Shelly Willis Prater had a two-month-old baby and was about to return to work in a Chicago school cafeteria. But one evening, as she was climbing the short steps to the kitchen, she gasped for her breath and nearly fell.
At the hospital, Willis Prater, then 42, was hooked up to a ventilator that pumped air into his lungs. Her doctors said her heart was operating at less than 20 percent of its capacity. She had developed a rare type of heart failure that develops after her pregnancy.
That diagnosis was the last thing she wanted to hear. After giving birth, Willis Prater recalled in an interview that she thought “she crossed the finish line”. “You don’t have to worry about anything anymore,” she said.
Most people consider labor and delivery to be the most dangerous part of pregnancy. However, new scientific research has cast doubt on this assumption and found that significant risk persists for the full year after birth. The most dangerous time for a mother is actually after the baby is born.
And for every woman who dies, an estimated 50 to 100 women experience serious complications that can lead to lifelong health problems. That number is rising as American women gain weight and hypertension and diabetes become more common.
And as more women postpone childbearing until later in life, they are more likely to start a pregnancy with chronic conditions that can lead to complications.
The new figures come amid an alarming rise in maternal and new mother deaths in the United States, which has the highest maternal mortality rate in the developed world. That number surged during the pandemic, rising from 20.1 per 100,000 live births in 2019 to 32.9 per 100,000 live births in 2021. Mortality rates for black and Native American women are two to three times higher than for white women.
However, these figures reflect the traditional definition of maternal mortality, that is, death occurring during pregnancy or within the first six weeks of life.
In September, a more extensive survey of maternal deaths by the Centers for Disease Control and Prevention analyzed maternal deaths during the full year after childbirth, revealing the full extent of the problem, including deaths attributed to mental health conditions. rice field.
Based on data provided by 36 states 1,018 pregnancy-related deaths From 2017 to 2019, the CDC concluded that about one-third of those occurred during pregnancy or on the day of delivery, and about another third occurred before the baby was six weeks old. . Her 30% occurred from that point to her 1st birthday of the baby, but this period was not the focus of maternal mortality studies.
The data has led to calls for closer follow-up care during the so-called “fourth trimester” and more support for new mothers, with particular attention to vulnerable women. It became so.
“Our approach to childbirth was that the baby was the candy, the mother was the wrapper, and when the baby was out of the wrapper, we set it aside,” said Alison Steube, professor of obstetrics and gynecology at American University. said Dr. North Carolina Medical College. “We need to realize that wrapping paper is human. Mothers are seriously ill and dying.”
Mental health conditions leading to suicide and fatal overdoses are the leading cause of maternal mortality among white and Hispanic women. Bleeding is a major cause in Asian women.
Among black women like Willis Prater, heart disease was the leading cause of death. Hypertension predisposition is more common among black women, who often have poor access to health care, a legacy of both poverty and racism.
The risk of late maternal death 6 weeks to 1 year after delivery is 3.5 times higher for black women compared with white women.
Medical practice is often slow to change. But the numbers are fueling reforms to Medicaid, a health insurance plan for low-income Americans, including more than 40% of pregnant women in the United States.
33 states plus Washington DC, Expanded Medicaid coverage for new mothers The Kaiser Family Foundation said the woman plans to stay insured while recovering from pregnancy, and eight other states are planning to do so.
Three states, including Texas, have expanded only to a limited extent, and six states, including Arkansas, have Highest maternal mortality rate in Japan — The foundation says it has no plans to expand Medicaid coverage.
Other efforts include a new law in New Jersey that requires emergency room doctors to ask women of childbearing age about their pregnancy history. Some illnesses that bring a woman to the hospital can be diagnosed more quickly if the doctor knows she is her new mother.
In North Carolina, providers get a $150 bonus when a patient comes in for a postnatal visit. Historically, nearly half of new mothers did not undergo a postpartum health check.
Doctors are now advised to see new mothers within three weeks of giving birth, rather than waiting six weeks for a check-up, which was once the norm.
“Now it’s like, ‘See you in two weeks, okay?’ And yes, you’re definitely coming,” said Dr. Tamika Auguste, co-author with Dr. Steube. New Guidance on Postpartum Care From the American College of Obstetricians and Gynecologists.
Dr. Auguste said new mothers with medical conditions such as high blood pressure should see a doctor sooner.
But more importantly, doctors and other health care providers listen when women express concerns and pay special attention when Black and Native American women say something is wrong. That’s it.
“It’s no longer ‘Miss, it’s okay,'” says Dr. Auguste. “No more. ‘Let’s see if we can meet today or tomorrow.’
multiple risks
Many doctors refer to pregnancy as a “natural heart stress test.” This condition puts a strain on the heart and circulatory system in women. Your blood volume increases by up to 50%, your heart works harder, and your heart rate increases.
Rachel Bond, M.D., a cardiologist and system director of the Women’s Heart Health Program at Dignity Health in Chandler, said elevated blood pressure affects other vital organs, and women develop cardiovascular disease during pregnancy and decades later. He said it could increase the risk of disease. Arizona.
“We tell women, ‘You passed your first stress test. You either pass or you fail,'” Dr. Bond said. “Failure doesn’t necessarily mean heart disease, but it does mean that we clinicians need to treat it more aggressively.”
When the baby is born, the uterus contracts, raising blood pressure and potentially causing a stroke.
New mothers are also more likely to experience life-threatening blood clots and infections. At the same time, hormonal changes can cause mood swings. Some of these are temporary, but more severe and long-lasting postpartum depression can develop.
Most women get over pregnancy-related complications after giving birth, but prompt treatment is key.
Deirdre Winsey, 28, a medical assistant in New Orleans, already had high blood pressure when she was pregnant with her third child. Her doctors gave her a blood pressure cuff to use at home and a remote monitoring system called “Babyscript” that sent her readings to her midwife.
Winsey was born two and a half weeks early after being diagnosed with pre-eclampsia, a dangerous high blood pressure condition. However, three weeks after her delivery, she woke up in the middle of the night feeling disoriented and dizzy. She was slurred and asked her friends for help.
Doctors initially didn’t want to take her to the hospital, thinking she might be having a panic attack. In fact she had suffered a stroke. “She came in just in time,” Winsey recalls. “If I hadn’t, I could have been paralyzed for the rest of my life.”
Winsey now suffers from short-term memory loss and debility, but is able to work. Still, as a single mother of three, she worries.
“My biggest fear is not being here for my children,” Winsey said. “What if I had another stroke and became paralyzed or died? That would be scary.”
For white women, mental health conditions account for 35 percent of pregnancy-related deaths, according to CDC data. Among Hispanic women, the figure is 24%. Pre-existing anxiety and depression can predispose a woman to postpartum depression, as can a difficult pregnancy or a sick baby.
Katayune Kaeni, a psychologist and chair of the Board of Substance Use Disorders, said the stress of parenting can trigger relapses for those recovering from substance use disorders. Postpartum Support International.
Karen Block, 39, of suburban Peoria, Illinois, had a difficult pregnancy, a traumatic premature birth, and struggled to breastfeed.
“Nothing happened spontaneously,” she said. “When the baby was born, I wasn’t happy. I was scared. Every time I saw him, I thought I didn’t know what to do with you.” Brock was eventually diagnosed with postpartum depression, She started taking medicine.
Complications can surprise even women who have successfully conceived. Ariana Jacobs, 34, a medical technology analyst in Washington, D.C., was told her blood pressure was fluctuating after a caesarean section. Ms. Jacobs checked her blood pressure using her blood pressure cuff at her home because of her family history of high blood pressure. Within days she had her measurements she reached 170/110.
She went to the hospital and was treated for pre-eclampsia. It usually develops during pregnancy rather than after pregnancy.
“I wish every new mother could go home with a box of chocolates and a sphygmomanometer to highlight that you, the mother, are still a patient,” Jacobs said. . “Your body is recovering from something big.”
