Serena Williams and why health professionals don’t listen

Last week, tennis player Serena Williams gave a remarkable interview to Vogue about her traumatic birth.

She had her baby, Alexis Olympia, by emergency casesarean section after the baby’s heartrate dropped dramatically during labour.

Williams has a history of blood clots, but she had to come off anticoagulants because of the c-section, so when she felt short of breath the following day, she found a nurse and told her she needed a CT scan with contrast and IV heparin (a blood thinner) right away.

According to Williams, the nurse thought her pain medication was making her confused. Luckily, Williams stood her ground, and a doctor performed an ultrasound on her legs, while Williams insisted that what she needed was not an ultrasound, but a CT scan. When the ultrasound found nothing, they sent her for a CT scan, which revealed several small blood clots in her lungs and they were able to treat her with anticoagulants.

That wasn’t the end of it. As Vogue tells it:

“Her fresh C-section wound popped open from the intense coughing spells caused by the pulmonary embolism, and when she returned to surgery, they found that a large hematoma had flooded her abdomen, the result of a medical catch-22 in which the potentially lifesaving blood thinner caused hemorrhaging at the site of her C-section. She returned yet again to the OR to have a filter inserted into a major vein, in order to prevent more clots from dislodging and traveling into her lungs. Serena came home a week later only to find that the night nurse had fallen through, and she spent the first six weeks of motherhood unable to get out of bed.”

Shocking as it may seem, her story isn’t that untypical. For most women, birth doesn’t cause disastrous complications and have near-fatal consequences, but it happens to enough women that it shouldn’t come as a surprise.

Women don’t want reassurance – they want to be taken seriously

The fact that Williams had a pre-existing condition should have meant that medical staff were extra-alert to the possibility of complications. That they were so blasé about it is worrying. And how fortunate that Williams knew what was wrong with her: patients with chronic conditions often become experts in them and can make a rapid diagnosis of a particular set of symptoms.

Not everyone is a fan of the skeptical OB, but she has a good record of pointing out that the high maternal mortality rate among black women in the US is largely a result of pre-existing conditions, such as heart problems. Doctors need to be aware of those conditions and take account of them when a woman is pregnant. Talking about Williams’s case, she notes the familiar advice of William Osler: “Listen to your patient, [s]he is telling you the diagnosis.”

In Williams’s account, that was literally the case – she told the nurse what was wrong with her and what she needed to do. The nurse assumed she was “confused”. I’ve heard a similar story time and time again, along with the other comments the skeptical OB notes:

Don’t worry; your baby isn’t moving less. He just has less room to move now.

Don’t worry; your headache isn’t serious. It’s just nerves.

Abdominal pain after birth? Don’t worry; that’s normal.

Denial and cover up

A story in Saturday’s Mail about a woman whose baby died also had a familiar ring: Sarah Hawkins was refused admission to the maternity suite because, despite being in agony, she was told that her contractions were too far apart, and she wasn’t in established labour. The subsequent denial and cover-up are all-too-familiar too. Sarah’s husband, Jack, a consultant at Nottingham University Hospital Trust where Harriet Hawkins was stillborn, says:

“We asked the Trust how many similar deaths there were to Harriet’s and we discovered there were 35 in just over two-and-a-half years.”

It seems hardly credible that so many babies should die in such a short space of time without any action being taken. And yet the response of the trust is not to investigate and improve, but to obfuscate and deny.

The Hawkins family weren’t alone in being turned away. The Guardian today has a story about women turned away from hospital because they supposedly weren’t in labour, only to give birth shortly afterwards – in one case, on the pavement. Luckily their stories had happier endings, but once again it’s a case of a woman knowing her own body better than the medical professionals.

The simple lesson from all of this is to listen to what women are saying: if they say there is a problem, don’t reassure them – take notice of what they’re telling you. They might actually be right.