The U.S. Centers for Disease Control and Prevention reports that severe complications in pregnancy are on the rise, especially among black women, whose risk of maternal mortality is three to four times as high as white women’s.
Even more striking, the New York City Department of Health & Mental Hygiene found that in New York City, the risk of pregnancy-related mortality was 12 times higher for black women, and both Hispanic and Asian women were also at higher risk of dying from childbirth complications.
These findings raise important questions: Why do these serious complications occur, and what can be done to prevent them?
Pregnant women have so much conflicting information coming at them about how to have a healthy pregnancy: Do this, don’t do that, eat this, don’t eat that.
There’s a lot of misinformation buzzing around. But doctors increasingly understand the hard science behind pregnancy, including which pregnancies are at higher risk than others.
For instance, we have identified certain risk factors associated with pregnancy complications, including advanced maternal age (35 and older), being overweight, and having a history of chronic illnesses, like high blood pressure or diabetes.
All of these components can elevate a woman’s risk of severe complications and even maternal mortality.
There is a wide spectrum of pregnancy complications. On the minor end of the scale, many women experience urinary tract infections, constipation, and heartburn. On the opposite end are severe complications like organ failure and seizures, the serious problems that can lead to death.
Severe maternal morbidity is the term we use for serious complications that happen when a woman comes to the hospital for her delivery. In some cases, these can be life-threatening complications, like eclampsia, seizures, kidney failure, or sepsis.
Or, if a woman hemorrhages badly, she might need to have a hysterectomy, an operation that removes the uterus in order to control bleeding.
Every year, there are around 4 million childbirths in America. Of that number, about 60,000 women suffer a severe complication, and 700 die in childbirth, according to the CDC.
So even though maternal mortality is somewhat rare, it’s concerning that we have much higher rates here than in our peer countries.
The numbers are quite startling. For every 100,000 live births In Japan and Canada in 2015, there were 6.4 and 7.3 maternal deaths, respectively. In the U.S., there were 26.4 maternal deaths that year for every 100,000 live births.
Potential factors include this country’s high rates of obesity, and even higher rates of chronic illness, like diabetes and high blood pressure. While it is true that we are doing a better job of tracking the numbers than in the past, it is clear that maternal mortality is on the rise.
My research group examined the role that hospitals might play in these complications in a study that looked at 353,773 deliveries in 40 New York City hospitals from 2011 through 2013. We found that some of the hospitals had very low complication rates — around 1% — while others had rates up to 6 percent. That variation is wide enough that it cannot easily be dismissed or explained away by factors like the income level or overall health of patients.
Our next question was, do black women go to hospitals with higher rates of maternal morbidity? And that is exactly what we found. About 65% of white women deliver at hospitals with the lowest number of complications, and only 23% of black women do. We need to figure out how to address these disparities, and why some hospitals are doing so much better than others.
Meanwhile, if you are pregnant, or planning to be, what can you do to protect yourself?
One of the best things you can do is to get into care early. In fact, it’s advisable to talk to your doctor about your health profile before you’re even pregnant. Having a consultation before conception can help you get a better sense of your risk factors. For instance, if you have high blood pressure, ideally you would work to manage that problem even before you’re pregnant.
It’s also important to discuss any medications you’re taking. Ask, “Is this drug okay to take during pregnancy?” You want to take good care of the fetus, but also your own health. In many ways, we’ve overlooked the mother’s health by primarily focusing on the baby’s.
As you reach the end of your pregnancy, you want to understand the anesthesia options. If you do require a caesarean section, it’s important to understand what goes into that decision.
After the baby is born, it’s crucial to have a strong sense of what you can do to take care of yourself. If you’ve had a C-section or a tear, ask the doctor, “What can I do to support my recovery? What are some of the danger signs that something is going wrong?”
For example, if you have a fever postpartum, it could be due to a wound that has become infected. You might need to go on antibiotics. If you do have complications in your first pregnancy, a longer-term goal is to avoid them in later pregnancies. Women with eclampsia are at particular risk of having a second attack. Make sure all of your doctors know your health history if you’ve had a severe complication. Ask, “What can I do to prevent this from happening again?”
Every woman wants to have a good labor and delivery experience. The best way to ensure that is to be an active participant in your own care. Make sure you understand what’s going on, and the decisions being made. Don’t hesitate to ask questions. And remember that your own health, as well as the baby’s, has to be a top priority.
Elizabeth Howell MD, MPP, is Professor of Population Health Science & Policy, Professor of Obstetrics, Gynecology, and Reproductive Science at Icahn School of Medicine at Mount Sinai, and Director, Women’s Health Research Institute
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