The dangers of pregnancy

NICK EICHER, HOST: Coming up next on The World and Everything in It: two reports about mothers and babies. First, a mystery on the dangers of pregnancy.

Over the course of history, childbirth has been a perilous ordeal. One out of every 100 births ended in the death of the mother, according to one report.

That began to change during the 19th century as science and medicine advanced.

MARY REICHARD, HOST: Today most wealthy, developed nations have extremely low maternal mortality rates. But here in the wealthiest nation on earth, maternal death rates are climbing. No one seems to know why.

WORLD Radio’s Sarah Schweinsberg spoke with several doctors working on the problem.

SARAH SCHWEINSBERG, REPORTER: The CDC defines pregnancy mortality as the death of a woman while pregnant or within one year of the end of a pregnancy. The death can be caused by the pregnancy or by the mother and her medical provider’s healthcare management.

Anita Showalter is an OB/GYN and a member of the Christian Medical and Dental Association. She also teaches at Pacific Northwest University. She says doctors began to worry about mortality rates within the last decade.

SHOWALTER: OB/GYNs thought that the rising mortality rate was due to the rising C Section rate, which was going up at about the same pace. But then the C Section rates, uh, leveled out a couple years ago, but our maternal mortality rates did not level out. They continue to rise.

According to the CDC’s latest report, about 700 American women die every year from pregnancy-related complications. That breaks down to 17 deaths for every 100,000 births.That number has been slowly climbing since 1996 when doctors recorded 11 deaths for every 100,000 births.

And that’s much higher than other developed nations. Canada has seven maternal deaths for every 100,000 births. Australia has six, Austria four, and Greece has just three.

Dr. Showalter says several factors could be at play in the U.S., including rising rates of obesity and cardiovascular disease. She says doctors could also just be missing the signs of serious complications.

SHOWALTER: Some of the concerns are the nature of healthcare today being very business like so that physicians are under productivity models that can be very frustrating and take their focus away from the patients.

But the CDC’s report poses another conundrum. Maternal death rates are significantly higher among minority women. Black and Native American women are three times more likely to die as a result of pregnancy complications than white women.

SHOWALTER: If you are a woman of color, even if you are educated and with means you still have a higher mortality rate than a similar woman who is a Caucasian. We don’t understand why that disparity.

Some researchers say we do understand that disparity: institutionalized racism within healthcare and communities. Dr. Pooja Mehta is a OB/GYN and professor at Louisiana State University. She studies maternal death rates in the state. Louisiana has the second-highest maternal death rate of the 48 states that report that data.

Dr. Mehta draws a connection between that low ranking and Louisiana’s large African American population.

MEHTA: We do think that some of the factors that may be driving that include the effects of institutional racism in communities. So, um, having access to high quality healthcare close by where you live, um, the effects of racism across someone’s life causing stress. Potentially the effects of racism embedded in medical care. So when someone notices that something is wrong, are they less likely to be heard because of what they look like? Because of what a provider may assume about what is happening?

But other researchers argue racism within healthcare doesn’t offer a complete answer. Dr. Ingrid Skop is an OB/GYN in San Antonio, Texas. She’s also the chairwoman of the American Association of Pro Life Obstetricians and Gynecologists.

Dr. Skop argues the effects of historical racism have pushed minority women toward abortions at much higher rates than white women. Some of those effects include generational poverty and the breakdown of the family which leads to a lack of social support.

And Dr. Skop notes strong evidence shows an abortion earlier in life can affect maternal health later.

SKOP: Black women are about three times as likely to die in relation to, uh, a pregnancy. Black women are also three times more likely to have an abortion than white women. There’s very good data that having an induced abortion, where the cervix is dilated open, that this can lead to a weaker cervix with a subsequent pregnancy. The rate of having a baby early, especially if it extremely premature baby is higher after an abortion.

These complications are more likely to lead to the mother’s death.

So what can doctors do to make sure more mothers live to see their babies grow up?

Dr. Pooja Mehta says hospitals need to work together. In the fall, 35 Louisiana hospitals launched a maternal health collaboration.

MEHTA: Our quality collaborative is focusing in on being able to quickly recognize when a woman is experiencing bleeding or high blood pressure and act better together in order to reduce that harm.

Thirty-four other states have started similar initiatives as well as state-to-state collaboration networks.

The CDC reports 60 percent of all maternal deaths are thought to be preventable. Dr. Anita Showalter says that points to a communication gap between doctors and patients that could also improve.

SHOWALTER: One of the initiatives to help reduce maternal mortality is to pay more attention to the signs and symptoms, to give patients more education about when to call their doctor. Doctors need to listen more. Patients need to understand the expertise that the physician brings to the table.

Reporting for WORLD Radio, I’m Sarah Schweinsberg.

(AP Photo/Teresa Crawford) In this Aug. 7, 2018 file photo, a doctor performs an ultrasound scan on a pregnant woman at a hospital in Chicago. 

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