U.S. mothers are dying. Why don’t we know that?

Cross-posted on BlogHer

This past week as I wandered, or you might say stumbled, around Stumble Upon familiarizing myself with the layout and realizing the potential to find a lot of great blogs, I came across an article that stopped me in my tracks. I wish I could say it was a fabulously uplifting story, but the reality is that it was the complete opposite.

I want to pause for a moment here and take this opportunity to note that I did not write this with the intent of scaring pregnant women. There is already enough fear surrounding childbirth in this country and I don’t wish to contribute to it. However, I feel strongly that the information below needs to be brought to light and so I wrote this with the intention of raising awareness and educating those who are interested.

A couple of years ago Orlando mother Claudia Mejia checked into Orlando Regional South Seminole hospital to have a baby. The birth went well, but then something went wrong, very very wrong. Ms. Mejia was told she contracted streptococcus, a flesh eating bacteria, and toxic shock syndrome and if she wanted to live, she would have to have both sets of limbs amputated. No further explanation was given. Twelve days after giving birth she was transferred to Orlando Regional Medical Center where she became a quadruple amputee, unable to hold or care for her new son. She has since filed suit against the hospital asking for answers as to how this could have happened. It appears that a judge ruled in favor of releasing her records in April 2007, but I was unable to find any more information to indicate if that ever happened.

This is no doubt a major tragedy, but what I find even more disturbing than the fact that this happened is that it did not seem to get much media attention. Why is that? Had Ms. Mejia been famous, more affluent, or Caucasian would it have made national headlines? Or would that even make a difference?

Unfortunately, this scenario of obscuring maternal complications and mortality appears to be the norm in the United States, rather than the exception.

Not two weeks before, I read an article by pioneering midwife Ina May Gaskin titled “Masking Maternal Mortality” in the March-April 2008 issue of Mothering magazine. Gaskin asserts that “the number of American women who die as a result of pregnancy and birth is almost four times higher than it should be” and says that begs the question, “Why is no one talking about it?”

The last time I recall hearing about a maternal death in the news was in the spring of 2007 when Valerie Scythes and Melissa Farah, two friends and teachers from the same school, both died following c-sections at Underwood Memorial Hospital in Woodbury, N.J. Had they not had the coincidences of knowing each other, both having been at the same hospital, and dying within weeks of each other, would either of their deaths have received media attention?

The maternal death rate in the United States is the highest it’s been in decades – 13 deaths* per 100,000 live births and, even more startling, for black women 34.7 deaths per 100,000, in 2004. Gaskin asserts it also may be seriously underreported. According to the Center for Disease Control in 1998, “there is so much misclassification in the US system of maternal death reporting that the actual number could be as much as three times greater than the number officially published each year.”

A significant part of the problem is that the 50 states are not required to use the same death certificate and only 21 states ask on their death certificate some version of this question, “Was the deceased pregnant in the week or months preceding her death?”

Another issue noted by the CDC is that physicians often do not fill out the cause-of-death section of the death certificate accurately enough. Additionally problematic is the US autopsy rate has dropped to less than 5 percent, there is usually no external review process when a maternal death takes place and hospital employees with knowledge about the death are generally warned to stay quiet about it.

How can we possibly expect to have accurate reporting under those conditions?

Contrast this with the United Kingdom where every three years the British Royal College of Obstetricians and Gynaecologists publishes a book titled “Why Mothers Die.” In addition to providing detailed, accurate numbers for each category of maternal death, “Why Mothers Die” also makes recommendations regarding what should be done to reduce the number of deaths over the next three years. The book is available to the public in bookstores, so anyone and everyone can have access to this information.

Also in sharp contrast to the US, when a maternal death occurs in a hospital in the UK, a team of people who do not work at the hospital is dispatched to review all of the woman’s records.

Where does that leave us here in the US? We have a mother who was forced to become a quadriplegic unable to get answers from the hospital as to why. We have an underreported rate of mothers dying from pregnancy and birth complications, often without any kind of outside review. And according to the CDC we have no improvement in the maternal death rate since 1982. Yet none of these stories are getting the kind of media attention they deserve.

To help draw attention to the underreported maternal death rate and lack of media interest, Gaskin started The Safe Motherhood Quilt Project. Whenever she receives documentation that a US woman has died from pregnancy- or birth-related causes from 1982 to the present, she arranges to have a quilt square made to honor her. The quilt, which can be viewed virtually online and is up to 85 squares, “acts as the voice for women who can no longer speak for themselves.” It is quite sobering to view, even online. The last square was just added one month ago.

Perhaps by raising awareness and demanding more information, we can turn the tide in this country.

She who has health has hope; and she who has hope has everything. — Arabic Proverb

 

Related links:
Refuse to be a Womb Pod: The Top Five Underreported Birth Stories for 2007
Banana Peel: I think I’m moving to Iceland…
The Lactivist: Go to Give Birth, Come Home with No Limbs
USA Today: Answers prove elusive as c-section rate rises
SouthCoast Today: At 67, hippie-midwife who changed childbirth in America still crusades for natural method

* Ina May informed me that since she wrote the Mothering article, the most recent figure for the maternal death rate has risen. It’s now at 15/100,000 births.

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35 thoughts on “U.S. mothers are dying. Why don’t we know that?

  1. Very nicely said.

    “Why is no one talking about it?”

    I can actually answer this – from personal experience.

    Please be aware that what I’m about to write isn’t something most people will *want* to read. It triggers some women. It makes others wish they had clicked away.

    I cam as close as you can come to dying in childbirth without needing a coffin. I’m going to try and condense this into less traumatic soundbytes – because I find that when I really express the horror of my daughter’s birth story, it’s too much for most people.

    My OB practice dropped the ball, not once, but many times. Despite my repeated attempts to communicate my concerns with them, I was brushed off with “no need to worry about that” statements by most of the 5 doctors in that practice.

    Given my medical history, I now know I should’ve been scheduled for a c-section and treated as high-risk.

    Instead, 3 weeks after my due-date, I was scheduled for induction. The doc on duty that day wasn’t told I was being induced. I had been in ‘non-productive’ labor for 72 hours when I checked into the ER at 2 a.m. My OB was told about the fact that I was there at 7 a.m. when she was down the hall w/ another birth. She was both annoyed and surprised. She hadn’t read my history the night before like she would’ve if she had been. She had met me 1 time before that day.

    So she had no reason to know that I should’ve had a c-section scheduled, or that I was high-risk for placenta accreta.
    http://en.wikipedia.org/wiki/Placenta_accreta
    Turned out I had placenta percreta.

    So shortly after my daughter was taken to down the hall w/ my husband, my ordeal began.
    Cutting to the chase, 9 pints of blood, 6 running IV’s and about a dozen people in the room trying to figure out how to save me later, I ended up with the then experimental surgery known as uterine arterial embolization – usually used for fibroids, in this case, the alternative to an emergency hysterectomy.

    I spent 5 days in the hospital. I spent a month with my husband taking care of me and our newborn daughter at home.
    I spent more months recovering just to get back to ‘normal.’

    Why tell you all of this? Because the cringe factor is why the media doesn’t report it. No one wants to know. No one wants to believe birth is risky. No one wants to be afraid like that.

    This is the edited version of my horror story – and most people never want to read it. Try and find a news editor who will continually put out stories no one wants to hear. :(

  2. It’s scary. There has been a few here recently, but with media attention. From what I can gather, one was totally not predictable, the other not sure… she bled to death in a hospital that has some very extensive equipment for dealing with her situation. DH services that equipment so he knows. They are still investigating that one. It’s tragic.

  3. Scary and shocking…All these secrets and whisperings cause so much fear. When I was to give birth in the US I was freaking out, something I did not do when i was to give birth in Canada. When you base a service for people on liability and to make money, how it in the best interest of the people?

  4. Last week I saw “The Business of Being Born” a documentary about conventional birth vs midwifery. It was so very interesting. All of the countries that have lower rates of deat have higer rates of midwifes. OBGYNs are surgeons!! It’s what they do…surgery.

    Now, I’m not PG, but hope to be soon. I so want a midwife!

  5. GeekMommy, what a close call you had with that placenta percreta. Had you had previous cesareans or uterine surgery?

    I got the news since writing the Mothering article that the most recent figure for the maternal death rate has risen. It’s now at 15/100,000 births.

    I’m wondering if Penny could contact me about any of the names of women who’ve died recently. I’d like to honor them in the Quilt.

  6. This is astonishing–but not really, I guess, when you think about the abyssmal state of health care in this country. But it is truly unacceptable and unforgivable…thanks for bringing it to our attention.

  7. If something similar happened during a homebirth the media would be all over it, the attackers would have used it as absolute proof that homebirth is dangerous, and it probably would have fueled a few new laws to limit women’s rights to birth how and where they choose.

    But when it’s a hospital, with doctors we look the other way. The guy playing golf with the politician every weekend holds more weight than the woman he injures or kills. A sad truth of reality.

  8. I wanted also to disagree with one point by Geekmommy for a minute. I don’t think it’s that no one wants to admit birth can be ricky, being a homebirth advocate the risk is what everyone likes to exaggerate. What they don’t want to believe is that birth is ricky in a hospital with a trained doctor. They want to keep telling themselves that these kinds of things don’t happen in hospitals, don’t happen if you do things the “right” way. They don’t want to think that the person they give control to may be fallible.

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  10. Thank you again for raising your voice for an important cause. I’m all goose bumps just reading it, including the comments.

  11. I always think it is interesting to read your articles, since we are on such opposite ends of the spectrum, and I think that you do a lovely job of writing.

    I routinely hear about maternal death and other such thngs in the news, but I am perhaps more aware than most so maybe just notice it more frequently.

    I do think that one of the reasons that perhaps it is not a major headline has something to do with a patient’s (and their family’s) right to privacy. There are a lot of factors that come into play, and very frequently that information is something that people would like kept private.

    I also wonder how much the lack of drop in maternal death rate has to do with the advances in infertility treatments. Such treatments have enabled many families to expand when it otherwise may not have been able to, but there is often a significant risk that goes along with such treatments. I am not in any way indicating that the death rate is acceptable or that infertility treatments is to blame, only that I would be interested to see a statistical breakdown of the causes of maternal death.

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  13. Ina May:

    “I’m wondering if Penny could contact me about any of the names of women who’ve died recently. I’d like to honor them in the Quilt.”

    Honor them? Beyond exploiting maternal deaths to generate publicity for your own agenda, do you, or do direct entry midwives in general, DO anything to lower maternal mortality? Do DEMs do any research or training to lower maternal mortality? Do they raise money for the cause or for individual victims? Do they offer assistance to families of the victims?

    It seems to me to be cynical in the extreme to exploit these tragedies in a publicity stunt to promote direct entry midwifery.

  14. Okay all, I’m going against the grain here on this one. I’m not a fan of c-sections or natural birth, I’m in support of a health mom and baby in the end. However this needs to happen. Personally, I had two c-sections and I am in no way ashamed of this. I ended up fine and so were the babies and that is what matters most in the end. I also have a complicated medical history. I tried to have a natural birth and pushed for almost three hours and labored all day and night. My son was stuck and his heart rate dropped and so did mine. It was a emergency. What matters was the end result. Moms should not feel pressured to choose home birth or hospital birth, midwife or doctor. It is not a competition, a status symbol and neither is right or wrong.

    If moms are worried about being pushed into a c-section they should also be worried about having a midwife who may not know what do to when something goes wrong and there isn’t a doctor around for a surgery. I don’t subscribe to the idea of calling OBGYN’s surgeons. They are doctors who do care about their patients but malpractice rates are at a all time high and putting them out of business. I just do not believe that doctors want for a maternal death to happen anymore than a midwife would. They are people with mothers and families too!

    I financially supported Bloom a fundraiser associated with The Ricki Lake Documentary. I am all for doing what is natural and best for mother and child. I am in support of the choice, supporting what the mother feels comfortable with and the end result of a happy mom and baby.Raising awarness for both sides happens to be important but there are two sides. A mom needs to be her own advocate and research her doctor, midwife and practice. Personally, I would never choose a midwife but that is my choice. I felt safest with a doctor but like I mentioned, my medical history is complex and dangerous. Thanks for raising this awarness Amy and creating such great dialogue.

  15. “Beyond exploiting maternal deaths to generate publicity for your own agenda, do you, or do direct entry midwives in general, DO anything to lower maternal mortality?”

    How about help women give birth away from doctors such as yourself Amy. That’s probably done a thousands times more to help mortality than all your self-righteous blatherings, exaggerated numbers, and flat out lies could even pretend to do.

    But hey, name calling and insults are the best you can do anyway. Wouldn’t expect anything more from you.

  16. Hi again! I just wanted to let you know that you are a winner from my little UBP on my blog. You won a manicure travel set! I am late posting this so I apologize! I just need you to email me your addy and I will get it sent off. Nice to see another Colorado mommy on here! Hope you are well. sweetpeacakesetc@yahoo.com Thank you! Dawn

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  19. Here in Canada we do have the same problem with mother dying after giving birth and cause by bacteria caught in the delivery room the hospital aren’t the safest place!

    Thanks for sharing

  20. Oooh you got a comment from THE Ina May Gaskin!

    Fascinating post and discussion. I think the whole way the USA views the birthing process needs to be completely changed. Just as it said in the Business Of Being Born, when you take a wrong turn, you need to go back to the point of departure and take a different route (paraphrased).

    I’d think the reason the UK is better about being upfront with the maternal death rates and tries to take the issue head on, and the reason the USA brushes it under the carpet, is that the UK so far doesn’t have the same issues with patients filing law suits against the medical profession. So the Drs aren’t as scared to admit failure. In the UK we just blame the government instead, for not paying enough into the NHS hehe. Can’t exactly sue the government though.

    Thanks for posting this. I think we need to becom more aware of the issues so we’ll realise we need to make changes in the way we deal with pregnant and birthing mothers.

  21. Can I just say “wow” Ina May commented!

    There is no way in hell I will ever give birth in a hospital again. My first birth was actually a very nice hospital experience, but since that time, all of the Midwives have been fired, VBACs are no longer allowed, children cannot visit their siblings and the C-section rate is sky high.

    It’s pretty obvious to me that the profession that has turned a natural process into a “convenience” medical procedure has done a terrible injustice to the women and babies of this nation.

    If you know anyone who is pregnant, will be pregnant, has ever been pregnant or who cares about maternal and infant health, strongly urge them to watch “The Business of Being Born.” It doesn’t cover everything, but it’s a great start.

    And to Dr. Tuteur, Ina May has spent her entire career dedicated to facilitating healthy births for mother and baby. Unfortunately, it seems like many OBs spend an entire career trying to avoid litigation.

  22. Wow! Wow! Wow! Can I just say that I’m sooo jealous. Ina May is definitely a role model for women who want to birth naturally. It’s incredibly unbelievable the horror stories that are taking place in the U.S. I gave birth at home and it was such an amazing journey. I could not imagine giving birth any other way!

  23. Well said, thanks for raising the topic! I’d read and been shocked by Ina’s Mothering article, seen The Business of Being Born, and am quietly but vehemently on the ‘natural if you can’ front. It’s such an explosive subject, so much guilt and defensiveness surrounding the most personal and intimate of decisions. And when it does go tragically wrong? The blame, real or not, is deadly in it’s own right.

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  25. I’m not sure if I did it right, but I gave you some link love (trackback link). Thanks for the thought provoking post. My wish is for people to THINK FOR THEMSELVES. Gather the information. Make an informed decision. Look beyond what we are told to think. Anyway…

    Thanks again!

  26. @Dr. Amy — yeah, DEMs do a lot for maternal mortality — they keep women out of hospitals which is where flesh-eating bacteria are known to reside. Hospitals are also the places of C-sections, which raise maternal mortality.

    As far as DEM research, it wouldn’t matter if midwives did research, because you don’t believe anybody that has disagrees with you, no matter how many doctorates they have; but if they don’t have a doctorate, then you treat them like scum.

    Save your ad hominem attacks for your own blog that you can control and delete comments that you disagree with at your whim. We’re dealing with facts. The fact is that if this woman gave birth at home she would still have all four of her limbs, and be able to hug her precious baby and walk around and do, you know, little things like fix her child a glass of juice, or give her breakfast or something.

    Kathy

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  28. Claudia Mejia’s story is 2 years old? Does anyone know whats happened since? I haven’t been able to find anything in google. I hope she got her answers and I hope she is doing well.

  29. For those with further interest in this subject, I just posted a long Mother’s Day answer to Amy Tutuer’s charges that the Safe Motherhood Quilt Project is nothing more than a “publicity stunt” at BlogHer.com’s Health and Wellness section, in the thread about Stumble.

  30. Anyone ever notice that “Dr Amy” always pops up on articles that have anything to do with birth issues?

    What does she do, troll the net looking for a place to post her unrequest “advice”?

    Figures. I tried to confirm her medical license but I cannot find anything on her. I’m not trying to dog her, but damn, I’m sick of seeing her arrogant rantings. The world knows she dispises homebirth (oh hell even low intervention hospital birth), so why doesn’t she just let it go.

    I wonder . . . . .

  31. My neighbor died after giving birth on Christmas ten years ago. It was all very tragic, as she and her husband were young newlyweds. She contracted a staph infection, and died in the hospital. We reasoned that it was a country hospital in the sticks and she was exposed to unsanitary conditions. I didn’t realize it was an epidemic or that there was a nation-wide pattern. These statistics are super scary.

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