美国国家公共电台 NPR Black Mothers Keep Dying After Giving Birth. Shalon Irving's Story Explains Why

 

MARY LOUISE KELLY, HOST:

We're going to hear the story of a woman who died earlier this year a few weeks after giving birth. Her name was Shalon Irving. She was in her mid-30s. She was black. NPR's Renee Montagne and ProPublica's Nina Martin learned about her at the beginning of an investigation¹ into the high rate of maternal² deaths here in the U.S.

KELLY MCEVERS, HOST:

Within that alarming rate is an even more troubling one. Black women are three times more likely to die than white women. Sometimes it's an issue of poverty, lack of prenatal care or not having access to the best hospitals. Racism³ also plays a role. Experts say prolonged exposure to bias⁴ is so stressful; it can make the difference between life and death. Here's Renee.

RENEE MONTAGNE, BYLINE⁵: It is an especially cruel irony⁶ that Shalon Irving was focusing on the exact issue of how racism figures into health. Armed with a Ph.D., she was rising through the ranks of the Centers for Disease Control and Prevention, where she researched the many ways the body can be negatively impacted by its surroundings.

By any measure, Shalon had accomplished⁷ a lot - highly educated and well-paid. She owned her own home and had access to the finest health care. Yet none of that protected her from becoming part of a shockingly high rate of black maternal mortality.

WANDA IRVING: Soleil, can you say hi? Hi.

MONTAGNE: On a recent afternoon, we joined Shalon's mother, Wanda Irving, in her home outside of Atlanta. She was surrounded by photos and mementos⁸ and caring for the baby Shalon left behind when she died from complications of childbirth.

IRVING: Here's a picture of her and Soleil with the same outfits⁹. That was taken the day she collapsed¹⁰, the morning of the day she collapsed. Soleil is French for sun. She just lights up a room when she smiles. She's the only reason I have for getting out of bed every morning.

(SOUNDBITE OF BABY COOING)

MICHAEL LU: The fact that in 2017 America a black woman is still three to four times as likely to die in pregnancy¹¹ and childbirth and that they are twice as likely to suffer a life-threatening complication - I think that's a national disgrace.

MONTAGNE: Dr. Michael Lu spent years as head of the Maternal and Child Health Bureau. That's the main federal funder of programs for mothers and infants. He and others have done studies showing that an important cause of poor outcomes in childbirth for all black women is prolonged exposure to the indignities¹² and dangers of discrimination.

LU: We're talking about African-American doctors and lawyers and business executives, and they still have higher maternal mortality rate than white women who were high school drop-outs. It's the experience of having to work harder than anybody else just to get equal pay and equal respect. It's being followed around when you're shopping at a nice store or being stopped by the police when you're driving in the nice neighborhood. Those types of experiences create the kind of chronic¹³ stress that continue to gun the engine which over time create the wear and tear on your body's systems.

MONTAGNE: There is a word researchers use for this accelerated deterioration¹⁴ of the body. It's called weathering. And some studies suggest it can be measured at the level of chromosomes¹⁵. One study looking at the chromosomal¹⁶ markers for aging found that middle-aged¹⁷ African-American women on average appear seven and a half years older than their white counterparts. The lead author was a pioneer in the study of weathering - Arline Geronimus of the University of Michigan School of Public Health.

ARLINE GERONIMUS: Long-term exposure to cascades¹⁹ of stress hormones²⁰ causes a lot of different health vulnerabilities, and it increases your susceptibility to infection but also the early onset²¹ of chronic diseases, in particular hypertension, diabetes²², morbid²³ obesity²⁴.

MONTAGNE: Weathering and chromosomal indications of aging can occur in anyone. One study, for example, showed similar weathering in white mothers caring for autistic children. The core problem is lifelong unrelenting stress. And for African-American women, pregnancy becomes an even more dangerous time.

LU: Pregnancy is a big stressor on the body. And a healthy body can adjust and adapt to it, but a body that's worn out will have a much harder time and therefore putting the woman at greater risk.

MONTAGNE: Photos of Shalon Irving show a vibrant²⁵ woman river rafting with friends, posing in a silky evening gown. At 36, Shalon would be categorized as high-risk. But added to that, a black woman who is, say, 35 can be biologically closer to 45, a far greater risk for giving birth. And beneath Shalon's broad smile and healthy glow lurked²⁶ many of the same issues that beset²⁷ less-privileged black women. Shalon had already lost both of her siblings²⁸ - a baby brother in a car accident. And then her beloved older brother, Sam, died slowly from MS. As a primary caregiver, Shalon fretted²⁹ over what she saw as sub-par treatment being offered to Sam because he was black and on Medicaid.

Then last year, Shalon got news she had long hoped for. She was pregnant but soon found herself single when her relationship with the baby's father fell apart. These traumatic life events do add to the risk of pregnancy. Along with Shalon's history of surgery for uterine fibroids, which meant she would have to have a caesarean. She was overweight and taking medication to control a blood clotting³¹ disease. Still, her mother says, Shalon managed to overcome all these risk factors through to the very end of her pregnancy.

IRVING: It was a great birth. It was just a beautiful time. So the problem didn't come in until after the birth, and she didn't have an after-birth plan.

MONTAGNE: In fact a few new mothers do. Obstetrician Elizabeth Howell is known for her work on racial disparities as a professor at Mount Sinai's Icahn School of Medicine in New York.

ELIZABETH HOWELL: We've had a longstanding history in this country of just sort of sending moms out. You know, they've done the big thing. They've delivered the baby, and now they'll heal. They'll be fine. And you know, that's actually not true, right?

MONTAGNE: In fact the CDC finds that more than half of America's maternal deaths occur postpartum. Fully³² a third of those happen at least a week or more after giving birth. Monica McLemore is a nursing professor at the University of California, San Francisco, now leading a major effort to reduce premature³³ births among black women. Her research involves scores of focus groups with black mothers.

MONICA MCLEMORE: And so one of the things that has been very striking from the focus groups that I've conducted is that people feel disrespected during their care. They talk about not being believed. They talk about reporting signs and symptoms of deterioration and not having any real action that occurs.

MONTAGNE: Numerous studies do support the existence of implicit³⁴ bias in the treatment of black patients. And in a survey recently released by NPR, the Robert Wood Johnson Foundation and Harvard's Chan School of Public Health, one-third of black women said they had been discriminated³⁵ against because of their race when going to a doctor or health clinic. One in 5 avoided going to a doctor or seeking health care out of concern that they would be racially discriminated against. Monica McLemore has found that anticipation³⁶ of bias can also disrupt key communication between a mother and her provider.

MCLEMORE: One of the patients who was talking through her birth story was going on and on and on about how she has no game face. And she says people who know me know that I have very emotional reactions. And as a black woman, I've learned to curtail³⁷ that because I don't want to appear to be angry all of the time.

But one of the things that was really difficult during her birthing experience was she was working so hard to not appear to be angry or to not appear to be in pain that every time she spoke³⁸ to the nurses and requested pain medicines, they didn't believe her. And so she really was trying to suppress what her natural facial expressions and responses were because she didn't want people to be buying into stereotypes³⁹ about black women and particularly whether or not we're angry.

MONTAGNE: Among the more than 200 stories ProPublica and NPR collected about black mothers, inadequate⁴⁰ care after birth was a constant theme. When we review Shalon Irving's medical records, we discovered a cascade¹⁸ of complications after birth. Within days, the wound from her caesarean became badly infected. It was treated, but a week later, she had to be seen again. The wound wasn't healing well and so painful she couldn't sleep.

Reflecting Shalon's mounting distress⁴¹, her medical records quote her. It just doesn't feel right. Her legs were swelling⁴² until one became bigger than the other, and she was gaining weight, not losing. When a visiting nurse noticed Shalon's blood pressure suddenly spiking⁴³, she made another appointment.

IRVING: And she went in. It was just sort of, oh, that's to be expected. You just had a baby. Don't worry about it.

MONTAGNE: She was tested for a blood clot³⁰ - it was negative - and given a new prescription⁴⁴ - pills for high blood pressure. But when Wanda looks back now, all she sees is a series of missed opportunities to save Shalon.

IRVING: Because there is something wrong with this lady. Why not check it out instead of just sending her home? She's got swollen⁴⁵ limb. She's not feeling well. She's got high blood pressure. Why wouldn't you put that person in the hospital? She thought they were not paying attention. She did indicate that, yeah, they never listen to us.

MONTAGNE: That night after her fourth visit in the three weeks since she'd given birth, Shalon collapsed.

IRVING: She just, you know, reached up one arm as if she was trying to grab something, and she just made a - I don't know - a gargling kind of sound like she was trying to say something and passed out.

MONTAGNE: Paramedics found her without a pulse and not breathing. She never regained⁴⁶ consciousness. An autopsy⁴⁷ later concluded Shalon Irving died from complications of hypertension. We can't know if Shalon would have survived had she been white. But hers is a story that does fit into the larger picture described by researcher Arline Geronimus of why black mothers too often die after giving birth.

GERONIMUS: Weathering itself just leads to a greater health vulnerability. So you could think of it as, we'll patch up this problem, and we'll patch up that problem. But overall you're in a weakened physiological⁴⁸ state. And so all sorts of different manifestations⁴⁹ in your health can show up and some very quickly.

MONTAGNE: In the 11 months since Shalon has been gone, Wanda's sorrow has never abated⁵⁰.

IRVING: I never really cry in front of Soleil.

MONTAGNE: Except once recently when she received a book put together by Shalon's friends and colleagues at the CDC called "Letters To Soleil," telling her how great her mother was.

IRVING: I was trying to read a couple of the letters to Soleil, and I just totally lost it. And she just looked at me like - this puzzled look and cocked her head a couple of times. And then she just put her head on my chest and started patting me like I do for her when she's crying. And it was just the sweetest thing. She's just an amazing little girl. She understands so much.

MONTAGNE: Wanda Irving is in her 60s now, raising the daughter her own daughter had so longed for. And Soleil - she will have her first birthday on January 3. Renee Montagne, NPR News.

1 investigation   

n.调查，调查研究

参考例句：

• In an investigation,a new fact became known, which told against him.在调查中新发现了一件对他不利的事实。
• He drew the conclusion by building on his own investigation.他根据自己的调查研究作出结论。

2 maternal   

adj.母亲的，母亲般的，母系的，母方的

参考例句：

• He is my maternal uncle.他是我舅舅。
• The sight of the hopeless little boy aroused her maternal instincts.那个绝望的小男孩的模样唤起了她的母性。

3 racism   

n.民族主义；种族歧视(意识)

参考例句：

• He said that racism is endemic in this country.他说种族主义在该国很普遍。
• Racism causes political instability and violence.种族主义道致政治动荡和暴力事件。

4 bias   

n.偏见，偏心，偏袒；vt.使有偏见

参考例句：

• They are accusing the teacher of political bias in his marking.他们在指控那名教师打分数有政治偏见。
• He had a bias toward the plan.他对这项计划有偏见。

5 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

6 irony   

n.反语，冷嘲；具有讽刺意味的事，嘲弄

参考例句：

• She said to him with slight irony.她略带嘲讽地对他说。
• In her voice we could sense a certain tinge of irony.从她的声音里我们可以感到某种讥讽的意味。

7 accomplished   

adj.有才艺的；有造诣的；达到了的

参考例句：

• Thanks to your help,we accomplished the task ahead of schedule.亏得你们帮忙,我们才提前完成了任务。
• Removal of excess heat is accomplished by means of a radiator.通过散热器完成多余热量的排出。

8 mementos   

纪念品，令人回忆的东西( memento的名词复数 )

参考例句：

• The museum houses a collection of mementos, materials and documents. 博物馆保存着很多回忆录以及文献资料。
• This meant, however, that no one was able to retrieve irreplaceable family mementos. 然而，这也意味着谁也没能把无可替代的家庭纪念品从火中救出来。

9 outfits   

n.全套装备( outfit的名词复数 )；一套服装；集体；组织v.装备，配置设备，供给服装( outfit的第三人称单数 )

参考例句：

• He jobbed out the contract to a number of small outfits. 他把承包工程分包给许多小单位。 来自辞典例句
• Some cyclists carry repair outfits because they may have a puncture. 有些骑自行车的人带修理工具，因为他们车胎可能小孔。 来自辞典例句

10 collapsed   

adj.倒塌的

参考例句：

• Jack collapsed in agony on the floor. 杰克十分痛苦地瘫倒在地板上。
• The roof collapsed under the weight of snow. 房顶在雪的重压下突然坍塌下来。

11 pregnancy   

n.怀孕，怀孕期

参考例句：

• Early pregnancy is often accompanied by nausea.怀孕早期常有恶心的现象。
• Smoking during pregnancy increases the risk of miscarriage.怀孕期吸烟会增加流产的危险。

12 indignities   

n.侮辱，轻蔑( indignity的名词复数 )

参考例句：

• The soldiers who were captured suffered many indignities at the hands of the enemy. 被俘的士兵在敌人手中受尽侮辱。 来自《简明英汉词典》
• What sort of indignities would he be forced to endure? 他会被迫忍受什么样的侮辱呢？ 来自辞典例句

13 chronic   

adj.(疾病)长期未愈的，慢性的；极坏的

参考例句：

• Famine differs from chronic malnutrition.饥荒不同于慢性营养不良。
• Chronic poisoning may lead to death from inanition.慢性中毒也可能由虚弱导致死亡。

14 deterioration   

n.退化；恶化；变坏

参考例句：

• Mental and physical deterioration both occur naturally with age. 随着年龄的增长，心智和体力自然衰退。
• The car's bodywork was already showing signs of deterioration. 这辆车的车身已经显示出了劣化迹象。

15 chromosomes   

n.染色体( chromosome的名词复数 )

参考例句：

• Chromosomes also determine the sex of animals. 染色体也决定动物的性别。 来自《简明英汉词典》
• Each of four chromosomes divide longitudinally. 四种染色体的每一种都沿着纵向分裂。 来自《现代汉英综合大词典》

16 chromosomal   

adj.染色体的

参考例句：

• Like mRNA, both tRNA and rRNA are transcripts of chromosomal DNA. tRNA及rRNA同mRNA一样，都是染色体DNA的转录产物。 来自辞典例句
• In mammalian species, a variety of chromosomal rearrangements are known to exist. 在哺乳类的物种中，已知有许多类型的染色体内部重新排列。 来自辞典例句

17 middle-aged   

adj.中年的

参考例句：

• I noticed two middle-aged passengers.我注意到两个中年乘客。
• The new skin balm was welcome by middle-aged women.这种新护肤香膏受到了中年妇女的欢迎。

18 cascade   

n.小瀑布，喷流；层叠；vi.成瀑布落下

参考例句：

• She watched the magnificent waterfall cascade down the mountainside.她看着壮观的瀑布从山坡上倾泻而下。
• Her hair fell over her shoulders in a cascade of curls.她的卷发像瀑布一样垂在肩上。

19 cascades   

倾泻( cascade的名词复数 )； 小瀑布（尤指一连串瀑布中的一支）； 瀑布状物； 倾泻（或涌出）的东西

参考例句：

• The river fell in a series of cascades down towards the lake. 河形成阶梯状瀑布泻入湖中。
• Turning into the sun, he began the long, winding drive through the Cascades. 现在他朝着太阳驶去，开始了穿越喀斯喀特山脉的漫长而曲折的路程。 来自英汉文学 - 廊桥遗梦

20 hormones   

n. 荷尔蒙，激素 名词hormone的复数形式

参考例句：

• This hormone interacts closely with other hormones in the body. 这种荷尔蒙与体內其他荷尔蒙紧密地相互作用。
• The adrenals produce a large per cent of a man's sex hormones. 肾上腺分泌人体的大部分性激素。

21 onset   

n.进攻，袭击，开始，突然开始

参考例句：

• The drug must be taken from the onset of the infection.这种药必须在感染的最初期就开始服用。
• Our troops withstood the onset of the enemy.我们的部队抵挡住了敌人的进攻。

22 diabetes   

n.糖尿病

参考例句：

• In case of diabetes, physicians advise against the use of sugar.对于糖尿病患者，医生告诫他们不要吃糖。
• Diabetes is caused by a fault in the insulin production of the body.糖尿病是由体內胰岛素分泌失调引起的。

23 morbid   

adj.病的；致病的；病态的；可怕的

参考例句：

• Some people have a morbid fascination with crime.一些人对犯罪有一种病态的痴迷。
• It's morbid to dwell on cemeteries and such like.不厌其烦地谈论墓地以及诸如此类的事是一种病态。

24 obesity   

n.肥胖，肥大

参考例句：

• One effect of overeating may be obesity.吃得过多能导致肥胖。
• Sugar and fat can more easily lead to obesity than some other foods.糖和脂肪比其他食物更容易导致肥胖。

25 vibrant   

adj.震颤的，响亮的，充满活力的，精力充沛的，(色彩)鲜明的

参考例句：

• He always uses vibrant colours in his paintings. 他在画中总是使用鲜明的色彩。
• She gave a vibrant performance in the leading role in the school play.她在学校表演中生气盎然地扮演了主角。

26 lurked   

vi.潜伏，埋伏（lurk的过去式与过去分词形式）

参考例句：

• The murderers lurked behind the trees. 谋杀者埋伏在树后。 来自《简明英汉词典》
• Treachery lurked behind his smooth manners. 他圆滑姿态的后面潜伏着奸计。 来自《现代英汉综合大词典》

27 beset   

v.镶嵌；困扰，包围

参考例句：

• She wanted to enjoy her retirement without being beset by financial worries.她想享受退休生活而不必为金钱担忧。
• The plan was beset with difficulties from the beginning.这项计划自开始就困难重重。

28 siblings   

n.兄弟，姐妹( sibling的名词复数 )

参考例句：

• A triplet sleeps amongst its two siblings. 一个三胞胎睡在其两个同胞之间。 来自《简明英汉词典》
• She has no way of tracking the donor or her half-siblings down. 她没办法找到那个捐精者或她的兄弟姐妹。 来自时文部分

29 fretted   

焦躁的，附有弦马的，腐蚀的

参考例句：

• The wind whistled through the twigs and fretted the occasional, dirty-looking crocuses. 寒风穿过枯枝，有时把发脏的藏红花吹刮跑了。 来自英汉文学
• The lady's fame for hitting the mark fretted him. 这位太太看问题深刻的名声在折磨着他。

30 clot   

n.凝块；v.使凝成块

参考例句：

• Platelets are one of the components required to make blood clot.血小板是血液凝固的必须成分之一。
• The patient's blood refused to clot.病人的血液无法凝结。

31 clotting   

v.凝固( clot的现在分词 )；烧结

参考例句：

• The study was also based only on the one anti-clotting drug. 所用抗血栓药物也仅限于一种。 来自互联网
• A plasma protein that is converted into thrombin during blood clotting. 凝血原酶一种血浆蛋白质，在血液凝聚时转化成凝血''。'酵'。''''。'素'。''。 来自互联网

32 fully   

adv.完全地，全部地，彻底地；充分地

参考例句：

• The doctor asked me to breathe in,then to breathe out fully.医生让我先吸气，然后全部呼出。
• They soon became fully integrated into the local community.他们很快就完全融入了当地人的圈子。

33 premature   

adj.比预期时间早的；不成熟的，仓促的

参考例句：

• It is yet premature to predict the possible outcome of the dialogue.预言这次对话可能有什么结果为时尚早。
• The premature baby is doing well.那个早产的婴儿很健康。

34 implicit   

a.暗示的，含蓄的，不明晰的，绝对的

参考例句：

• A soldier must give implicit obedience to his officers. 士兵必须绝对服从他的长官。
• Her silence gave implicit consent. 她的沉默表示默许。

35 discriminated   

分别，辨别，区分( discriminate的过去式和过去分词 )； 歧视，有差别地对待

参考例句：

• His great size discriminated him from his followers. 他的宽广身材使他不同于他的部下。
• Should be a person that has second liver virus discriminated against? 一个患有乙肝病毒的人是不是就应该被人歧视？

36 anticipation   

n.预期，预料，期望

参考例句：

• We waited at the station in anticipation of her arrival.我们在车站等着，期待她的到来。
• The animals grew restless as if in anticipation of an earthquake.各种动物都变得焦躁不安，像是感到了地震即将发生。

37 curtail   

vt.截短，缩短；削减

参考例句：

• The government hopes to curtail public spending.政府希望缩减公共事业开支。
• The minister had to curtail his visit.部长不得不缩短访问日期。

38 spoke   

n.（车轮的）辐条；轮辐；破坏某人的计划；阻挠某人的行动 v.讲，谈（speak的过去式）；说；演说；从某种观点来说

参考例句：

• They sourced the spoke nuts from our company.他们的轮辐螺帽是从我们公司获得的。
• The spokes of a wheel are the bars that connect the outer ring to the centre.辐条是轮子上连接外圈与中心的条棒。

39 stereotypes   

n.老套，模式化的见解，有老一套固定想法的人( stereotype的名词复数 )v.把…模式化，使成陈规( stereotype的第三人称单数 )

参考例句：

• Such jokes tend to reinforce racial stereotypes. 这样的笑话容易渲染种族偏见。
• It makes me sick to read over such stereotypes devoid of content. 这种空洞无物的八股调，我看了就讨厌。 来自《现代汉英综合大词典》

40 inadequate   

adj.(for,to)不充足的，不适当的

参考例句：

• The supply is inadequate to meet the demand.供不应求。
• She was inadequate to the demands that were made on her.她还无力满足对她提出的各项要求。

41 distress   

n.苦恼，痛苦，不舒适；不幸；vt.使悲痛

参考例句：

• Nothing could alleviate his distress.什么都不能减轻他的痛苦。
• Please don't distress yourself.请你不要忧愁了。

42 swelling   

n.肿胀

参考例句：

• Use ice to reduce the swelling. 用冰敷消肿。
• There is a marked swelling of the lymph nodes. 淋巴结处有明显的肿块。

43 spiking   

n.尖峰形成v.加烈酒于( spike的现在分词 )；偷偷地给某人的饮料加入（更多）酒精（ 或药物）；把尖状物钉入；打乱某人的计划

参考例句：

• High spiking fever with chills is suggestive of a complicating pylephlebitis. 伴有寒战的高热，暗示合并门静脉炎。 来自辞典例句
• We could be spiking our own guns. 我们可能要遭到失败。 来自辞典例句

44 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

45 swollen   

adj.肿大的，水涨的；v.使变大，肿胀

参考例句：

• Her legs had got swollen from standing up all day.因为整天站着，她的双腿已经肿了。
• A mosquito had bitten her and her arm had swollen up.蚊子叮了她，她的手臂肿起来了。

46 regained   

复得( regain的过去式和过去分词 )； 赢回； 重回； 复至某地

参考例句：

• The majority of the people in the world have regained their liberty. 世界上大多数人已重获自由。
• She hesitated briefly but quickly regained her poise. 她犹豫片刻，但很快恢复了镇静。

47 autopsy   

n.尸体解剖；尸检

参考例句：

• They're carrying out an autopsy on the victim.他们正在给受害者验尸。
• A hemorrhagic gut was the predominant lesion at autopsy.尸检的主要发现是肠出血。

48 physiological   

adj.生理学的，生理学上的

参考例句：

• He bought a physiological book.他买了一本生理学方面的书。
• Every individual has a physiological requirement for each nutrient.每个人对每种营养成分都有一种生理上的需要。

49 manifestations   

n.表示，显示（manifestation的复数形式）

参考例句：

• These were manifestations of the darker side of his character. 这些是他性格阴暗面的表现。 来自《简明英汉词典》
• To be wordly-wise and play safe is one of the manifestations of liberalism. 明哲保身是自由主义的表现之一。 来自《现代汉英综合大词典》

50 abated   

减少( abate的过去式和过去分词 )； 减去； 降价； 撤消（诉讼）

参考例句：

• The worker's concern about cuts in the welfare funding has not abated. 工人们对削减福利基金的关心并没有减少。
• The heat has abated. 温度降低了。