When I almost died in childbirth, I was blissfully unaware. I was captivated by the lights and sounds of the ambulance and said to the EMT, "Code Blue...that's serious, isn't it?!" It never crossed my mind that I might die, that two women, women like me, die from pregnancy-related complications every day in the US.
The thought would have been an affront to my smug sense of complacency: I am white, affluent, educated, insured, and besides, I read all the books and even kept a pregnancy journal. I had it under control. It was a picture perfect pregnancy.
Yet there I was - delighting in the blue lights -- and thinking how 'cool' it was that I had IVs in both arms ...completely unaware I was dying.
Much of the focus on global maternal mortality is understandably on the countries that sit at the bottom of the maternal mortality list - poor countries in regions with few resources and substandard infrastructure. In recent years, different governmental organizations and NGOs have worked in these countries to bring improvement to their maternal health care systems. The Bill & Melinda Gates Foundation, the MacArthur Foundation, EngenderHealth, Every Mother Counts, the WHO, USAID, and many others have stepped up and dramatically improved the survival rates of women and their children.
Meanwhile, most people in the US are unaware that maternal mortality and near-miss is still a problem in 2013. Two women die every day; ninety-three more nearly do. Many are unaware that the United States ranks 50th in the world in maternal mortality - behind such countries as Iran and Croatia.
According to a recent study by Merck for Mothers, only 11% of Americans surveyed had heard or read anything about maternal mortality in the US in the past year.
It is particularly disturbing when we consider that the US's number one area of medical spending is pregnancy and childbirth; a $98 Billion a year industry. I'm no MBA but even I know that is an abysmal return on investment.
So, what causes maternal death and near-miss in the U.S. and why aren't we doing more here at home?
Part of the problem in the US is that we simply don't know exactly why women are dying, or even how many are. It is hard to be aware when we don't have a system that tracks these deaths and near-misses in a uniform fashion in all 50 states. Let me state that plainly - many states do not even have "pregnancy-related" on the death certificate. If we don't ask the question, how will we ever know the answer?
In the absence of complete data, we are left to jump to conclusions, right or wrong, about where to put the blame. Fortunately, there is no shortage of targets:
Blame the mothers - older moms, overweight moms, moms with pre-existing conditions (diabetes, hypertension, etc...), women who use IVF, have multiples, bow to the pressure of a caesarian...
Blame the doctors, big pharma, insurance companies, fiscally motivated hospitals - "medicalized" birth, interventions, Pitocin, Cytotec, membrane stripping, caesarian sections, infections, medical malpractice, inadequate follow-up, inadequate prenatal care...
Blame the midwives, homebirths, natural child-birth community, lack of intervention, midwives without a nursing degree, or blame the belief in positive thinking...it won't happen as long as you think it won't...
Blame the media, and frankly, people like me, advocates, who in the effort to reduce anxiety and fear, provide constant reassurance that 'this won't happen to you.'
After a recent Downton Abbey episode, a popular PBS miniseries, lost Lady Sybil in childbirth due to eclampsia, there was an admirable flurry of news articles talking about 'what is eclampsia?' and readers asking 'does it happen here?' The response from leading organizations was reassuring, and frankly, disappointing. Most provided a variation of "While it happens here, it is very, very rare, the real problem is overseas." That means I'm off the hook. I'm safe, except, when I'm not.
While pregnancy-related death in the US is indeed rare, it is not rare enough when it's your partner, your sister, or your mother who died. It is not rare enough for the 93 women a day who - 'there but for the grace of God, go I' - tried, but did not die. Nor for the 3,600 women a day who have unexpected complications and aren't sure what hit them.
Near-miss: an unplanned event that did not result in maternal death - but had the clear potential to do so.
Often, families of women we've lost, and those of us who survived near-miss, have never even heard of the conditions - hemorrhage, preeclampsia, HELLP syndrome, amniotic fluid embolism, ectopic pregnancy, pulmonary embolism, sepsis, placental abruption - that nearly or do kill them.
Many of the popular pregnancy books are practically useless -- a swath of pink and blue and unicorns and rainbows. Try finding something in the majority of books that mention complications - even common complications like preeclampsia (5-8% of all pregnancies); they are relegated to the back of the book.
I didn't read the back of the book. I was not high-risk.
The truth is we're all responsible. Each of us contributes in some way to the problem. In an effort to reduce fear, we resort to what one of my Twitter friends calls, the "big hush, hush" - a 'don't ask, don't tell' policy that shames women with bad outcomes into silence. In an effort to avoid frightening pregnant women, the majority of whom aren't high-risk, we neglect to foster an educated and healthy respect for the miracle of childbirth and the complications that can compromise that perfect birth.
When, every year, 1.7 Million of your pregnant women have unexpected complications, when it is safer to give birth in Uzbekistan than Washington D.C. ; it's time to talk about it.
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