America Is Blaming Pregnant Women for Their Own Deaths

What does it look like to face death during childbirth in the richest country in the 21st century?

Thea was 35 years and 40 weeks pregnant when she went to see her doctor for her last antenatal appointment. She was fit, did not smoke, and had regular antenatal care, although she was not enthusiastic about the obstetrics practice she had chosen in Chicago. Doctors were "more interested in protocols than people," he said.

That day, he was surprised to learn that his amniotic fluid was low, even though the baby's vital signs were still strong. The doctor informed Thea that she should be induced immediately. Thea questioned this guideline, asking for success rates for induction and whether she should consider a caesarean section instead. The doctor said he had no other choice. He then asked if he could go home to find his travel bag. She was told, she said, that if she left, she could be "arrested for endangering a child's life".

Thea asked me to name her only by name, because the details of her story are very personal. He also warned that "in trauma, memory can be fragmented and skewed". But more than ten years later, she remembers this confrontation with her doctor when it became clear that when she became a mother, she was no longer perceived as a person: "I really felt that I was a piece of meat, do not consider me like that, all about the baby. "

Recently, I reflected on the remarkable ways in which American women continue to be devalued and dispossessed through the lens of motherhood, even as we insist on the preeminence of the status of the mother. Voters in Alabama have just approved a constitutional amendment recognizing the "fetal person", a measure that could be used to further reduce the rights of pregnant women for the safety of fetuses.

Seventy years ago, Simone de Beauvoir wrote that pregnancy could be "enrichment and mutilation"; the mother "feels as vast as the world, but this same wealth annihilates her, she has the impression of being nothing else".

For experts who study maternal mortality and injury rates in the United States, which are estimated to far exceed those of other developed countries, and for women in labor, not treating mothers as irresistible people.

In September, USA Today published important research on recent efforts to reduce maternal mortality rates. Several States commissioned panels to examine what was not working in the case of maternal deaths. This looks promising. Unfortunately, it did not work, rates continued to rise and the reason is hard to understand.

"At least 30 states have avoided controlling the medical care provided to deceased mothers or have not studied these deaths at all," the paper said. "Instead, many state committees have focused on lifestyle choices and social issues in their reporting of maternal deaths, and they believe that women are smoking too much, getting too much fat, or not asking. prenatal care ". It seems that mothers, in addition to being solely responsible for all aspects of the well-being of their children, are also responsible for it. for their own death.

Talk about blaming the victims.

According to USA Today, when asked about their decision not to analyze medical care, some panel doctors said they did not have the resources and hospitals did not like (and did not have to) tables of their dead patients. Legislators have said that it is not up to the state to interfere with the decisions of doctors. And state officials argued that it was more important to focus on larger issues related to maternal health than on what might have failed in specific cases of women.

But it is difficult to imagine another scenario in which patients die in hospitals because of complications related to routine procedures, such as an appendectomy, and instead of studying the care received before their death, the groups experts focus on the lifestyle of patients. in the year preceding his treatment.

The problem is not that we do not know how to make childbirth safer. Stephanie Teleki, head of the maternity care portfolio at the California Health Care Foundation, said, "Women know what they want, in labor and delivery, and what they want is what they want. -women, doulas, less unnecessary cesarean interventions) are less expensive and give better results ". The problem is not that pregnant women are neither educated nor informed; The problem is that the officials do not listen to them.

I wanted to know what it's like to live this: face the death of a child during childbirth in the richest country in the world during the second decade of the 21st century. Obviously, I could not talk to the women who had died in childbirth. So I talked to women who were almost dead. That's what brought me to Thea.

After 36 hours of pitocin, a drug that causes work and three hours of pushing, Thea had to undergo a caesarean section because the baby had turned to the side. Prolonged exposure to pitocine may increase the risk of postpartum hemorrhage. And that's what happened a few minutes after giving birth to your daughter. Thea bled for three hours, while receiving intravenous medications to promote coagulation and signed forms in case she needed an emergency hysterectomy.

"They told me how healthy the baby was," he told me, "but it only made me more terrified that I could die now." He spent a week in the hospital.

"In the end, they saved me," she says, "but they almost killed me."

When Serena Williams spoke of the medical emergency she suffered after her son was born last year and the resulting psychological trauma, a long-delayed debate was launched on the abysmal death and maternal injury rates in the United States. -United. like the ways in which women of color are most affected.

African-American women are nearly 3.5 times more likely than white women to die as a result of pregnancy. "Women are not heard," Dr. Teleki told me. "But black women are the least listened to and it costs them their lives at a much higher rate."

Ms. Williams' story provided a personal overview of an epidemic of preventable deaths that has long been ignored in this country.

In 2000, UN Member States published a Millennium Development Goal of reducing the maternal mortality ratio in 1990 by 75 per cent by 2015. Through a large-scale international effort, maternal mortality has has been reduced by 43% worldwide during this period and by almost 50% in developed countries. Meanwhile, the rate of American women dying of pregnancy has increased.

Marian MacDorman, research professor at the University of Maryland, told me that the United States is barely participating in the UN effort. "Nothing was done, partly because no one knew what was going on," he said. "The data we had was bad and people did not study it."

It was not until 2003 that states started adding a pregnancy checkbox to death certificates, and some did not do so until the last two years. "This created a data disaster in which no one could know what the national trends were," he said. She described this as "an excellent missed opportunity to work together with the Millennium Development Goal". At the same time, "the National Center for Health Statistics, which is the government agency responsible for publishing data on maternal mortality, has stopped publishing them completely".

The only exception to the United States is California, where, in 2006, the Stanford University School of Medicine collaborated with the state to create the California Maternal Quality Care Collaborative. The initiative has developed "quality improvement toolkits" that doctors and hospitals could download. They included detailed instructions on best practices for various preventable complications that may occur during or after pregnancy, such as haemorrhage and preeclampsia.

It sounds simplistic, but it had a powerful effect. "What you need to understand," said Dr. MacDorman, "is that these emergencies are horrible and occur too often, but even if they are not common, an OB could easily spend a year without finding an emergency of this type . "

As a result of this initiative, between 2006 and 2013, the maternal mortality rate in California decreased by 55%, from 16.9 to 7.3 deaths per 100,000 live births. According to the Washington Post, the national rate has increased from 13.3 to 22 deaths per 100,000, according to estimates.

These figures, however disturbing, do not take into account the much larger number of women injured during delivery or victims of the trauma of near-death experiences. For many, this trauma can last a lifetime.

Claire, who also asked me to use only her first name, had spent 38 weeks since her fourth pregnancy in 1992, the year she entered the hospital because she was in active labor. She protested when the doctor decided that the baby was not full term and gave her injections to stop the delivery. A few weeks later, the baby's head came down and Claire went back to the hospital, but now she was so big that she worked unsuccessfully for 24 hours before she had an emergency Caesarean section.

Here is how she described her experience: "They gave me an epidural and asked me if I could feel the knife, and I said," Yes, I can, "and they did not believe me. They said it's impossible. But I kept saying, "No, I can feel it." "Then, his blood pressure went down." I hear my husband say, "Look at his blood pressure." And the doctor says, "Oh, it must be a malfunction of the machine." Then I heard, "Oh, my God, he'll be shocked." She explained: "At one point, I heard them say," We are going to lose her, we are going to lose the baby. " "

Claire still remembers it as one of the most terrifying experiences of her life. "I never fully recovered," he said. "Now, I have a girl who is pregnant, I would love to be happy about that, but I can not be happy."

Thea's daughter is now 13 years old. She decided not to tell him how terrible the birth experience was, for fear of not wanting to have children.

However, there was another reason, he said, in an email following our conversation: "I did not want my daughter to know that the joy of her birth mingled with trauma and fear of my own death. " He always feels guilty about this fear, of "worrying about myself and my mortality". This, he wrote, "talks about how myself and probably many other women have been dehumanized and degraded during childbirth" and told me that "our babies are much more important than us" .

"They have invested me in maintaining this story as a way of loving it," wrote Thea.