U.S. Maternal Mortality Rate & Systemic Misogyny

The New York Times asks the question best: “How is it that the United States, a country with some of the most cutting-edge medical treatments, has some of the worst maternal mortality rates in the developed world?” And to shut down the misogynist’s excuse that the United States’ maternal mortality rate is simply endemic to our lack of socialized healthcare and systemic racism, the Times provides:

Eugene Declercq, a professor of community health sciences at the Boston University School of Public Health who has tracked maternal mortality for years, said the racial disparities in the American rates were deeply troubling, but only part of the story.

“People may think this is happening because the U.S. has more minorities and poor people,” he said. “But even if you limit the analysis to whites, we would still rank behind all other industrialized countries.”

And, yes, the poor and disenfranchised are hit harder, as well as women of color. However, even if you take just white women, America is still has the highest maternal death rate of first world, industrialized countries. “Last year, a study published in Obstetrics and Gynecology found that the maternal mortality rate in the United States had increased by more than 25% from 2000 to 2014. This trend differed by state, however. Although California had shown some declines, Texas had seen significant increases.” (JAMA)

The Centers for Disease Control and Prevention tracks conditions and factors contributing to the severe American maternal mortality rate, citing the U.S.’s high cesarean delivery, as well as complications that arise during pregnancy resulting in severe maternal morbidity – disseminated intravascular coagulation, adult respiratory distress syndrome, and acute renal failure. Unnecessary c-sections/cesarean deliveries not only contribute to the rising numbers of mothers dying, but secondary infertility, emotional trauma, and a longer recovery time.  A very necessary c-section can save your life. An unnecessary c-section can kill you.

If an American women hasn’t had a negative experience as a pregnant woman, she knows a woman who did. As an accountant with a side job of selling Mary Kay products, Annie works full time. However, Annie cannot afford health insurance; her employer does not offer such benefits. Annie’s children are covered by Medicaid; she is uninsured. During her last pregnancy, she overheard the obstetrician roughly complaining to the nurses that he was going to miss an engagement. The nurses returned to Annie’s room to prep her, and two other women, for immediate c-sections. These women were all under-insured or uninsured, and Annie is Hispanic. Class and race discrimination allows doctors and medical personnel an opportunity to intimidate and bully expecting mothers, who are at their mercy, into unnecessary c-sections and unnecessary induced labor.

The Association of Health Care Journalist: “Nationally, about a third of women now give birth by C-section, according to the American College of Obstetricians and Gynecologists. The World Health Organization says the C-section rate shouldn’t be higher than 10 percent to 15 percent.” Brenda Goodman of the AHCJ reports:

The U.S. is a scary place to be expecting a baby.  We spend more than any other country in the world on health care and more on childbirth related care – $86 billion annually – than on any other area of hospitalization, according to a 2011 editorial in the journal Contraception. Yet our maternal-fetal outcomes are some of the worst among developed nations.

If that’s not bad enough, for the last two decades or so, while the rest of the world reduced the number of mothers who died in childbirth by about a third, maternal mortality nearly doubled in the U.S. “Near misses”—instances where a woman has complications from childbirth so severe that she nearly dies—are up 27 percent here.

Texas Representative Shawn Thierry nearly died in childbirth due to complications from an epidural. Texas has the worst maternal mortality rate in the world – the mortality rate is three times higher for African American women. The Texas Observer reports:

Three years later, in 2016, Thierry read with interest a report by a state maternal mortality task force that found that African-American women in Texas are much more likely to die of pregnancy-related causes in the year after birth than white or Hispanic women. That report came on the heels of research showing that Texas’ maternal mortality rate had doubled over a two-year period, and now exceeds that of anywhere else in the developed world.

In the 2017 legislative session, Thierry’s No. 1 priority was legislation requiring more research into why so many new African-American mothers in Texas are dying. But despite bipartisan support, the measure was indiscriminately killed by the far-right House Freedom Caucus last month as part of what came to be known as the “Mother’s Day Massacre.”

While the global maternal mortality rate fell by almost half between 1990 and 2015 as reported by UNICEF, the maternal mortality rate continues to rise in the United States of America. Iran, Vietnam, Russia, and Romania – nations that are less medically advanced and known for their overt sexism – have a lower maternal death rate than the United States. We have all the technology and means to keep mothers safe, yet our own systemic misogyny combined with slashes to Medicaid and attacks on any attempt to implement national health care and maternity leave, women are in very real danger. Pregnancy and childbirth are both life-threatening in 21st century America. The very same country that put a man on the moon cannot seem to lower its maternal mortality rate.

The medical community is as much to blame as legislators. Doctors and nurses tend to ignore a mother’s pain, either pushing more intravenous opioids, readjusting epidurals, or completely dismissing a woman’s pain as normal. Preeclampsia is killing women in the United States. Yes, preeclampsia, is still killing women in a first world country largely because nurses and doctors are ignoring the symptoms and dismissing mothers’ complaints.

Lauren Bloomstein’s fatal case of preeclampsia went ignored by medical personnel of Monmouth Medical Center of New Jersey. And Bloomstein was an employee – a nurse- who worked along the very people who neglected her, who let her die. NPR reports:

Lauren figured, it would be the doctors and nurses she worked with on a daily basis. She was especially fond of her obstetrician/gynecologist, who had trained as a resident at Monmouth at the same time as Larry. Lauren wasn’t having contractions, but she and the ob/gyn agreed to schedule an induction of labor — he was on call that weekend and would be sure to handle the delivery himself.  […]

The ability to protect the health of mothers and babies in childbirth is a basic measure of a society’s development. Yet every year in the U.S., 700 to 900 women die from pregnancy or childbirth-related causes, and some 65,000 nearly die — by many measures, the worst record in the developed world.

American women are more than three times as likely as Canadian women to die in the maternal period (defined by the Centers for Disease Control as the start of pregnancy to one year after delivery or termination), six times as likely to die as Scandinavians. In every other wealthy country, and many less affluent ones, maternal mortality rates have been falling; in Great Britain, the journal Lancet recently noted, the rate has declined so dramatically that “a man is more likely to die while his partner is pregnant than she is.” But in the U.S., maternal deaths increased from 2000 to 2014. In a recent analysis by the CDC Foundation, nearly 60 percent of such deaths are preventable.

The list includes teachers, insurance brokers, homeless women, journalists, a spokeswoman for Yellowstone National Park, a co-founder of the YouTube channel WhatsUpMoms, and more than a dozen doctors and nurses like Lauren Bloomstein. They died from cardiomyopathy and other heart problems, massive hemorrhage, blood clots, infections and pregnancy-induced hypertension (preeclampsia) as well as rarer causes. Many died days or weeks after leaving the hospital. Maternal mortality is commonplace enough that three new mothers who died, including Lauren, were cared for by the same ob/gyn.

The causes of high death rates in and after childbirth sit on the cornerstone of systemic misogyny, as seen in the one-size-fits-all approach to women’s health care. Unnecessary c-sections and unnecessarily induced labor, as well as lack of birth style choices and a dogmatic approach to medical procedures, continue to harm and kill mothers. Mothers are treated as vessels – not as mothers, and not as human beings. While the infant mortality rate decreases, maternal deaths continue to rise.

Infant mortality has fallen to its lowest point in history, the CDC reports, reflecting 50 years of efforts by the public health community to prevent birth defects, reduce preterm birth, and improve outcomes for very premature infants. […] The divergent trends for mothers and babies highlight a theme that has emerged repeatedly in ProPublica‘s and NPR’s reporting. In recent decades, under the assumption that it had conquered maternal mortality, the American medical system has focused more on fetal and infant safety and survival than on the mother’s health and well-being.

“We worry a lot about vulnerable little babies,” said Barbara Levy, vice president for health policy/advocacy at the American Congress of Obstetricians and Gynecologists(ACOG) and a member of the Council on Patient Safety in Women’s Health Care. Meanwhile, “we don’t pay enough attention to those things that can be catastrophic for women.

It’s not just medical negligence, lack of birthing choices, and the procedural dehumanization of mothers that get women killed, it is a gross cultural oversight. Often, women’s health issue, especially the growing maternal mortality rate, takes the backseat to petty non-issues. Both political parties are guilty of over-looking or dismissing the fact that women are increasingly dying due to complications in pregnancy or childbirth for trivial “SJW” issues. The Texas Observer reports on the wrong priorities of its state’s Legislature:

[…] Most legislation focused on extending research efforts, rather than addressing what the maternal mortality task force has said is the underlying problem: lack of access to health care. Even the calls for more research languished during a legislative session in which trans people’s bathroom use was a top priority. In the end, only two piecemeal bills dealing with maternal mortality passed.

“Women’s health once again got caught in the political crossfire,” said Thierry.

[…] More than half of all births in Texas are paid for by Medicaid, but coverage for new mothers ends just 60 days after childbirth. The majority of the 189 maternal deaths the task force looked at from 2011 to 2012 occurred after the 60-day mark. […]

The task force recommended that lawmakers extend health care access for women on Medicaid from 60 days to one year after childbirth. One bill, from Representative Jessica Farrar, D-Houston, was filed to do so, and it didn’t get a committee hearing  — probably a reflection of how little appetite there is in the Legislature to spend any more money on health care for low-income people.

“To say I’m upset would be an understatement,” said Representative Armando Walle, D-Houston, who wrote the House bill that established the task force in 2013. “I’m disappointed we couldn’t tackle this issue in a much more thoughtful way. We debated bathrooms all night. There are women dying.”

The variables contributing to our nation’s rise in maternal deaths are numerous. But the finding the solution doesn’t have to be complicated. As a nation, as a people, we need to start valuing women, particularly motherhood. And we need to listen to women. In any other scenario, ignoring a patient’s concerns and pain would be seen as inhumane and reprehensible. But when it comes to expectant mothers, it is commonplace.

NOTE: If you are pregnant or family planning, NPR’s and ProPublica’s joint project and investigation into the surge in maternal mortality and near deaths in the United States offers life-saving guide and tips, “‘If You Hemorrhage, Don’t Clean Up’: Advice From Mothers Who Almost Died”.