July 3rd of 2020 should have been a beautiful day for Sha-Asia Washington and her loved ones. Her pregnancy appeared to be a joyous one, and she displayed her excitement in a photo captured moments before her daughter’s birth.
Unfortunately, Sha-Asia Washington’s birthing experience—an event that was supposed to center the act of giving life—resulted in the tragic ending of her own. She was at Woodhull Medical Center for a routine stress test when doctors noticed her heightened blood pressure. They gave her a drug to induce her labor after two days without blood pressure medication. Before the birth, the team asked if she wanted an epidural, to which she agreed after a moment of hesitation. Things would only grow worse from there. Sha-Asia went into cardiac arrest while doctors delivered her baby via c-section. Sha-Asia’s newborn daughter, Khloe, was born healthy, but Sha-Asia was unable to meet her. After 45 minutes of CPR, Sha-Asia was tragically pronounced dead.
While maternal mortality is a shocking occurrence, it is an unsettling reality of the Black birthing experience in the United States. According to the CDC, Black birthing people are 3 to 4 times more likely to die as a result of pregnancy-related complications—and Woodhull Medical Center is located in one of our nation’s hardest-hit regions. In New York, Black birthing people are 8 times more likely to die from pregnancy-related complications.
Sha-Asia’s passing sheds light on the troubling realities of maternal mortality and the historical legacies of anti-Black racism in medicine. It galvanized her community members, who long emphasized a reality that news outlets are only now beginning to acknowledge.
On a GoFundMe page organized by Sha-Asia’s family members shortly after her passing, you can see these words printed in all caps: “WOODHULL HOSPITAL KILLED SHAASIA GIVING HER A EPIDURAL PLEASE HELP US GET JUSTICE”. Sha-Asia passed after the administration of the epidural, which she and family members were hesitant to accept. In addition to the realities of the United States’ maternal health crisis, Sha-Asia’s passing is a reminder of the troubles of the United States’ birth medicalization. Her loved ones knew long before the doctor who administered the epidural was subject to investigation by the New York State Board for Professional Medical Conduct.
According to the Board, Brooklyn doctor Dmitry Anatolevich Shelchkov deviated from appropriate standards of care in not only his administration of the epidural, but also his administration of oxygen treatment once Sha-Asia reported difficulty breathing. According to a New York Times investigation, a state medical review board found that Dr. Dmitry Anatolevich Shelchkov improperly conducted the procedure. The catheter should have gone four inches into Sha-Asia’s back. Instead, Dr. Dmitry Anatolevich Shelchkov inserted the line up more than 13 inches.
What’s worse, Dr. Dmitry Anatolevich Shelchkov concealed the details of his care of Sha-Asia in an attempt to evade accountability. In a December interview, he claimed that he did not administer other numbing agents after the administration of the epidural. During Sha-Asia’s procedure, he administered a full dose of anesthesia without waiting to ensure she’d respond well to a test dose. What followed was alarming—Sha-Asia’s breathing grew labored and then stopped entirely. While Sha-Asia is the only person to die as a result of her complications, she is only one among six other birthing patients that suffered adverse outcomes tied to the administration of anesthesia at Woodhull Medical Center.
Unfortunately, the United States’ field of obstetrics and gynecology creates the conditions for these tragic events to occur. In 1996, the World Health Organization called for the elimination of unnecessary technological interventions during labor. Of the 140 million births that occur each year, most do not come with unmanageable complications for the birthing person and their baby. And yet, the past few decades have seen a marked increase in unnecessary practices that initiate, accelerate, terminate, and/or regulate aspects of labor—such as oxytocin infusions and cesarean sections. Despite widespread knowledge that birth is a normal physiologic process, our current medical system treats it as a pathology that requires clinical intervention. This ultimately sets the foundation for medical professionals to treat the administration of an epidural as a requirement, and not an option.
Supporting physiologic and low-intervention births requires a training system that emphasizes exposure to these birthing experiences. Unfortunately, because medical students engage directly with the current system, the issue of heightened birth medicalization has implications for their practices as physicians. Medical students and residents cannot support empowered physiologic birthing experiences because they cannot conceive of them. When they assist with births that involve unnecessary interventions, they internalize the notion that high-intervention births are “normal” births. When used appropriately, interventions are ultimately life-saving. When used unnecessarily, however, they can result in tragedy. With the use of each birth intervention comes the possibility of risk or unintended consequences—such as those of Sha-Asia Washington’s birthing experience.
The additional danger lies in the positive feedback loop that is intervention use. Sometimes, the introduction of one intervention calls for the use of another that comes with its own set of potentially fatal side-effects. One example is the use of pitocin, a synthetic form of oxytocin, to augment labor. With the use of pitocin comes a higher risk of hemorrhaging and c-section. Additionally, the strength of the contractions makes the baby susceptible to oxygen loss. They’ll often couple this intervention with the use of epidural, as pitocin augmented labors are typically more intense and painful. Epidurals typically elongate the second stage of labor, so physicians end up administering more pitocin to achieve the desired frequency and strength of contractions. With the use of both pitocin and epidural, the risk of c-section is significantly higher. Birthing people who receive both induction and an epidural are six times more likely to have a c-section than those who had neither. This comes with additional risk—studies show that elective C-sections can increase a birthing person’s chances of experiencing life-threatening complications during childbirth.
Sha-Asia Washington’s passing is a story of both medical malpractice and the shortcomings of the United States’ heightened use of technological interventions. Honoring Sha-Asia requires the acknowledgment of the full scope of the issue shaping her birthing experience. Medical technology should facilitate an empowered birthing experience, rather than lead to adverse and/or fatal outcomes for our nation’s birthing people. Spotlighting the implications of our current practices is key to ensuring that our medical establishment honors our birthing people lost at its hands, and that it does not continue to replicate these devastating outcomes.