In 2016, four women from the United States – in the prime of their lives and in peak physical condition – stood together and received gold Olympic medals. By 2023, three of the four had suffered life-threatening complications as a result of pregnancy or childbirth, and one of them had died.
That kind of news is slowly making waves in the nation’s consciousness, as more women become aware that childbed deaths are not a thing of the past, especially in this country.
All the advanced health care doesn’t seem to be enough
The U.S. has, arguably, the world’s most advanced medical facilities – but it also has the highest rate of maternal deaths among all developed nations. Over the last 40 years, the U.S. maternal death has continued to rise, while rates in other countries have dramatically fallen.
What is the U.S. doing wrong when it comes to maternal care? The answers are complicated. Some of the issues include:
Failures to properly address health issues
Some women are dying simply because their doctors aren’t doing enough to address obvious risk factors created by age, high blood pressure, obesity and poor nutrition.
For example, women are increasingly delaying pregnancy until they’re in their late 20s and early 30s and financially stable, but a higher maternal age increases the chances of pregnancy complications like gestational diabetes and preeclampsia. More women of advanced age are turning to in vitro fertilization to have children which increases the chances of a twin or multiple birth pregnancy that are more complicated to manage.
Doctors sometimes fail to educate their patients sufficiently about diet and blood pressure. Blood pressure monitoring should be a routine part of every pregnancy, and this should even be done at home. A rise in blood pressure can be an ominous sign that problems are developing in the placenta that need to be assessed. The increase in blood pressure does not be sustained to require evaluation, and the American College of Obstetricians and Gynecologists requires only four hours of elevated pressure to make the diagnosis of gestational hypertension, which should trigger an array of testing and monitoring to ensure fetal well-being. Heightened awareness by both physician and patient is needed to minimize the chances for morbidity and mortality caused by hypertension in pregnancy.
Monitoring blood sugar during pregnancy is important to diagnose gestational diabetes, which creates additional risks for both mother and fetus caused by excess growth in the fetus leading to a large baby, a condition known as macrosomia. Macrosomic babies have more difficult births and are at greater risk for shoulder dystocia and caesarian section. Doctors also sometimes delay making the decision to do a C-section longer than they should, which can also increase the risk to both the child and the mother.
Racial disparities and biases
While White women have seen their mortality rise, maternal deaths among Black women have doubled in the last 20 years, and the rate of death among Indigenous women has tripled. This strongly suggests that women of color may be victims of poorer nutrition, less social support and exercise and, in some areas of the country, unequal access to quality medical care both during their pregnancies and their postpartum periods. Different ethnic groups also pose different risks for hypertension and diabetes and may need more support during pregnancy.
Inadequate postpartum care
A majority of maternal deaths occur postpartum due to complications with things like hemorrhage, cardiomyopathy, stroke, pulmonary embolisms, anesthesia, infections and the aggravation of pre-existing illnesses. The most dangerous post-partum condition is post-partum hemorrhage, which can occur after prolonged labor, placental accreta and uterine rupture. Another sometimes underappreciated problem in post-partum depression which can occur after birth. The reasons for post-partum depression are complex, and screening and monitoring new mothers is important for the health of the mother, child and family.
Errors in Care
When a mother dies in pregnancy, during childbirth or slightly after, it’s a tragedy for the entire family. The loss may be even more profoundly felt when the death is a result of negligence on the part of a doctor or hospital, and the sad truth is that many maternal deaths are preventable. The surviving loved ones of a mother who may have died from pregnancy complications due to a provider’s negligence should have the care reviewed by an experienced obstetrical malpractice attorney to see if there is an ability to pursue compensation for their losses.