Krystal Anderson lived in a charming home on a quiet, tree-lined street in Leawood, Kansas, with her husband, Clayton, and their two black Lab mixes, Sprocket and Louie.
From the second visitors walk into the home through its French-style front doors, they can see her — everywhere. Photos of her beaming smile hang in almost every room. Clayton Anderson says they renovated the house to their liking when they moved in, dreaming of one day sending their kids to the elementary school next door.
“She literally touched every room with her signature or her style,” he said. “And a lot of pictures. I'm so grateful that she made us take so many family pictures.”
Clayton Anderson and the dogs now live alone in that house. In March, Krystal Anderson died suddenly from cardiac arrest brought on by maternal sepsis after giving birth to their stillborn daughter, Charlotte Willow.
“It’s very quiet without her here and now,” he said. “There’s a difference between being alone and being lonely, as I’m finding out.”
Krystal Anderson was a pillar in her community. She was a beloved Kansas City Chiefs cheerleader for nearly a decade, well known for her bright smile and positive attitude, influential in her career in health technology. She also taught yoga and volunteered for charities in her spare time.
Her death due to complications with childbirth unfortunately isn’t rare in the U.S. Across the nation, women die from pregnancy-related causes at much higher rates than in other high-income countries. And Black women like Krystal Anderson are more likely to die than white women.
What the numbers and the experts say
The most recent data from the the Centers for Disease Control and Prevention shows that the number of people who died from pregnancy-related causes dropped in 2022, to 817 from 1,205 women in 2021. Still, those numbers are higher than the 658 deaths recorded in 2018 and the 754 deaths recorded in 2019.
Overall, maternal mortality dropped from a rate of 32.9 per 100,000 live births in 2021 to 22.3 in 2022. But experts say those numbers are abysmal when compared to maternal mortality in other modern nations.
“I've always been baffled by the fact that we spend more per capita on health care than any other country in the world, and yet we have these really poor maternal mortality rates,” said Dr. Jamila K. Taylor, president and CEO of the Institute for Women’s Policy Research.
Taylor holds a doctorate in political science from Howard University. She’s also worked in health policy, specializing in women’s rights and reproductive health for more than 20 years.
Although all women in the U.S. are at risk of dying from maternal causes at high rates, the numbers are especially high for women of color, she said.
In 2021, the maternal mortality rate for non-Hispanic Black women was 69.9 per 100,000 live births. In 2022, it dropped to 49.5. But Black women are still nearly three times more likely than non-Hispanic white women to die from pregnancy-related causes.
In Kansas, the state’s maternal mortality review committee says that between 2016 and 2020, 29 people died from pregnancy-associated causes. Around 80% of the deaths were preventable, and more than 60% were among racial and ethnic minorities, the committee said.
Taylor said research shows the increased death rate for Black women does not correlate with education or socioeconomic status.
“Even for Black women with advanced degrees, they're more likely to die in pregnancy than white women who didn't even finish high school,” she said.
Taylor said women, especially Black women, are often not listened to in health care settings. She said most health care providers approach patients with empathy and care, but racial stereotypes are still rooted in the health care system, even if unconsciously so.
“Negative perceptions about Black women and our backgrounds, how we look, is seen as a negative thing, a perception that we don't have the education to take care of ourselves, our bodies and our children,” Taylor said. “That can cause us to be discounted in a health care setting.”
For example, many physicians historically believed that Black people had thicker skin and higher thresholds for pain than their white counterparts, she said.
“That myth is linked back to slavery,” she said. “I think we've seen that be recycled throughout American history. And it is something that is closely linked to the mistreatment of particularly Black Americans in the health care system. ”
Problem solving
To make birth and maternal care more equitable, Taylor said laws like the Momnibus Act, a package of bills designed to address high maternal mortality rates and racial bias at the federal level, are a start.
Additionally, Taylor said anti-racism and anti-bias training in medical schools and increased funding for culturally congruent community health workers would help lower maternal mortality rates.
Kansas has taken some steps toward decreasing maternal mortality. In 2022, the state’s Medicaid program, KanCare, expanded health care coverage from two months to a year postpartum. Also, as of July 1, KanCare pays for doulas to aid in pregnancy and postpartum care.
Organizations like the Kansas Birth Equity Network, the Kansas Birth Justice Society and the Kansas Perinatal Quality Collaborative research birth outcomes and push for improvements and policy change in the state.
In New York City, author and advocate Kimberly Seals Allers is taking her own approach to increase equity and reduce pregnancy-related deaths among Black women.
She said she became interested in maternal health equity years ago when, as a Black woman, she experienced bias from health care providers during pregnancy. Seals Allers said during her pregnancy with her daughter, she felt unheard, unseen and disrespected by doctors.
“It was very jarring for me because I was blaming myself, like, ‘What did I do wrong? Why didn't I get what everyone else said they got?’” she said. “Everything that I had read was a standard practice of care I had to fight for.”
With help from her son, Seals Allers has developed a Yelp-like app that allows people of color to review their experiences with hospitals or doctors when receiving maternal care. Health care workers, like nurses or doulas, can also leave reviews.
The app is called Irth – like “birth” without the “B.” Seals Allers said they dropped the “B” for bias. Currently, her team is working directly with a handful of cities across the U.S., including Topeka, to spread awareness and get reviews from the community.
“We're literally building the first national database of patient experiences of care in maternal and infant health. It doesn't exist for Black and brown folks,” she said.
Seals Allers said the app has reviews from 46 states. To protect the privacy of users, reviews aren’t published until the provider or institution has at least three.
The goal, in addition to making it easier for Black people to find culturally competent care, is to bring the data from reviews back to hospitals. Seals Allers said she wants the app to work as an early-detection tool for hospitals to alert them of harmful patterns with their patients.
“We need to get to the root of the issue, and that is the way that bias and racism is impacting care,” she said. “And until we're ready to deal with that in a way that drives accountability and transparency, we're not going to see the needle move at all.”
What happened to Krystal Anderson?
Back in Leawood, Clayton Anderson struggles to make sense of his wife’s sudden death earlier this year.
The couple met and got married later in life, brought closer by their mutual love of food and sports. About a year after their 2021 wedding, they decided to try for a baby.
Krystal Anderson, who worked at Oracle and strived to improve women’s health through technology (more on that later), was keenly aware of the risks she faced, her husband said.
“She specifically said, ‘Hey, here's the things we got to look out for because the pregnancies that you see on social media, that ain't the case with a lot of Black women's pregnancies,’” he said.
Krystal Anderson religiously followed doctors’ orders when she found out she was pregnant in 2022. The pregnancy was healthy until she was almost 20 weeks pregnant.
It was a Sunday afternoon in late November, and she was taking part in alumni duties at a Chiefs game. She called her husband to tell him she was feeling sick. When she got home, the couple immediately went to an emergency room.
There, Krystal Anderson was monitored for the flu and COVID-19. Then she spiked a fever, and the pain started coming in waves. By 6 p.m., doctors said they could not detect the baby’s heartbeat. She gave birth to a stillborn boy in the emergency room. The Andersons named the baby James Charles, after their grandfathers.
After giving birth, Krystal Anderson got sicker; she was septic. According to the World Health Organization, sepsis is the third most common cause for maternal mortality. It happens when the body has an extreme reaction to an infection, sometimes causing damage to tissue and organs. Sepsis moves fast, and if it isn’t caught early, it can lead to organ failure and death.
Krystal Anderson was hospitalized with sepsis for several days after delivery. When she was released, her husband said the loss strengthened their marriage. They attended an infant loss group and leaned on each other.
Eventually, they began preparing for another pregnancy. In February 2023, she had surgery to remove fibroids. They were given the green light by physicians to try again for a baby around seven months later.
Clayton Anderson recalls being in their basement on a fitness bike when his wife walked downstairs with a giant grin, holding a positive pregnancy test. He said he almost fell off the bike.
“I was so happy … I was like, ‘It's got to be a sign from James,’” he said. “This is his little birthday gift to us, you know, ‘Don't worry, Mom and Dad, I got you. I'm sending another baby.’”
The second pregnancy initially went smoothly, even if it was difficult. Early on, they had a false alarm when Krystal Anderson woke up bleeding; they thought they had lost the baby.
Doctors told her it was a subchorionic hemorrhage, which happens when blood builds up between the walls of the uterus and the membranes surrounding the fetus. It’s the most common cause of vaginal bleeding between 10 and 20 weeks of pregnancy. The baby’s heartbeat was still strong.
“We went from thinking we lost the baby to actually getting to see her heartbeat on the ultrasound the first time,” Clayton Anderson said. “So, it was a whirlwind of a day.”
This time around, Krystal Anderson worked with a team of maternal fetal medicine specialists along with an OB-GYN. Maternal fetal medicine doctors specialize in high-risk pregnancies. They help diagnose and treat complications.
Clayton Anderson said he and his wife wanted the specialists involved from the beginning of the pregnancy, but were told they don’t get involved until the 14th week.
And because of their experience with pregnancy loss, the couple wanted to be seen by doctors more than once a month, even though most patients have medical appointments every four weeks during the first part of pregnancy. That also didn’t happen until her 14th week.
During Krystal Anderson’s 16th week of pregnancy, the doctor discovered her cervix was shortening, which can be a signal of preterm birth. To keep the baby in her uterus longer, she had an operation called a cerclage, which stitches up the cervix to keep it closed.
After the procedure, Clayton Anderson said their next check-up with the maternal fetal medicine specialists was scheduled for week 18, but it was canceled by the hospital. He said they were told that’s part of the process after a cerclage — a patient doesn’t need to be seen again until week 20 for an anatomy scan.
“It's going to haunt me for the rest of my life … Why didn’t we fight harder (to be seen)?” he said.
When week 20 finally came, they went to see the specialists for the anatomy scan. The first half of the visit was full of joy.
“We're seeing a baby girl, and she looked incredible, like a big girl,” Clayton Anderson said. “You're smiling so big, you have tears in your eyes, seeing her.”
But things took a turn. He said the doctor told them the baby was healthy, but the cerclage procedure didn’t work and the amniotic sac was “hourglassing,” coming through the stitch in the cervix. He said the doctor told them this meant Krystal Anderson’s water could break prematurely; instead of aiming for 36 or 37 weeks before delivering, the goal was now to make it to week 22.
On March 16, a Saturday and a few days after the anatomy scan, Krystal Anderson started cramping and experiencing sharp pains in her back. She was also leaking some fluid, which she worried was amniotic fluid. They went to the emergency room and then the labor and delivery unit to await the maternal fetal medicine specialists, who were due to visit on Monday.
Around 6 p.m. that evening, the couple were relieved to be at the hospital. Close to 8 p.m., a nurse told them she’d be waking the mom-to-be later in the night to check the baby’s heartbeat. Clayton Anderson said they requested the nurse check the baby’s heartbeat then. The nurse couldn’t find the heartbeat.
Ultrasound technicians confirmed their fears: Charlotte was gone. The couple were in shock.
“We'd seen her heart beating, seen her moving like two and a half hours before,” he said. “To see no heartbeat there that quick … we were lost. We didn't understand why this happened.”
Krystal Anderson had been at 20 weeks and four days in her pregnancy. Her husband said the doctors gave them a couple of hours to grieve. The plan was to remove the cerclage, administer an epidural and induce labor so Charlotte could be delivered vaginally.
Krystal Anderson got worse through the night, her husband said. She said she wasn’t feeling well, and she complained her vision was blurry. Around 6:30 Sunday morning, she went to the operating room to have Charlotte removed. Doctors said she had an infection, and the stillborn child could be the cause, her husband said.
When Krystal Anderson came out of surgery, doctors told her husband she was septic with total lung, kidney and liver failure. She was hooked up to a ventilator and a dialysis machine and put in the intensive care unit.
Over the next few days, physicians performed several surgeries to try to find the cause of the infection.
In the early hours of Wednesday morning, Krystal Anderson went into cardiac arrest brought on by maternal sepsis three times. The third time, she could not be resuscitated.
“It doesn't seem real until you get back in the room and see the person you love not breathing,” Clayton Anderson said. “And so you hold their hand, you tell them everything that you wanted to tell them and hope that maybe they're up in heaven already and they can hear you.”
He stayed with her for several hours after her death, unable to leave her side. She was 40 years old.
Lingering questions
Clayton Anderson said he has a lot of questions. He wonders if things would have been different if his wife’s doctors were more attentive, or if they’d had more medical appointments. He wonders if a rescue cerclage could have been performed with a maternal fetal medicine specialist at 18 weeks of pregnancy.
“I shouldn't ask myself those questions, but I do at night, every night. And, you know, I have trouble sleeping because of those questions,” he said.
AdventHealth Shawnee Mission, where Krystal Anderson was a patient, said it could not respond to specific questions about her death because of patient privacy laws. In an emailed statement to the Kansas News Service, they said they are deeply saddened by the situation, and they’re praying for her family and friends.
“Our team members, as well as independent providers who care for patients in our facilities, work diligently to always provide the highest level of attention and compassion to address every patient’s needs and concerns,” the statement said.
Clayton Anderson said he hopes his wife’s death brings policy changes. He hopes legislation like the Momnibus Act passes. And he hopes there are systemic changes to address racism and bias in the medical system.
“If we can do a better job with our Black mamas, that's a good thing for everybody,” he said. “It does start with listening better.”
Krystal Anderson’s legacy
From El Paso, Texas, Krystal Anderson’s hometown, her parents, Bertha and Burnette Johnson, also have questions. They said they believe she should have been seen by doctors more frequently prior to her death, and they wonder if she got the treatment she needed.
“The jury is still out on that … There’s so many questions that need to be answered,” her father said.
For now, the Johnsons want their daughter (they called her Keshia after her middle name, Lakeshia) to be remembered for the incredible woman they say she was. They said from a young age, she was a good student who cared deeply for the people around her.
“She would always give the clothes off her back to people, you know, and try to make people fit in,” her mother said.
As a child, Krystal Anderson worked hard at school, danced and sang, and was active in her local church. As an adult, her love of dance stayed with her. She got a degree in computer science and minored in dance. After school, she was offered a job by Cerner, now Oracle, and moved to Kansas City, where she auditioned to be a Chiefs cheerleader and made the team.
The Chiefs became her life, her parents said. She was a Chiefs cheerleader for nearly 10 years while working full-time.
Earlier this month, in an article about Krystal Anderson’s legacy, the Chiefs announced they would honor her during the 2024 season in two ways. Cheerleaders will wear a cuff featuring her initials, embroidered and bedazzled with red and white rhinestones (because she was known for how she loved to “sparkle”). The same logo will be added to the padding near the 10-yard line, where she worked every game for the past seven years as an alum, “often dancing with her headset on,” the Chiefs organization said.
A few years before she died, Krystal Anderson had been awarded a patent for computer software that measures how much blood a person is losing postpartum. Before her death, when she was in the hospital for her own pregnancy complications, she got to see the software in action.
“That’s what’s so ironic about this – the very thing she was fighting for, that’s what she died from,” Burnette Johnson said.
Bertha Johnson said she still cannot believe her daughter is gone. She said they were extremely close, talking on the phone daily – and sometimes two to three times a day.
The Johnsons said their only solace is that they believe they will see their daughter and two grandchildren in heaven one day.
“I see her with both of her kids, one in each hand as you walk into those clouds, heading towards those other babies that she's taking care of,” Bertha Johnson said. “God needed an angel to take care of all those babies that she so wanted. She has tons of babies now.”
Bek Shackelford-Nwanganga reports on health care disparities and access for the Kansas News Service. You can email her at r.shackelford@kcur.org.
The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.
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