What killed Erica Garner?


Every maternal death is an extraordinary tragedy, but Erica Garner’s death seems particularly bitter in its irony.

According to NPR:

She entered the public eye in July 2014 when her father, Eric Garner, died after being put in a chokehold by a New York City police officer. Eric Garner was seen on video saying, “I can’t breathe” 11 times before he died.

Why did Erica Garner die? She died because she couldn’t breathe.

She died because she couldn’t breathe.

Erica Garner had been in a coma since Dec. 23, when she had an asthma attack that triggered a heart attack, according to the New York Daily News.

“When her son was born in August, she named her newborn after her father,” the newspaper reports. “Garner suffered her first heart attack shortly after the delivery, with doctors saying the pregnancy stressed her already enlarged heart.”

Eric Garner became an icon in the Black Lives Matter movement. Now Erica Garner appears destined to become a icon in the effort to reduce black maternal mortality. In many ways, she is emblematic of the current crisis of black maternal mortality.

Prior to 1999, Erica Garner’s death would not have been included in maternal mortality statistics for two reasons. First, occurring as it did four months after the birth of her son, it would have been considered a “late” maternal death; US mortality statistics which included deaths up to 42 days after delivery. Second, Garner did not die of a pregnancy complication but of pre-existing diseases (heart disease and asthma). Indeed, researchers have found that anywhere from 75-100% of the recently reported increase in US maternal mortality is the result of expanding the classification of maternal deaths.

Erica Garner’s death is emblematic of US maternal deaths in several other ways. She was black and black women die at 3X the rate of other American women.

She appears to have had pre-existing heart disease (an “enlarged” heart). Heart disease is the leading cause (and fastest growing cause) of maternal mortality in the US. What causes an enlarged heart and how did it contribute to Garner’s death?

An enlarged heart can reflect a dilatation of the chambers of the heart (dilated cardiomyopathy) or an increase in the size of the heart muscle (hypertrophic cardiomyopathy).

According to the American Heart Association:

Dilated cardiomyopathy (DCM) is the most common type, occurring mostly in adults 20 to 60. It affects the heart’s ventricles and atria, the lower and upper chambers of the heart, respectively.

Frequently the disease starts in the left ventricle, the heart’s main pumping chamber. The heart muscle begins to dilate, meaning it stretches and becomes thinner. Consequently, the inside of the chamber enlarges. The problem often spreads to the right ventricle and then to the atria.

As the heart chambers dilate, the heart muscle doesn’t contract normally and cannot pump blood very well…

Often, cause of dilated cardiomyopathy isn’t known. Up to one-third of the people of those who have it inherit it from their parents.

Some diseases, conditions and substances also can cause the disease, such as:
Coronary heart disease, heart attack, high blood pressure, diabetes …
Complications during the last month of pregnancy or within 5 months of birth

Dilated cardiomyopathy that develops at the end of pregnancy or within 5 months postpartum is known as peripartum cardiomyopathy.

Alternatively, an enlarged heart can be a pre-existing condition that occurred independent of pregnancy.

Hypertrophic cardiomyopathy (HCM) is very common and can affect people of any age. It affects men and women equally. It is a common cause of sudden cardiac arrest in young people, including young athletes…

Hypertrophic cardiomyopathy occurs if heart muscle cells enlarge and cause the walls of the ventricles (usually the left ventricle) to thickenHypertrophic cardiomyopathy usually is inherited. It’s caused by a change in some of the genes in heart muscle proteins. HCM also can develop over time because of high blood pressure or aging. Diseases such as diabetes or thyroid disease can cause hypertrophic cardiomyopathy. However, the cause of the disease isn’t known.

Peripartum cardiomyopathy usually leads to heart failure (inability of the heart to pump effectively) and not a heart attack (myocardial infarction or MI). Hypertrophic cardiomyopathy can lead to an MI when the enlarged heart’s increased need for oxygen can’t be met by the ineffectively beating heart. Of course it is impossible to know what happened to Garner simply based on news reports since mainstream media sources tend to use terms like heart attack, heart failure and cardiac arrest interchangeably even though they mean very different things.

The proximate cause of Garner’s death was not pregnancy or cardiovascular disease, but asthma. Pre-existing chronic health conditions like asthma are the second leading cause of US maternal deaths.`A severe asthma attack leads to a decrease in oxygen because the patient literally cannot breathe. Garner’s heart was already compromised twice over, first by the enlargement and then by any damage sustained as a result of the heart attack that occurred in the days after her baby’s birth. It seems as though her heart simply could not tolerate any additional damage and she suffered a cardiac arrest. Although she was resuscitated at a hospital, she had sustained severe brain damage and died as a result.

Erica Garner could be the face of American maternal mortality. She was black; her death took place months after delivery; she suffered from heart disease and asthma and they combined to kill her.

Is her death emblematic of systemic racism? That’s difficult to say. So far there have been no accusations of poor medical care. She died of the diseases that probably existed prior to her pregnancy. It may be impossible to determine if racism was a factor in the development of those diseases.

  • Platos_Redhaired_Stepchild

    she was also constantly harassed by the police and the stress could not have been healthy

  • lawyer jane

    There’s also the asthma part of this story — the 2nd heart attack was brought on by an asthma attack. African Americans have far higher asthma rates due to having to live in more air polluted environments and less access to health care to control it with meds.

    • sdsures

      How much (what percentage) of asthma in African Americans is hereditary, rather than environmentally caused?

  • CSN0116

    OT: Food for thought — has anyone else noticed that the issues associated with mothering that Dr. Amy writes heavily about here, seem to have transferred to pet ownership? Caring for a dog, for instance, has become literally moralized. Dogs have become arguably humanized. There have always been people overly obsessed with their cats or dogs, but it seems so much more common now. Every commercial dog food is bad – one must feed a raw, “chemical-free” diet. Crates are unacceptable, and if allowed must be lined with thick bedding for ultimate comfort. Bred dogs are unacceptable (despite want or need), you can only acquire a dog in one acceptable way: adoption. One is expected to second mortgage a house to pay vet bills for a dog, or she has fallen short in “truly” caring for it. No matter how sick or terminal the dog, you are expected to pay and treat.

    I don’t own any animals. I have enough work with my brood! But I watch and read how people (mostly women but some men too) write about dog care and the similarities to human mothering are striking. It must be as labor intensive and moralized as possible to be “good” dog ownership. And the rules are strict as hell.

    • momofone

      I’m a dog person, and I totally agree. I am also a dog owner, and I’ve found that describing myself that way instead of as a “pet parent” is offensive to some people. Nope; I’m a parent to the youngest human in my house. (We adopted her, but my plan was to buy a puppy from a reputable breeder, and you would have thought I was going to roast and eat puppies from the reaction some people had.) She also has a crate, and we undermine her innate caninity by discouraging barking and jumping on people and things, and otherwise behaving like a banshee, so pretty much the same rules we have for our son. 🙂

    • PeggySue

      Part of the “pay and treat” is from the proliferation of large chain vet practices with “treatment protocols,” and also the proliferation of pet insurance. I took a dog in with bloody diarrhea and they did not want to do anything without $4,000 worth of scans, yes, that’s right, $4,000. It seemed baffling to them that I didn’t have $4,000 lying around, even before treatment. With some talking we worked out an approach but the vet was very aggressive, stating that if something went further wrong “you will need to authorize those scans.” This was the intern on duty at night. The next day the regular vet called and said the dog was doing great and I could pick her up. The intern had told me that the dog likely had cancer from one blood value, and wanted to run tests for that. I asked the regular vet, who said, no test needed, that blood value did not indicate cancer…

    • KeeperOfTheBooks

      Ayup. And it’s bloody annoying. Nor is it entirely recent; I remember being in college, 10 years ago or so, and having someone lecture me about the brand of cat food I was feeding my cat. Apparently, it wasn’t pricey/raw/chemical-free enough, or something. I pointed out that I personally had about a $20/week food budget, had owned the cat for the last ten years, there was no WAY she’d have made it out of the pound without my adopting her, and that while I suppose I could surrender my deeply-attached-to-me-and-loathing-all-other-humans cat, as she suggested, I had a pretty good idea what would happen to a ten-year-old, antisocial (loved me, hated all other humans), terrified scrap of calico fur in such a situation, and it wouldn’t involve having a human who loved or cared for her as much as I did, much less a full belly, a clean litter pan, and a bed in a patch of sunshine.
      Fell on deaf ears, lemme tell you.

  • Eater of Worlds

    Wasn’t there a recent article that links chronic stress from racism as a factor in poorer health outcomes for black pregnant women, for both their babies and theirselves?

  • Sheven

    I had heard about Erica Garner’s death, but hadn’t connected it to her pregnancy. Thanks for the information.

  • Tigger_the_Wing

    My heart bleeds for her and her family. What a terrible thing to happen to someone who had already suffered so much. I wonder what kind of life those poor orphaned children have to look forward to.

    It seems to me that whatever they put on the death certificate, what killed her was chronic, unbearable stress, either aggravating or actually leading to her asthma and heart disorders. Even those of us with lives of privilege which protect us from fighting constant prejudice because of our race, let alone losing family members as a consequence of that same prejudice, find that our health problems – such as asthma and heart conditions – are worsened considerably by stress. Being the victim of relentless racism from infancy onwards – going back generations – has to have a debilitating effect.

    This post hits home particularly hard because I was 27 when I nearly died from undetected PPH after the birth of my third child; thankfully, I had the best of care when I got back to the hospital. Although my heart nearly gave out during the life-saving surgery*, I survived (with a warning to refer the surgical team back to that hospital, should I need future surgery).

    (*At the time, diagnosis of my own asthma and heart disorders was still decades in the future, due to the faulty, sexist assumptions of the Old White Men then in charge of medicine)

  • moto_librarian

    I think that it can be argued that Erica Garner’s death is related to structural racism. We know that bias exists in medicine, particularly in regard to treating pain in women and people of color. The high levels of stress related to the death of her father, the complete lack of justice of it – that has a negative impact on health. This has to change. My heart breaks for the Garner family (especially her children). They have lost far too much.

  • MaineJen

    This whole story, this whole situation, just makes my heart hurt. Injustice after injustice was heaped upon this family. Erica was 27 years old. That is far, far, far too young to die. Things HAVE to change. It HAS to be different for Erica’s children.

  • The Computer Ate My Nym

    Ever noticed that many chronic diseases just happen to be more common and/or more severe in minorities, particularly blacks? Diabetes: more common in blacks…and Hispanics…and Native Americans…and Asians, though to a lesser degree. Hypertension, cardiac disease, stroke: more common in blacks. Colon cancer: hits at a younger age and is more deadly. Breast cancer: more common and more deadly. And so on. Lots of factors could go into this, but it seems nearly impossible to me that it’s a coincidence. Prejudice almost has to play a role.

    • LeighR

      With PPCM, having genetically African heritage is actually a known risk factor. Any woman of any age or race can get it (I’m Caucasian and a PPCM survivor myself), but black women are particularly vulnerable. There are undoubtedly social factors related to race that contribute to unequal access to care and therefore impact morbidity and mortality, but as far as *occurrence* of the condition, genetic makeup does play a role.

      • The Computer Ate My Nym

        There are lots of factors and PPCM specifically could be largely genetic. But the idea that African-Americans (who are, genetically, often more European than African) just happen to always have bad luck genetically is just unlikely.

        • LeighR

          No, there are many conditions for which ethnic background is associated with increased risk. Sickle cell anemia for example, also more common among those with genetically African heritage. Tay-Sachs disease in Ashkenazi Jews. PPCM is one of those diseases that, while it can happen to anyone, IS more common within a particular population. http://www.myheartsisters.com/aboutppcm

        • Sarah

          That’s a good point re mixed heritage. If it were purely about African ancestry, one would expect that black people with higher rates of European ancestry would have rates more similar to Europeans than to those whose background is more fully African (perhaps more recent immigrants for example). Has the research broken things down to that level?

          • LeighR

            All I can really tell you is that the condition is also more common in countries with predominantly black populations. For example, one of the key researchers of PPCM, Dr. James Fett, has conducted quite of bit of research in Haiti where the occurrence of PPCM is about 1:350 pregnancies (vs 1:1500-3000 in the US, 1:6000 in Japan). Note I’m referring to occurance, not mortality rates. Higher rates of cardiovascular complications of pregnancy have also been observed in sub-Saharan countries like Uganda, with occurence is estimated at 1:1000 (though I imagine many cases go undiagnosed). Even in the US there is still much about PPCM that is unknown, such as exact number of yearly cases, or what causes it.

            But as I said before, having African ancestry is simply one known risk factor. Anyone can get it. Literally anyone. 17 year olds, triathletes, 1st time moms, 6th time moms… anyone, no matter how young and healthy or how many pregnancies they’ve had. The point here should be to spread awareness of the condition since it very, very often goes undetected or is misdiagnosed until something disastrous happens, and basic screening both in the 3rd trimester and the early postpartum period should be routine.

          • Sarah

            Now that’s interesting, because the Haitian population and Ugandan population are both more Black African than that of the US. I suppose there’s likely to be a higher incidence of undiagnosed cases in those populations too. Uganda in particular does have some very remote and badly served areas. I don’t know so much about Haiti but given the poverty of the country I can well imagine there are many women going without adequate care.

    • Many, if not all, of those conditions can be caused or worsened by stress, especially chronic stress. Being discriminated against on a regular basis, and always having to be on the lookout for such discrimination, is very stressful. Prejudice definitely plays a role.

      • Merrie

        I’ve heard the rates are higher as well in ethnically black populations in Africa where everyone is black so prejudice against black people isn’t a thing, versus white people under otherwise comparable conditions.

        And other non-white groups in the US suffer prejudice and consequent stress but don’t have these same issues.

        There does seem to be something genetic going on.

        • I agree. I think it’s probably a super complex mixture of genetics and social circumstances.

          • sdsures

            Genetics definitely plays a part in asthma.

    • SporkParade

      Prejudice would make a lot of sense. Asthma and cancer are more common in areas of high pollution, which are usually minority neighborhoods. People living in poverty (disproportionately minorities) are also more likely to be overweight, so conditions associated with that, like diabetes and cardiovascular diseases, would also be more prevalent.

    • Eater of Worlds

      They’ve also done a recent study on how the chronic stress of poverty screws up people for generations. It changes how the minds of children develop. Racism causes the same sort of chronic stress.

    • Sarah

      Yeah, this. At this point I’m not really willing to give racism the benefit of the doubt wrt life expectancy.

  • PeggySue

    And, totally OT, we had a shooting near where I live in Colorado where a white male US citizen, military veteran, known to possess guns, who had had a several week pattern of uttering escalating threats, shot 5 law enforcement officers and two civilians, killing a law enforcement officer. From what has been released so far, it seems that law enforcement grossly underestimated their danger in responding to the final call, sending several officers into an apartment where they could not see the shooter (he was in a bedroom). In reading about the shooter, this was a case when “fearing for their lives” would have been the right attitude for the police; the law enforcement officers sound like they were essentially sitting ducks when the shooter started firing in the apartment. Contrast this to the drunk black man who was killed in a motel hallway because someone *thought* he might be reaching for a weapon… he died pleading for his life…

    • Oh, pish, everyone knows white men can’t possibly be dangerous to cops or anyone else. They definitely aren’t overrepresented among mass shooters in the US or anything.


    • Daleth

      Yup. Kinda like this: “In a scene that neighbors described as a war zone, a gunman fatally shot three police officers on Saturday morning as they responded to a domestic dispute between a mother and her son. Chief Nathan Harper of the Pittsburgh police said the gunman, Richard Poplawski, 22, surrendered after a nearly four-hour standoff with SWAT team officers.”


      Non-paywall link:


      • PeggySue

        Indeed. And the more I read about the Colorado shooter, the more this seems like a giant clusterf!#k. Just as in the story above, the officer killed here could not be moved because of fire from the shooter, and here a second wave of law enforcement, this time SWAT, was engaged, and the shooter ended up dead. Our shooter, it now turns out, had a facebook page with loads of white supremacist symbols, had eloped from an inpatient psychiatric facility a few years ago, had been threatening law enforcement officers, was reportedly not taking needed medication, reported to the police that he had been drinking, reported to the police that he had firearms. Would officers have entered the apartment if he were black? A friend reminded me last night that we have no idea what the responding officers knew. Whatever, a group of officers ended u in a situation where the shooter probably could see them, but they could not see him, which seems like a very basic thing to avoid. So we have the myth of a hero officer, which won’t help the young wife and two young children live without him. Yep, there’s danger out there, but–and this is so hard for privileged white people to understand–it often looks very much like us.

  • no longer drinking the koolaid

    One of the factors identified in the NPR/ProPublica series is the increased risk of poor outcomes for black women because of the daily stress of being black. As one journalist put it when someone mentioned that she was tired of every discussion turning to race, “You’re tired of talking about it? I am bone tired, dragged out weary from having to live it every day.”
    That additional stress of living while a POC should be counted as an indirect contributing factor in Erica Garner’s death.

    • PeggySue

      The first time I heard this sentiment was when I read an autobiography of Arthur Ashe, who wrote that being a black man in the US was harder than living with AIDS. Very sobering. Got my attention for sure.

    • Eater of Worlds

      That’s how I feel being disabled. Every single damn person wants me to explain the disability, explain how I can possibly manage to live my life and not fall over dead, explain how I can possibly be happy living in my body like I do, then they expect me to stand up and represent ever other disabled person in the US then go and be happy to take the shit I’m dealt with by random strangers who bitch and complain and tell me I should have been aborted rather than allowed to reach adulthood. And when I choose to just go about my life without making use of every single interaction as a teaching moment for someone able bodied I’m again treated like crap, like I have some obligation to personally teach the world how to behave. Most days I can barely manage to physically get from start to end let alone mentally make it in one piece. Add in all those working parts I mention and there are no breaks, not from others and not from m own body. I’ve told my spouse many times that I am not going to live as long as he will and he’ll be lucky if I make it past 46. I’ve begged him to promise me to find someone to love, who is younger and can give him the children he wanted but I couldn’t provide.

      • Tigger_the_Wing

        I’m so sorry. It sucks when people want us to educate them, as if our lives don’t have heaps of extra hassle already. I don’t mind children wondering why I’m not walking, but adults? Then there’s: “Does it hurt?” “Yes.” “When?” “All the time.” “How do you stay so cheerful?”

        “What? You want me to be sick, crippled AND miserable too?”


        • sdsures

          You guys are describing my life, too! I have cerebral palsy, and what Eater of Worlds wrote, up until the end of the sentence, “Add in all those working parts I mention and there are no breaks, not from others and not from m own body.”

          My god, I thought I was the only disabled person fed up with being viewed as an inspirational teaching tool! I once watched a BBC documentary about 2 parents having their second child – both parents have cerebral palsy. Everything went fine, and they now have 2 boys.

          One Youtuber commented: “People with cerebral palsy always look so happy!”

          I lost it and started yelling at the TV. ARGH!

  • PeggySue

    I remembered recent posts about post-partum illness and differing access/outcome for Black women, and I wondered about all of those things when Ms Garner was unconscious. From 10 years in hospice, I knew that if you don’t wake up after sedation is withdrawn, it’s a very bad sign. It’s such a loss, and a little baby and two other little kids have no Mom. Things HAVE to change. Poor family, poor Ms Garner, what an awful thing. Her father had asthma as well which was part of why the chokehold killed him. He couldn’t breathe.

  • attitude devant

    That poor family. How much are people supposed to take?