@ Maternal Mortality Crisis Continues to Worsen

[NewOrleans]

We’ve discussed this crisis before, but this is more updated info, and of course, the landscape of choice to remain pregnant is so miserable now. These graphs, my God. Can you imagine how they will look a couple years after Roe? ☹️ The racial discrepancy is egregious.

www.commonwealthfund.org/blog/2022/us-maternal-mortality-crisis-continues-worsen-international-comparison

[SwimDeep]

And H wonders why I don't want to get pregnant 🙄 I'm white, but I'm in a state with a "heartbeat" bill and multiple major hospitals that are closing due to lack of funding (because the governor refuses to expand medicaid... so all thar money just sitting there while people are dying 😔). I think we only have one level 1 trauma center left.

[Velar Fricative]

Jesus, that first graph.

[Jalapeñomel]

It’s hard to imagine that with such huge advances in medical technology, we continue to leave woman’s health at the bottom of the barrel, and not only that, that, POC feel this the most. The racial disparity of this is the more egregious and horrific part of this data.

[shauni27]

I remember reading about this and hearing about this while I was pregnant 5 years ago and jesus. it was terrifying, and I am white and privileged.

[ellipses84]

This impacts all states and it will only get worse over time. The doctors who know how to perform abortions in states where it’s legal are overwhelmed due to patients from other states. In the states with restrictions, medical students and residents aren’t being properly trained.

TW: I heard an awful story about a woman who was nearly given a hysterectomy instead of a D&C because the Dr. she saw didn’t know how to treat her in a life or death situation in a state where abortion is legal. Luckily someone called in another Dr. who knew what to do.

[Saudade]

I've posted about this before.

There is a woman in Alabama, Dr. Stephanie Mitchell, DNP, CNM CPM who is trying to open the first CNM freestanding birth center in Alabama. The state has been giving her such a fight. They wouldn't recognize her CNM credentials and made her complete training to certify as a CPM (which is utter bullshit). Then the Alabama Department of Health tried to shut down the birth center itself. They're fighting her tooth and nail and the statistics keep getting worse.

If anyone feels inclined, she still needs donations for the construction of the birth center.

thebirthsanctuary.com

[karinothing]

Dec 7, 2022 12:30:57 GMT -5 Saudade said:

I've posted about this before.

There is a woman in Alabama, Dr. Stephanie Mitchell, DNP, CNM CPM who is trying to open the first CNM freestanding birth center in Alabama. The state has been giving her such a fight. They wouldn't recognize her CNM credentials and made her complete training to certify as a CPM (which is utter bullshit). Then the Alabama Department of Health tried to shut down the birth center itself. They're fighting her tooth and nail and the statistics keep getting worse.

If anyone feels inclined, she still needs donations for the construction of the birth center.

thebirthsanctuary.com

Doesn't a CNM have more training than a CPM?

[Saudade]

Dec 7, 2022 13:24:58 GMT -5 karinothing said:

Dec 7, 2022 12:30:57 GMT -5 Saudade said:

I've posted about this before.

There is a woman in Alabama, Dr. Stephanie Mitchell, DNP, CNM CPM who is trying to open the first CNM freestanding birth center in Alabama. The state has been giving her such a fight. They wouldn't recognize her CNM credentials and made her complete training to certify as a CPM (which is utter bullshit). Then the Alabama Department of Health tried to shut down the birth center itself. They're fighting her tooth and nail and the statistics keep getting worse.

If anyone feels inclined, she still needs donations for the construction of the birth center.

thebirthsanctuary.com

Doesn't a CNM have more training than a CPM?

Yes, absolutely. Plus she specifically has her doctorate and something like 12 years of nursing experience prior to obtaining her CNM. 

[wanderingback]

Dec 7, 2022 13:24:58 GMT -5 karinothing said:

Dec 7, 2022 12:30:57 GMT -5 Saudade said:

I've posted about this before.

There is a woman in Alabama, Dr. Stephanie Mitchell, DNP, CNM CPM who is trying to open the first CNM freestanding birth center in Alabama. The state has been giving her such a fight. They wouldn't recognize her CNM credentials and made her complete training to certify as a CPM (which is utter bullshit). Then the Alabama Department of Health tried to shut down the birth center itself. They're fighting her tooth and nail and the statistics keep getting worse.

If anyone feels inclined, she still needs donations for the construction of the birth center.

thebirthsanctuary.com

Doesn't a CNM have more training than a CPM?

Well your definition of "more" depends if you’re using that in assuming a CNM has better training.
A CPM is generally trained in "traditional” midwifery with specific training for out of hospital and birth center birth. A CNM doesn’t necessarily get that same training and it can definitely be more hospital based since they have to be a RN first. So if someone wants to primarily work in out of hospital births a CPM might be the better degree to get (ignoring all the unfortunate issues with insurance and credentialing that one might have to deal with if not a CNM).

[wanderingback]

Thanks for sharing the article to make people more aware.
As a Black woman who just gave birth and works in prenatal and postpartum care and abortion care, I don’t have the mental space to read the article, but obviously I know all the statistics and racism in medicine.
I really struggle with being part of the racist medical industrial complex that has caused such issues.
There are so many things we as a society could do to help improve this crisis, and bandaids aren’t going to help, but I think it’s going to be a long road if anything changes.

[NewOrleans]

The article mentions “Research has shown that in the Netherlands there was an increase in home births and vaginal deliveries and a decrease in cesarean sections (both planned and emergency) during the pandemic. These practices may have contributed to lowering maternal deaths.” Why would homebirths save lives? Similarly, I understand the credentials of the CNM referenced above, but why would a birthing center save lives? Is there something to suggest, beyond c sections, hospital births are contributing to maternal mortality?

[NewOrleans]

Dec 7, 2022 17:48:15 GMT -5 wanderingback said:

Thanks for sharing the article to make people more aware.
As a Black woman who just gave birth and works in prenatal and postpartum care and abortion care, I don’t have the mental space to read the article

(hugs)

I feel horrible learning your wonderful news from this dismal thread.

[aprilsails]

Dec 7, 2022 18:09:45 GMT -5 NewOrleans said:

The article mentions “Research has shown that in the Netherlands there was an increase in home births and vaginal deliveries and a decrease in cesarean sections (both planned and emergency) during the pandemic. These practices may have contributed to lowering maternal deaths.” Why would homebirths save lives? Similarly, I understand the credentials of the CNM referenced above, but why would a birthing center save lives? Is there something to suggest, beyond c sections, hospital births are contributing to maternal mortality?

@@@i don’t have studies to back things up but this is my assessment based on a personal sample of one hospital birth with OB, one natural birth with midwife in a birthing centre attached to a hospital.

In Canada, where midwifery care and home birth/birthing centres are becoming more common, the improvements in outcome are due to two main reasons: having midwifes and nurse practitioners increases the pool of medical professionals available to take care of patients. As a result you have more people with more eyes on patients at a lower cost. Midwifes refer out any complicated cases to OBs immediately. As a result OBs are taking care of more complicated cases in the appropriate environment, while not having the hospital stressed by a large patient load. Less stressed hospital systems mean better quality of care and more time to spend on each individual patient.

In terms of personal anecdotes, I had two very uncomplicated pregnancies. However, with my eldest I had a hospital birth. I had a bad reaction to the epidural (it took too hard) which resulted in a whole pile of complications that kept me in the hospital for three days initially, and then had me back in the hospital on and off for the next 5 weeks. I had laughing gas with the midwife for my second, and was home with no complications within 1hr30 minutes of his birth. I had midwifes visiting us regularly for the next two weeks. That birth was in a birthing centre attached to the birthing unit in the hospital. OBs and nurses were just 50 yards down the hall. I was never technically admitted. DH was not ok with a home birth after the complications I had with my first. I wasn’t either to be honest, so the birthing centre was the best of both worlds for us.

[Michelle]

It would be really helpful to also see mortality rates for black women vs all women in all the other developed countries. I can imagine some people trying to say there might be a genetic predisposition to complications or something as continued refusal to see the systemic racism in our system.

Comparative data would show - the U.S. system doesn't work for women overall but is flat out racist against black women, and thus unjust.

[seeyalater52]

Dec 7, 2022 18:54:23 GMT -5 Michelle said:

It would be really helpful to also see mortality rates for black women vs all women in all the other developed countries. I can imagine some people trying to say there might be a genetic predisposition to complications or something as continued refusal to see the systemic racism in our system.

Comparative data would show - the U.S. system doesn't work for women overall but is flat out racist against black women, and thus unjust.

I mean, there is a lot of racism, and anti-Black racism in particular, in most “developed” countries despite their having different (largely better in a lot of ways) health systems than ours. Even if the data showed that Black pregnant people had higher rates of complications, interventions, and mortality compared to pregnant people of other races I’m not sure how we could conclude that it didn’t have to do with systemic racism. Those trends existing across multiple health systems in multiple countries still wouldn’t mean there was any sort of genetic predisposition for complications (which, as you know, is a totally horrifying attitude.)

[seeyalater52]

Dec 7, 2022 18:09:45 GMT -5 NewOrleans said:

The article mentions “Research has shown that in the Netherlands there was an increase in home births and vaginal deliveries and a decrease in cesarean sections (both planned and emergency) during the pandemic. These practices may have contributed to lowering maternal deaths.” Why would homebirths save lives? Similarly, I understand the credentials of the CNM referenced above, but why would a birthing center save lives? Is there something to suggest, beyond c sections, hospital births are contributing to maternal mortality?

My state recently passed a bill providing insurance coverage for doulas and I think a lot of the core principles are the same in terms of the potential benefits. Homebirths (when done safely and responsibly) are pretty safe overall and having the ability to labor and birth at home can be beneficial to pregnant people who are systemically marginalized in mainstream health settings. If you think about being able to have more individualized care by a medical professional you have more of a relationship with you can start to see how that would be beneficial. Frankly any interaction with the health system can be really stressful and unsafe as a minoritized person, and pregnancy care perhaps even moreso than average. I’d be surprised if that didn’t have any impact on maternal mortality overall.

There’s also the fact that homebirths can be attended by providers who are more representative of the communities they are serving, which is another major benefit to doula care as well. That improves both the experience for the birthing person as well as the likihood that they will be well-supported (believed when reporting symptoms, have autonomy over their choices, and lower intervention, especially when not strictly needed.)

Edit to add: I had an elective csection so I’m definitely not anti intervention but my comfort with that decision is definitely informed by certain types of privileges (just as my decision not to want to labor and birth vaginally was informed by my history with sexual and reproductive trauma.)

[wanderingback]

Dec 7, 2022 18:54:23 GMT -5 Michelle said:

It would be really helpful to also see mortality rates for black women vs all women in all the other developed countries. I can imagine some people trying to say there might be a genetic predisposition to complications or something as continued refusal to see the systemic racism in our system.

Comparative data would show - the U.S. system doesn't work for women overall but is flat out racist against black women, and thus unjust.

Racism against Black people exists all over the world.

Black maternal mortality is higher in UK.
www.openaccessgovernment.org/childbirth-black-women-uk/117437/

[NewOrleans]

Thanks for thoughtful answers seeyalater52, and aprilsails,

[loira]

Dec 7, 2022 20:01:36 GMT -5 wanderingback said:

Dec 7, 2022 18:54:23 GMT -5 Michelle said:

It would be really helpful to also see mortality rates for black women vs all women in all the other developed countries. I can imagine some people trying to say there might be a genetic predisposition to complications or something as continued refusal to see the systemic racism in our system.

Comparative data would show - the U.S. system doesn't work for women overall but is flat out racist against black women, and thus unjust.

Racism against Black people exists all over the world.

Black maternal mortality is higher in UK.
www.openaccessgovernment.org/childbirth-black-women-uk/117437/

I think it would be interesting (depressing) to break down mortality rates to compare with Indigenous women in places like Canada and New Zealand. I am positive this would look similar to the difference between non Black and Black women in the US or UK. ☹️

[aprilsails]

Dec 7, 2022 20:19:18 GMT -5 loira said:

Dec 7, 2022 20:01:36 GMT -5 wanderingback said:

Racism against Black people exists all over the world.

Black maternal mortality is higher in UK.
www.openaccessgovernment.org/childbirth-black-women-uk/117437/

I think it would be interesting (depressing) to break down mortality rates to compare with Indigenous women in places like Canada and New Zealand. I am positive this would look similar to the difference between non Black and Black women in the US or UK. ☹️

The way indigenous women are made to leave their communities to give birth in Canada is absolutely heartbreaking. I’m currently working on midwifery clinics for several Cree communities in Quebec. Talking to community members, once these facilities are built this will be the first time in over twenty years that babies would be born in their own community. They will be attended by licensed midwives and nurses, and any complicated pregnancies will still be sent out to the closest hospital which is a flight away. Right now most women have to leave the community a month in advance of the birth, go live in a hotel until baby comes, and then stay there for another couple of weeks before they are released to return home. They often can’t communicate well in the cities where they are sent (French is often a third language for the Cree in Quebec, after Cree and English). The need for healthcare within the community is so vital, and the local women have gone out and completed the midwifery training programs to make this work. It’s been a really rewarding project to be a part of.

As part of the design package I was sent this artwork that will be featured in one of the buildings. I am in love with it. Spoiler since it is very @@@@

SPOILER: Click to show

[loira]

aprilsails, that sounds like a much-needed initiative and I love the artwork. I read a CBC article recently about how women in rural communities in BC were forced to relocate to give birth and my very first thought was it must be even harder for those living in remote First Nation communities.

[underwaterrhymes]

Whenever anyone mentions the “outstanding” healthcare in the United States, I bring this up. We have many outstanding medical professionals who care deeply about their patients. But we also have a deeply racist, misogynistic and capitalistic system that means countless people (largely women and people of color) receive substandard and ignorant care. The is shameful.

[somersault72]

There was an article posted here a couple years ago about maternal mortality, but in addition to facts and figures it gave some stories of women who had died during/after childbirth. That article still haunts me, first of all because most, if not all of those deaths were preventable, but there was one in particular who kept saying she didn't feel well and was essentially blown off and then she died.

When my daughter was 3 days old I was SO short of breath. It was terrifying. A home nurse who had come for a visit told me it was because my iron was probably low (??). My lower legs were also swollen beyond belief (that was new, and never had happened during either of my pregnancies). I texted my OB and she told me to come the next morning. My pulse ox was normal but she did a chest xray "just in case." My chest xray showed fluid around my lungs, so I went to the ER and was hospitalized for 4 days for post partum pre-eclampsia. I did a round of mag and they got 6 liters of fluid of my body during my stay there. When I returned to see her the follow week I had lost 30lbs. I think about my OB who is my friend and who I consider a wonderful doctor. Not that I would have died or anything, but I imagine things could have had gotten pretty bad had she not ordered that "just in case" xray.

How many women (especially WOC and/or underserved women) get blown off after having a baby when they say something doesn't feel right like the woman in that article? I wish there was more of a push to advocate for moms, especially new moms and especially moms with NO support systems.

[cattledogkisses]

Dec 8, 2022 10:14:13 GMT -5 somersault72 said:

There was an article posted here a couple years ago about maternal mortality, but in addition to facts and figures it gave some stories of women who had died during/after childbirth. That article still haunts me, first of all because most, if not all of those deaths were preventable, but there was one in particular who kept saying she didn't feel well and was essentially blown off and then she died.

When my daughter was 3 days old I was SO short of breath. It was terrifying. A home nurse who had come for a visit told me it was because my iron was probably low (??). My lower legs were also swollen beyond belief (that was new, and never had happened during either of my pregnancies). I texted my OB and she told me to come the next morning. My pulse ox was normal but she did a chest xray "just in case." My chest xray showed fluid around my lungs, so I went to the ER and was hospitalized for 4 days for post partum pre-eclampsia. I did a round of mag and they got 6 liters of fluid of my body during my stay there. When I returned to see her the follow week I had lost 30lbs. I think about my OB who is my friend and who I consider a wonderful doctor. Not that I would have died or anything, but I imagine things could have had gotten pretty bad had she not ordered that "just in case" xray.

How many women (especially WOC and/or underserved women) get blown off after having a baby when they say something doesn't feel right like the woman in that article? I wish there was more of a push to advocate for moms, especially new moms and especially moms with NO support systems.

My BFF just had her first baby a few weeks ago, and I was chatting with her recently and she was kind of amazed that after she was discharged from the hospital her doctor didn't want to see her again for 6 weeks. She was like, "I have questions about things I'm experiencing during my recovery that I don't know if they're normal or not, but it feels like no one cares about me anymore now that the baby's here."

[wanderingback]

My city has a post partum home visiting program but it’s only for first time parents in certain zip codes. I do think that would be very helpful for maternal and infant morbidity and mortality and for people to have more support. I don’t know what specific evidence the program has, I’ll have to look it up.
It’s not realistic to expect people to come in for an in-clinic visit before 4-6 weeks.

Where I work we try to do a televisit within a few days of discharge, but even that is very hit or miss to get people on the phone or video visit. Obviously the first few weeks are overwhelming so I completely understand. I typically leave my patients a couple voice messages if I can’t get in touch with them and then our nurse and lactation consultants also tries to check in and let them know to call us with any questions/concerns. Home visits would be much better to connect with people and provide support. We also try to make sure all our patients have a blood pressure cuff at home, and talk about post partum pre-eclampsia but sometimes insurance is such a nightmare to get a cuff. Nationally I think about 30-40% of people show up for their 4-6 week postpartum visit, that’s why people need support at home.

[sent]

Dec 8, 2022 10:56:34 GMT -5 wanderingback said:

..insurance is such a nightmare to get a cuff. 

I wonder if our abysmal insurance industry responsible for some of this. Aren't they the ones that set the standards of 2 nights in a hospital for a vaginal birth, 4 nights for a c-section, 6 week in-office followup appointment. Is this normal in other parts of the world?

[wanderingback]

Dec 8, 2022 12:22:28 GMT -5 sent said:

Dec 8, 2022 10:56:34 GMT -5 wanderingback said:

..insurance is such a nightmare to get a cuff. 

I wonder if our abysmal insurance industry responsible for some of this. Aren't they the ones that set the standards of 2 nights in a hospital for a vaginal birth, 4 nights for a c-section, 6 week in-office followup appointment. Is this normal in other parts of the world?

When I lived overseas that was pretty standard.
As far as I know insurance doesn’t set the timeline for the 6 week postpartum visit. The 6 week thing actually comes from traditional postpartum care in much of the world through cultural practices that said the women should stay home and have complete rest for 40 days and not leave the house and be supported during that time. So it’s totally an arbitrary thing and our society has gotten so far from that type of rest and support, unfortunately.

Medical societies currently recommend a post partum follow up (telehealth can be included) within the first week and then within 4-6 weeks afterwards. That’s what I try to do for my patients and I think is reasonable.

Some places who have nurse visiting programs do a few weekly visits and I know some midwives do a few weekly home visits as well. I know in my area insurance covers midwifery lead home births, but I do not know the details of the post partum care insurance coverage for midwives.

[wise_rita]

Dec 8, 2022 12:22:28 GMT -5 sent said:

Dec 8, 2022 10:56:34 GMT -5 wanderingback said:

..insurance is such a nightmare to get a cuff. 

I wonder if our abysmal insurance industry responsible for some of this. Aren't they the ones that set the standards of 2 nights in a hospital for a vaginal birth, 4 nights for a c-section, 6 week in-office followup appointment. Is this normal in other parts of the world?

I've given birth in two different countries and yes, that's standard, but add in 2x home midwife visits as mentioned above.

[Deleted]

When I was in the UK, I think first-time mums got one overnight in the hospital. Subsequent deliveries, they were usually home in a few hours, though I think they got a few home health visits from midwives.

I was seen on the US base there, and I only got the standard 6-week postpartum visit. Actually I take that back…:I had to bring the baby in for several visits in the first few weeks, and at some of them I was screen for PPD/PPA. The focus was very much the baby, and as others have mentioned, I felt like my well-being was definitely secondary.

We did hire a (British) doula for the delivery and postpartum, and she came over to the house a few times and texted often! We’re actually still in touch years later.