement. She didn’t find many examples in research or in her own experience. Her professors drilled in the tenets of treating all patients with respect and dignity, but there was never any discussion of the way “some of our experiences may shape the care that we provide,” she said.
Boatwright wanted to put together a curriculum to address the issue, but her faculty advisers said that would be too great an undertaking. She narrowed her focus to an introductory seminar with four key elements.
Two establish a baseline understanding that everyone holds implicit biases and that Black women have consistently spoken out about their health needs, only to be ignored. A third briefly explains the long history of abuse against Black women, including being used for surgical experiments or subjected to procedures such as compulsory sterilization. The fourth encourages a shift away from “blaming someone’s race as a reason for why they have this certain health disparity,” Boatwright said.
Members of the thesis committee noted that Boatwright “identified a major disparity in maternal care and sought to make an original contribution to resolve it,” said Kristin Shargots, who also was Boatwright’s nursing adviser for four years.
“Alex is an asset to this nation’s nursing workforce,” Shargots said. “She will ensure all of her patients receive high-quality care and are listened to, regardless of the color of their skin.”
Cathy Dyson: 540/374-5425