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Scary things to note before thinking about giving birth in the U.S

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5 years ago

February 19, 2019

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American mothers die in childbirth at higher rates than in any other developed country — and those most at risk are mothers of color.

Elise Salazar was 19 years old when she gave birth in Hawaii. She was being seen at a military hospital and, as a mixed-race Latina-American, felt early on that her opinions didn’t matter to the OB-GYN team that was providing her care.

In fact, when she asked for an epidural the anesthesiologist told her she’d have to prove she was in enough pain first.

“I had to perform labor pain to his expectations before he would authorize the epidural,” Salazar told Healthline.

When an epidural was finally approved, Salazar was surprised it wasn’t the anesthesiologist who gave it to her, but a student he passed the task off to instead.

Salazar says the student missed three times, ultimately stabbing her in the spine a total of four times before the medication was delivered. She then only set the epidural for 40 minutes, saying she wanted it to wear off before Salazar went into labor.

“After the epidural wore off, I was in the most horrific pain of my life. I was screaming, having trouble breathing, and panicking. A nurse came in the room and told me to ‘shut up’ because I was scaring other patients. By the time I was ready to deliver, I’d been laboring med-free for about an hour and a half,” Salazar said.

What followed was third-degree tears after the medical team failed to give her an episiotomy (which she’d had with her first baby).

The nursing staff also cleaned her baby shortly after delivery, but left Salazar lying in sheets soaked with blood and fluids and a soiled vaginal area for more than an hour after giving birth.

Most people might hear Salazar’s story and hope it was an isolated tale. But the truth is, stories like hers are far more common in the United States than they should be.

A history of poor maternal health outcomes

The number of poor maternal health outcomes in America isn’t new news. NPR teamed up with ProPublica for a six-month investigation on maternal mortality in the United States in 2017. What they found was disturbing:

The United States has a higher maternal mortality rate than any other developed nation.

Treatable complications are often to blame for mothers dying when the right care could have prevented those deaths.

Hospitals remain unprepared for dealing with maternal emergencies.

Only 6 percent of grants slated for “maternal and child health” actually go to the health of mothers.

CNN, The New York Times, and USA Today have had similar stories with convincing data finding that, while other developed nations have seen a decrease in maternal deaths, the United States has seen a sharp rise.

Women of color at greater risk

Another facet of the recent reports surrounding maternal health outcomes in the United States is one that seems to be largely ignored: For women of color, the outcomes are even worse.

The Center for American Progress reports, “African American women are three to four times more likely to die from childbirth than non-Hispanic white women, and socioeconomic status, education, and other factors do not protect against this disparity.”

In fact, Salazar is in good company with her story of traumatic birth, as both Beyoncé and Serena Williams came out earlier this year with stories of their own.

The numbers

Gene Declercq, PhD, is a professor of community health sciences and assistant dean of doctoral education at Boston University. He’s also a researcher who has spent several years striving to compile accurate numbers on maternal health outcomes in the United States.

“The government hasn’t published an official rate since 2007,” he told Healthline. “There are semi-legitimate reasons for that, because there were some measurement changes. But we thought we could develop a general estimate, and then we dug into the disparities.”

His goal is to shift the debate from just maternal health outcomes to an overall public health conversation. In his research, he’s learned that while the death rates of women under 15 and over 45 in the United States are going down, the death rates of women 15 to 44 (childbearing age), and particularly 25 to 34 are going up. He sees the issue as one related to women’s health in general.

The disparity

When asked about the disparity of outcomes for women of color, Declercq cited an issue of not listening to minority mothers, and of not taking the problems they are reporting seriously — just as Salazar experienced.

“That’s a big piece of it,” he said. “But we also can’t neglect the fact that for a lot of women in a lot of states, if they’re not on private insurance, they won’t get public insurance until they are pregnant.”

He explained that the system for Medicaid coverage is set up in many states to be easier to gain approval once a woman is pregnant. But at that point, she’s carrying all her previous, unchecked healthcare issues into the pregnancy, and she may have a hard time finding a provider who will care for her. She’ll find a place to deliver, but in most states, she’ll be dropped from public insurance within 60 days of giving birth.

“It certainly sends the message to women that their only importance is as a baby carrier, and after the baby is born, we don’t care anymore,” Declercq said. “They’re not falling through the cracks, there are no cracks. There’s no system at all for them to be cared for in.”