Pregnancy and childbirth complications have put women at risk of death throughout human history. In America, up until the 1930s, the chances were 1 in 100.
Later advances in obstetric medicine dramatically improved access to care in the U.S., reducing the maternal mortality rate by almost 99 percent over the next few decades. But as the 20th century drew to a close, the numbers began to creep back up – and eventually skyrocketed.
Maternal mortality now affects the U.S. more than any other country in the industrialized world. And an additional, underestimated problem, named by experts as “severe maternal morbidity,” further highlights just how poor women’s healthcare has become.
The Rise in Near-Death Birth Complications
Each year in the U.S., nearly 4 million women give birth. Childbirth is the leading reason people are admitted to hospital, constituting almost 12 percent of all hospital stays, and most of these stays are free of concerns.
But a vast number do not go smoothly. Pregnancy and childbirth account for 700 to 900 annual deaths. And for every new mother who dies, up to 70 suffer significant, sometimes permanent, and often life-threatening complications.
Severe maternal morbidity comprises a spectrum of unexpected complications that arise before, during, or after birth. They can be moderately serious to near-deadly, physically or emotionally traumatic. And according to the Centers for Disease Control and Prevention (CDC), these complications more than doubled between 1993 and 2014 and now affect over 50,000 women per year.
Risks to Women’s Health ‘Brushed Off’
CDC data show that the increase is mostly driven by a 5-fold rise in blood transfusions and a 60 percent rise in emergency hysterectomies. That’s not including healthcare-associated infections that put 1 in 25 patients at risk, or secondary conditions that develop as a result of complications. For example, 6 percent of new mothers suffer from post-traumatic stress disorder (PTSD), a condition more common among veterans, but they are nearly 2.5 times more likely to develop PTSD after an emergency hysterectomy.
“There’s this misconception that these complications are rare,” said Kristen Terlizzi, co-founder of the National Accreta Foundation. “We [women] get brushed off – ‘The risk is not a big deal.’ But it is.”
These CDC estimations only reflect what happens up until a new mother is discharged from hospital. Health issues that arise in the days or weeks afterward may also have long-term repercussions, but are difficult for researchers to track. Some believe the annual tally could be much higher; the Alliance for Innovation on Maternal Health (AIM), for example, thinks it could be 80,000.
“The nature of our system is to focus on these women while they’re pregnant,” said Eugene Declercq, professor of community health services at Boston University School of Public Health. “And then if there are difficulties later, they get lost to the larger system that doesn’t particularly care about women’s health to a great degree, unless they’re pregnant.”
What’s Behind the Rise in Morbidity?
Experts cite maternal age, pre-existing conditions, and unequal access to care as partially responsible for severe maternal morbidity. However, in many cases, it’s the care itself that compounds the danger.
The first problem that separates the U.S. from other developed countries is protocol. U.K. doctors investigate every death to mitigate future mistakes. In the U.S., scrutiny over why new mothers die is limited to only about 30 states and cities. Even less scrutiny is focused on complications that aren’t fatal, though experts argue near-deaths could provide important insight.
When they do analyze maternal deaths and near-deaths, researchers consistently note a pattern of medical malpractice known as “delay and denial,” when doctors or nurses fail to notice signs of complications.
And where these doctors do too little, others do too much – interventions once designed to save lives are now more likely to risk them. Labor induction, which more than doubled between 1990 and 2006 but leads to prolonged labor and hemorrhages, is often performed for the doctor’s convenience more than the mother’s health.
An even greater danger? Unnecessary C-sections, the most common type of in-patient surgery in U.S. hospitals. The rate of C-sections has risen from less than 5 percent in the 1960s to nearly 1 in 3 in 2016. But only about one-third of the surgeries are medically justified, according to Declercq, because they are so dangerous – and not just to the mother.
The Impact on the Baby
Another concern about medical malpractice is life-changing birth injuries to the infant. Birth injuries caused by medical errors, which include everything from lack of oxygen to the baby’s brain to facial nerve damage to skull fractures, can lead to permanent disabilities like cerebral palsy or Erb’s palsy.
Like unexpected injuries to the mother, these are preventable. They also point to a practice called “defensive medicine,” when doctors perform unnecessary procedures for fear of being sued for not doing enough.
According to a 2010 survey, OB-GYNs are sued at higher rates than doctors in most other medical fields. In another survey conducted a year earlier, nearly 30 percent of OB-GYNs admitted to operating more than they normally would to avoid legal action for failing to protect the baby. But it’s a vicious cycle: Defensive medicine does more harm than good, and the crippling costs of healthcare for children with birth injuries have caused lawsuits to rise.
U.S. Hospitals Must Adopt Emergency Protocols
Experts agree these deaths and injuries could have been prevented if doctors followed procedures and scrutinized deaths. One study of women admitted to a medical center in Los Angeles, California found “opportunities for improvement in care” in 44 percent of cases.
Better care could reduce complications or stop the treatable ones from spiraling out of control, but many U.S. hospitals have so far failed to implement protocols that help doctors act quickly. Meanwhile, they keep patients in the dark. When a new mother nearly dies, doctors are under no legal obligation to provide more than medical records to explain what happened.
However, mothers can and should hold doctors accountable for physical, psychological, and financial consequences that can persist long after birth. And for babies affected by birth injury, there is absolutely no reversing the damage. The impact of these disabling situations can be immeasurable.
“The pain and suffering is exponential,” said Miranda Klassen, a maternal health advocate who almost died from an amniotic fluid embolism in 2008. “It’s not just the moms, it’s the spouses, it’s the parents, it’s the children, it’s the larger family and community … It completely turns your world upside down.”