9

Maternal Mortality

Room spinning, tired, I didn’t realize I was hemorrhaging. My daughter had just been born in a rapid birth spurred by Pitocin because my labor wasn’t progressing. I went from being six centimeters dilated to giving birth in seven minutes flat. Too fast.

Having elected for natural childbirth, it felt something like a tsunami hit the room, I’d been pulled deep under the churning waters, and she was swept in on a wave. To say I was worried about her is an understatement. Hearing my tiny daughter take that first breath and then start crying was one of the most relaxing noises I’ve ever heard. Such sweet relief. She was fine.

But I wasn’t.

Shortly after my daughter was born, I remember my doctor leaning over me with the light framing her head above mine, looking me in the eye, and saying something like: “You’re not done yet, and what I’m about to do is going to hurt more than anything you’ve ever felt in your life. Hold on.” Without hesitation, she pulled out the broken pieces of placenta that were causing hemorrhaging that I didn’t even know was happening at the time. As she did this I possibly broke a decibel record, dropping an epically loud F-bomb. But quick action was needed. If not treated quickly, postpartum hemorrhaging can be a sneaky, silent killer. In fact, it’s the fourth leading cause of pregnancy-related deaths in the United States.¹

There’s already a lot of blood involved in giving birth, and pain, too, so the person in trouble—in this case me—can be clueless that there’s an emergency until it’s too late.

I lived.

But many—too many—women don’t. Women of color, in particular, are losing their lives at alarming rates. Hemorrhaging, like I did when I had my daughter, is one of the most common ways women die in childbirth, and the situation isn’t getting better. According to the World Health Organization, the maternal mortality rate in our nation more than doubled between 1990 and 2013²—and some places in our nation have truly appalling maternal mortality rates. For instance, in 2017, the maternal mortality rate in Texas is the highest not only in the United States, but in the entire developed world.³ It’s no coincidence that this surge in maternal deaths coincided with devastating budget cuts to health care and clinics that provide reproductive health care in Texas. Lack of access to health care services during pregnancy can determine if a woman and her child live or die during or after childbirth.⁴ In 2011 alone, the Texas state legislature slashed its family planning budget by $38 million, and maternal deaths increased.

But maternal deaths aren’t limited to just Texas. Two or three women die every day in the United States while they are in the process of giving life, and every ten minutes a woman nearly dies due to pregnancy-related complications. This gives the United States the dubious distinction of being one of the only countries in the world where maternal deaths and injuries have been increasing in recent years.⁵

It doesn’t have to be this way. While our maternal mortality rate has more than doubled over the past twenty years,⁶ deaths related to pregnancy and childbirth fell by more than a third worldwide,⁷ including in many developing countries.⁸ Behind these shocking numbers in the United States is the appalling fact that nearly 60 percent of all maternal deaths are entirely preventable.⁹

We can, and we must, do something about this.

More Women of Color Are Dying

The truth of the matter is as the rate of moms in America who die in childbirth has been rising, large groups of people have been more significantly more likely to suffer serious complications of birth or die simply because of the color of their skin.¹⁰ In every state, women of color experience disproportionately higher rates of maternal deaths. Black women in the United States are more than three times more likely to die during pregnancy and childbirth compared to white women, independent of age, education, or other measures of parity.¹¹ For every 100,000 births, 43.5 Black women die, compared to 12.7 deaths among white women and 14.4 deaths among women of all other races.¹²

“I remember everything like it was yesterday,” Patrisse Khan-Cullors, co-founder of Black Lives Matter, shared. “My water broke. It broke in the way like you see on TV and you yell, ‘My water broke!’ I was excited. I was nervous. Then after contracting for twenty-four hours at home, my uterus was tired and just stopped contracting. It was at this moment that I learned I had to have a C-section at the hospital.”

She continued: “After my baby was born, doctors checked on me, but no one took the time to tell me about the possible consequences of having a C-section. And this was at a hospital that was thought to be ‘good.’ After I got home I was tired, busy feeding and caring for the baby, and I started to wheeze. My mom heard me and said, ‘Something sounds off.’ So I went to the hospital and found out that I had pneumonia. I googled it and found out that pneumonia was pretty common after a C-section, but I had missed the early signs because my doctors never took the time to talk with me about self-care. Although I survived pregnancy and childbirth, many Black women don’t.”

So what’s going on here? And can we fix it? Three key factors have been found to be at the root of maternal mortality in our nation. The first is inconsistent obstetric practice.¹³ In other words, one of the top reasons for maternal mortality in the United States is that some doctors and hospitals know how to spot and treat childbirth emergencies but some don’t. Unbelievably, hospitals in America don’t have a standard protocol in the case of emergencies during childbirth, so crucial early treatment is often missing. This also means that because of implicit bias and racism, some groups of women are consistently getting life-saving treatment and others are not.

The second factor is lack of access to health care services during pregnancy, which can determine if a woman lives or dies during or after childbirth. This is particularly important for women with chronic conditions like diabetes and hypertension, which are known to spark pregnancy complications. Access to health care during pregnancy is also critical for the health of the baby. There’s been a surge in the rate of babies born dangerously early in the past eight years.¹⁴

It’s also not a coincidence that at the same time maternal mortality rates have been going up there has been a drop in availability of qualified midwives, obstetricians, and family medicine physicians to deliver babies across the country.¹⁵ To put this problem in perspective, according to the American College of Nurse-Midwives, nearly half of all U.S. counties don’t have a single obstetrician-gynecologist, and 56 percent are without a nurse-midwife.¹⁶

This is no small thing.

In the United States, not only are the lives of babies on the line, but women without access to health care services during pregnancy are four times as likely to die in childbirth¹⁷—and of course low-income women are significantly less able to afford health care.

The last factor is particularly maddening: We don’t collect consistent data across all states in our nation about how, when, and where women are dying—which means that we can’t target fixing this growing problem in our nation.

Black Women Are 400 Percent More Likely to Die in Childbirth than White Women

I’m white, I was in the upper middle class when my daughter was born, and I lived. This is not a coincidence. For example, Black women in California are 400 percent more likely to die in childbirth than white women.¹⁸

This is a big deal. As stated previously, more than 80 percent of all women have children by the time they’re forty-four years old. What’s more, the numbers of women and babies born in the United States are projected to increase sharply over the next decade and beyond. So it’s absolutely unconscionable that race, income level, access to health care during pregnancy, and hospital training protocol and location play such major roles determining if a woman will survive or die while bringing a new life into the world—especially when half of all maternal deaths are preventable.¹⁹ Every woman should have equal opportunity to live. But too often that’s not happening in our nation.

We have to start by fighting for solutions that lift the people who are most impacted first. In doing that, we can lift our whole nation and save lives as we also maximize our return on investment. In doing that we all rise.

Fortunately, we already know how to solve these problems. The World Health Organization has done the research and has a list of the top ways to save lives:

All doctors and hospitals need equal access to best practices and shared plans for childbirth emergencies, along with training. Women shouldn’t die in childbirth simply because they choose the wrong hospital.²⁰

Everyone must have equitable access to health care services before, during, and after pregnancy.

We have to consistently collect data—across all cities and states—on the when, where, why, and how of maternal mortality in our nation.²¹

Two additional concrete solutions are supported by advocates, scholars, and medical organizations. The first is to ease state and federal restrictions on nurse-midwives, who attend to labor and delivery as well as provide routine primary and gynecological care for women of all ages. The second is to offer financial incentives to encourage more medical professionals to specialize in maternal health care and to encourage them to locate in regions with extreme shortages, particularly in rural areas.²²

Together we can make these changes a reality.

All Pregnant Women Need Access to Health Care

When we fight for these changes, we need to make sure all women are covered—particularly because not all women get to choose under what circumstances and when or how they’re going to give birth, and the impact of that can be deadly. Women in prison and their babies are particularly at risk. The United States has the highest incarceration rate in the world, so it should not be that surprising to find out that many incarcerated women are pregnant. According to the most recent data available from the Bureau of Justice Statistics, 4 percent of women who enter state prison and 5 percent of those who enter jail are pregnant. But this data is more than a decade outdated. Why does the timing of the data matter so much? Because things have changed. In the past decade, the number of women incarcerated in the United States has nearly tripled, and women are now among the fastest growing segment of the U.S. prison and jail population. We have very little information and data on what medical care is provided to incarcerated pregnant women.²³

What we do have is way too many heartbreaking horror stories about giving birth in prison or jail. Imagine losing your baby because no one would respond to your cries of help when you went into labor. And it’s not that they didn’t hear you… they ignored you.

Nicole Guerrero was eight and a half months pregnant and alone in a Texas county jail cell in 2015 when she suddenly started having contractions. After screaming for help over and over again and being ignored for hours, someone finally came to her assistance, but it was too late.²⁴ Her baby was born on a jail cell floor, a deep shade of purple, with the umbilical cord wrapped around her neck. Sadly, Nicole’s baby did not survive.²⁵ Reports from advocates in Texas have told me this wasn’t the first time a pregnant woman in a county jail was denied access to medical care.

No mother should face this nightmare, and no baby should have to suffer a lifetime of health problems or even loss of life because his or her mother was denied access to health care. No mother should have to endure what Nicole Guerrero did.

After Nicole’s tragic loss, moms stood up, spoke out, and reached out to organizations like the Texas Jail Project, ACLU of Texas, and Mama Sana, and to Rachel Roth, a MomsRising blogger who writes extensively on these issues. A campaign was born. MomsRising and the coalition crafted an open letter to the Texas Commission on Jail Standards, which quickly garnered over a thousand signatures. But the campaign didn’t stop there. A mom gave a brief statement and delivered the signatures to the commission at their quarterly meeting along with other moms backing her up. As a result of their strong showing, the commission agreed to open a dialogue with MomsRising and our Texas partners on how to address the larger issue of pregnant women in Texas jails.

But the wins didn’t stop there. During the outreach to MomsRising members, one of the moms who received an email through a local moms group happened to be the chief of staff to Texas representative Celia Israel.

Israel’s chief of staff brought the issue to the attention of the Texas House of Representatives and introduced bipartisan legislation with Representative Marisa Marquez to begin to address some of the issues we discussed with the Texas Commission on Jail Standards, including requiring counties to share their plans for care of pregnant inmates and a mechanism to evaluate and enumerate the number of pregnant women in jails throughout the state. After the bill passed we got this letter from a member of the Texas state legislative staff: “MomsRising brought the care of pregnant inmates to our attention, and we owe you one for that! (Both as a Texan and as a mom.)”

In other words: We won.

Women are powerful, we’re often more networked together than we often realize, and by speaking out and working together we can save lives and change policies.

Our powerful voices are needed. Solitary confinement of pregnant women, as well as shackling pregnant women during delivery (which continues in the United States despite the fact that it violates the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment and our own Eighth Amendment of the U.S. Constitution), are both still allowed by the federal government even as states work to update their policies.²⁶ Many pregnant women also don’t get ob-gyn and other health care, and pregnant women in prisons face other human rights nightmares as well. So even though women won this fight in Texas, there’s a lot of work still to do. Just bringing the problems to the attention of the public and elected leaders can have a bigger impact than most people think.

Never underestimate the power of your voice in simply raising the obvious.