The Dark Side of Delivery: Maternal Mortality and Me...
Can you imagine if every 1st visit to the obstetrician they asked about your diet, your goals for your pregnancy, and at the end asked if you were prepared to die? Sounds crazy I know but the reality is that the happiest time in a woman's life also carries the chance of being the last thing she does in the world.
Maternal mortality in this country has become a topic being discussed more and more in recent years and it's not because it's declining but just the opposite it is on the rise. According to the CDC there were 7208 reported deaths of women from pregnancy related issues from 2011 to 2014 within a year of giving birth. 2726 of those deaths being found to be directly related to pregnancy. Even more alarming is the fact that black women lose their lives at a rate that is 4 times higher than white women with no documented reasons as to the cause of the discrepancy seen between the races. With the technological advances available in the United States you would think that these numbers would be much lower but in fact the CDC sites cardiovascular disease ( 15.2%) ,non cardiovascular disease ( 14.7%) , infection and sepsis ( 12.8%) , and hemorrhage ( 11.5%), as the top reasons for death among these women with more than half of the above named being preventable. The United States as of 2018 is seeing a rise in these numbers with a staggering 20+ deaths per 100,000 reported with 47.2 deaths per 100,000 being black mothers .
47.2! That number means that if you are black, female, and childbearing the chances that you may pass away during delivery or shortly after pregnancy is incredibly high compared to other races.
Take for instance the story of Kira Johnson. Kira gave birth to a son Langston on April 12, 2016 at Cedars-Sinai medical center in California. After her husband noticed blood in her catheter he alerted hospital staff who subsequently ordered stat diagnostic CT scans. Expecting the test to be performed immediately they waited 7 hours for the test which was never performed. Instead after Kira began to shake uncontrollably an internal exam was performed which they told husband Charles would take 15 minutes. Watching his wife be rolled away that was the last time he saw Kira alive. But the Johnson's story is not isolated, thousands of women's family share this heartbreak every year in this country. Hospitals fail these women on multiple fronts yet the CDC reports the over all reason for this is unknown. To that I call bullshit.
As a health care worker and black woman in this country the reasons for this horrific trend are abundantly clear. Every day I see the concerns of women in hospitals go unnoticed or ignored for one reason or another. I have personally witnessed women reporting pain or complications to their providers to have them be told they are fine and in capable hands without even a simple check. Concerns raised by women about their own bodies are often passed off as irrational or unfounded.
Take Shalon Irving who was a lieutenant commander in the US Public Health Service Commissioned Corps and CDC epidemiologist who died after complications from high blood pressure in 2017. She sought medical care on 5 different occassions before her death. She was told to just give it time, given medication and sent home where she only had a few hours before she was admitted to the hospital and died 4 days later. She was 36 years old.
Stories like these are part of my own decision to wait. Having a complex medical history that includes auto immune disease, nerve damage, chronic pain, and internal chronic organ spasms, I fall into the category of high risk. Add in prior spontaneous miscarriage and it would require the collaboration of multiple health care providers to ensure a safe pregnancy and delivery for both myself and my child. Having that information up front and knowing what it would take you would think that would squelch some of my fears. But in that time having to fight for years to have my pain taken seriously, being given multiple medications that interact negatively by my "team" who failed to recognize the contraindications resulting in suicidal ideations, ulcers, palpitations, and more, while also having my own doctors tell me my pain is all in my head and sending me to therapy only to later realize I suffered from real diagnosable conditions, has left me with little faith that should any issues arise they would be taken seriously and treated in a timely fashion or even prevented when possible if I don't figure it out myself 1st.
Being a first time mom even with all of my experience, knowledge, and tenacity there are things I don't know and that scares the crap out of me.
"Never be afraid to trust an unknown future to a known God" ~ Corrie ten Boom
I know having kids comes with a requirement of "have faith" but seeing what I've seen, hearing what I've heard, and experiencing the things I have has left me in a place of inherently shaky faith on this topic. Watching mothers come in hopeful and being rolled back to the OR due to hemorrhages, and complications has left me paralyzed with the question of what more could have been done?
Some of the work being done out there does give me a glimmer of hope though. Like the tool kits being used in California that take real life scenarios and transform them into policies, and step-by-step procedures to deal with complications including dry runs, skills labs, and continuous meetings to assess and reassess the policies which resulted in a 55% decline in maternal mortality from 2006 to 2013 would be one of those things. Also the efforts of North Carolina to incentive care resulting in risk assessments for Medicaid mothers which leads to care managers being assigned to those found to be at risk which provides hands on care plans during and after delivery to ensure maternal and infant safety. I also believe the hard work of doulas can be attributed to this topic as a win. Doulas have been statistically proven to reduce low birth weight at 4x the rate of other methods as well as producing 2x times fewer maternal complications.
Overall the topic of maternal mortality and especially in black women can be and should be discussed constantly and thoughtfully until the numbers have seen a dramatic decline. Until then I will be keeping a constant watch, praying, and moving to see change.
I love and send light to every mother and mother to be out there and don't worry together we can #changethenarrative.
To watch the TED Talk by America’s Maternal Nightmare | Dr. Monique Rainford | TEDxWilmington click the link below:
Click below to hear from Kira Johnson’s husband Charles on being asked to lend Kira’s story to the writers of The Resident.