Serena Williams's HBO series 'Being Serena' is shedding light on the crisis of black maternal mortality

The second episode of HBO’s Being Serena aired Wednesday night, giving viewers an inside look at the life-threatening complications the tennis star faced after giving birth to her daughter, Alexis Olympia. “My pregnancy was so easy,” Williams says in the episode’s beginning, sitting stoically in her living room. “But once I had my C-section, everything was pretty much a nightmare.”

Williams had hoped for a vaginal delivery, but when her daughter’s heart rate began dropping during contractions, doctors decided to opt for a cesarean section. As the 36-year-old has a history of blood clots, her risk of developing a clot from surgery was higher — which made the prospect of a C-section terrifying. Fortunately, the procedure went smoothly, and Williams gave birth to a healthy baby girl. But it was a few days later, while she was still recovering in the hospital, that things took a turn.

“I told the nurse I can’t breathe, I need a mask,” Williams remembers in the episode, as an image of her wincing in pain on a hospital bed flashes on screen. “I put the oxygen mask on and I started coughing because I couldn’t breathe. It hurt so bad.” Williams says she was rushed into surgery, where doctors restitched her C-section and tested her for blood clots. But when the tests came back negative, they insisted everything was fine. Williams adamantly insisted they were wrong.

“I’m like, ‘Listen, I need you to run a CT scan with dye,’” she told the nurses. “‘I have a pulmonary embolism [blood clot] in my lungs — I know, I’ve had them before, I know my body.’” When doctors performed a CT scan, they found several blood clots in her lungs, as well as a hematoma in her abdomen. Thanks to her insistence, they were able to remove them and put a filter in her vein to stop it from happening again.

In an interview with Vogue earlier this year, Williams said that nurses pushed back against her, saying she might be “confused” because of the pain medicine, and doubted her every step of the way. It’s for that reason that Alexis Ohanian, Williams’s husband, says she saved her own live. “I was grateful that she had the wherewithal to speak up. She knew her body better than any of us,” Ohanian says in the film.

While the story of Williams saving her own life is remarkable — for women of color, it’s unfortunately not unique. Black women face a crisis in both maternal and infant mortality that regularly forces them to advocate for better care and to self-diagnose their own life-threatening complications.

According to the Centers for Disease Control and Prevention, the risk of pregnancy-related death for black women is three to four times higher than for white women, and black infant mortality rates are more than double that of whites. That means new black mothers are not only dying at rates far surpassing white women, but their babies are too.

One contributing factor to the high rate of mortality in black women is preeclampsia/eclampsia, a pregnancy condition that involves elevated blood pressure that can lead to seizures, coma, or even death. For black women, according to the CDC, the rate of preeclampsia/eclampsia is 70 per 1,000 deliveries, a rate 60 percent higher than that for white women.

Although there are many factors that can contribute to this — including poverty level and educational background — research has shown that hospital quality is one of them. In 2016, one researcher found evidence that the hospitals where black women give birth often offer poorer quality care. If black women gave birth at the same hospitals as white women, the researcher found, their maternal mortality rates would decrease.

But if that’s the case, why would Serena Williams — who can arguably afford better care, at nicer hospitals, than nearly every mom in America — face the same dangers?

Her story is emblematic of what some researchers view as a bigger problem than just hospital care, poverty level, or educational background. Williams’s story suggests the issue is rooted in racism. The leading researcher behind this theory is Arline Geronimus, a professor at the University of Michigan. In 2006, Geronimus published a groundbreaking study that connected health deterioration in the African-American community to the stress induced by racism, a phenomenon she named “weathering.”

Geronimus created an algorithm to measure what she called “stress-associated body chemicals” as well as “their cumulative effect on the body’s systems.” The group with the highest load — by far — was black women. She theorized, then, that the constant stress black women face contributes to many chronic health conditions and can have catastrophic effects on black maternal mortality.

Writer Linda Villarosa captured the impact this has on the health care black women receive for the New York Times Magazine last month. “For black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions that lead directly to higher rates of infant and maternal death,” Villarosa writes. “And that societal racism is further expressed in a pervasive, longstanding racial bias in health care — including the dismissal of legitimate concerns and symptoms — that can help explain poor birth outcomes even in the case of black women with the most advantages.”

After the article, which received widespread praise, the New York Times ran a page called “Black Mothers Respond” in which African-American women from varying backgrounds shared stories similar to those in Villarosa’s article. In one, a PhD student at Harvard discussed diagnosing her own postpartum preeclampsia after emailing a cardiologist she knew from a Facebook group.

“If I didn’t have my Harvard email address, I often wonder if he would have emailed me so quickly. But he did,” Whitney Polk writes. “An MRI led to a diagnosis of peri-partum cardiomyopathy — a type of pregnancy-induced heart failure. I am receiving better care now, but it’s been hard physically and psychologically.”

Another mother featured on the Times response page was Nicole A. Taylor, a food writer in Brooklyn who learned, when she was seven months pregnant, that her baby was gone. “I had just had a baby shower the week before,” she tells Yahoo Lifestyle. “But when I went for a checkup, there was no heartbeat.” (According to the National Institutes of Health, black women are also twice as likely as white women to suffer a stillbirth.)

Taylor says her ob-gyn — a black woman she had been seeing for a decade — was out of town at the time, which meant she had to have a stranger deliver her stillborn baby. Thankfully she had been seeing a doula, who helped her through it. Still she says some of the nurses weren’t listening to her and that one was somehow unaware that she was giving birth to a stillborn.

Just hours after giving birth two months prematurely, the hospital staff told Taylor they were ready to discharge her. “They said, ‘You’re free to go,'” Taylor recalls in an interview with Yahoo Lifestyle. “I said no, I’m not ready to leave yet.” She ended up staying at the hospital for 24 hours — all thanks to advocating on her own behalf.

Advocating for herself, much like Williams did, is something that Taylor is used to when facing medical professionals. “I think a lot of black women know that’s the case, we have to go in with our questions written out, ready to advocate for ourselves,” she says. “Sometimes the doctors see that as ‘Oh, she’s being a bitch, she’s trying to tell me how to do my job.'”

In Williams case, it was lifesaving, and Taylor hopes that bringing stories like hers into the light will help save others. “To show that women of color who have the best access to health care are still experiencing these problems is a big freaking deal,” Taylor tells Yahoo Lifestyle. “Women of color don’t even talk about it, we just push through and go on about our lives, so the fact that it’s getting more attention, that’s a really good thing.”

Read more from Yahoo Lifestyle:

• How one pregnant woman learned to deliver her baby through YouTube videos

• Chrissy Teigen says pregnancy made her gain weight in her nose

• ‘We’re sex workers and we vote: Women’s March event shines light on marginalized group

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