In May Pro Publica, in conjunction with NPR, released a report on US maternal mortality that garnered a lot of attention. I criticized the piece for misrepresenting the problem. Pro Publica framed its story with the tragedy of a well off, healthy white woman who died of malpractice when the reality is that maternal mortality disproportionately affects black women and women with pre-existing medical conditions.
I was not the only one to criticize them, and to its credit, Pro Publica acknowledged the criticism and set out to do better. Today it published new findings, Lost Mothers, profiles of 16 women who died within a year of giving birth.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The problem of US maternal mortality is far more political than medical.[/pullquote]
Although their picture, relying as it does on reader submissions, is still incomplete, it is a far better reflection of the actual problem.
I created a chart of the profiles. Even a cursory look shows that the problem is far different than Pro Publica initially presented.
This group of 16 profiles shows that maternal mortality is not really a problem of healthy white women dying of common complications. Fully half the women are not white. Very few were expecting a first baby. Nearly half had pre-existing obstetric or medical conditions. The causes of death ranged from hemorrhage (3 cases) and infection (2 cases), both of which are potentially preventable, to serious cardiac conditions (4 cases) like peripartum cardiomyopathy, heart attack and spontaneous coronary artery dissection, to mental health issues (2 cases), to stroke (1 case) to ectopic pregnancy (1 case), a complication of early pregnancy.
Most of the women who died did so because of LACK of timely access to medical technology, NOT overuse of technology. Contrary to the assertions of natural childbirth advocates like Henci Goer, these deaths could NOT be prevented by midwives, doulas and birth plans.
Goer, like most natural childbirth advocates, positively delights in misrepresenting maternal deaths to promote natural childbirth. Titling a recent piece Preventable Maternal Mortality: Disgrace of the US Maternity Care System, Gore asserts, with no evidence:
The overuse of cesarean surgery contributes (largely by increasing the numbers of women with placental attachment complications in subsequent pregnancies).
But most cases of maternal death profiled by Pro Publica have nothing to do with C-sections and it is not clear that any of the C-sections were unnecessary.
Indeed, contrary to the assertions of natural childbirth advocates that pregnancy is safe and interventions have made it dangerous, this list of maternal deaths makes it clear that pregnancy is dangerous (as it has always been, in every time, place and culture) and only MORE interventions are likely to make it safer. Moreover, pregnancy and childbirth put tremendous stress on many women, often too much for those with pre-existing or existing mental health issues to handle.
There are a number of things we could and should do if we really want to prevent maternal deaths instead of merely talking about them:
- We must increase access to high tech medical and obstetrical care.
- We must create a system of maternal critical care triage to parallel the highly effective system of neonatal critical care triage. Just as there are now Level I, II and III neonatal intensive care units, there should be Level I, II and III maternal intensive care units.
- We must create algorithms and hold drills to prevent and treat common causes of maternal death.
- We must devote significantly more research dollars to understanding cardiac complications of pregnancy.
- We must provide more psychological support for women suffering mental health complications of pregnancy.
- We must ensure that all women have easy access to contraception, abortion, and other gynecological services.
The maternal death rate is NOT a reflection of problems with our obstetric care system so much as it is an indictment of the general contempt in which we hold women’s health in the US.
Any country to seeks to restrict access to contraception and abortion is a country that doesn’t care whether women die.
Any country that restricts prenatal care to only those who can afford it is a country that doesn’t care whether women die.
Any country that predicates access to high tech obstetric and medical technology on whether women can pay for it is a country that doesn’t care whether women die.
The problem of US maternal mortality is far more political than medical. We have the ability to save more maternal lives; we just don’t have the will.
