As a mother who recently gave birth, I am of two minds about this issue. I agree with the author's overall point but question the way she defaults to the culturally fashionable, noted in the quote from Ms. Teleki: “Women know what they want when it comes to labor and delivery, and it turns out the things they want (midwives, doulas, fewer unnecessary interventions and cesarean sections) are less expensive and produce better outcomes.” I am sure Ms. Brooks could have easily found women who had all those things but faced adverse outcomes, but she didn't, which to me is telling. Having seen many women of my generation flippantly reject medical care to give birth in their living rooms with midwives with little training, and others who feel guilt for years for having succumbed to C-sections and "failed" at the ideal, natural birth, I wish that we could get over the medical-establishment-as-villain narrative.
I've had seven pregnancies and have one living child. I have my living child because of, not in spite of, medical science. Pregnancy was the time in my life when I've come closest to real, physical harm. Pregnancy can be dangerous, maybe not for all women, maybe not for most women, but for enough women. When I was born in a foreign country, my mother was not offered a c-section. As a result I have a heavily scarred face and she got a lifetime of incontinence. She still talks about how "lucky" I am to have had a c-section!
84
@Amv Science recommends midwives and doulas in addition to, not instead of, medical support. Having someone in the delivery room whose sole job is to listen to, support, and liaise with the mother and is a specialist in caring for labouring mothers means they are more likely to recognize and be able to quickly react to serious problems, and better equipped to sooth parents through more minor concerns. In Canada, you get to have a midwife come to the hospital with you (paid for by the government) and it means you get one on one support throughout the labour you simply can't get from a labour and delivery nurse with 8 patients.
31
@Anonymous
I'm curious if you're aware of the fact that a great number of midwives in the US have very little training of any kind. I know that in most developed countries midwives are professionally trained. In this country such midwives (CNMs) are in the minority. Your American midwife, and certainly your American doula, can easily be as much of a "specialist" as your yoga instructor.
15
What exactly does a doula do, besides get paid a lot of money to take the call button out of your hand if you “cave” and try to ask for an epidural?
5
I found this opinion piece overly alarmist. The title could not be true and is sensationalist. The data in the body of the article doesn't seem to warrant the claim made in the title. It is also illogical. Can a country blame? People blame. Maybe organizations blame. Written word can blame. Also, the women whose near death stories were shared did not seem to support the writer's thesis: that fetal life is taking precedence of mother's life; or that America (Uncle Sam? Alabama?) is blaming women for their own deaths. Absurd. Thea and Claire were women who had difficult and dangerous deliveries that could possibly have been made better with better doctors and better hospitals. The sensationalist tone of the title and the examples in the piece make me doubt the data and the veracity author's assertions. Why would NYT publish this?
32
I finally have an education to be able to "feed it if I am going to breed it", and since my child will never be president, I will have him or her in another country besides the United States. Because sadly "united" we are not in America.
9
Reading this article and the accompanying comments makes me wonder if giving birth in 1969 sans the “technology” of today and the absence of religious fervor that spouted up after Reagan didn’t make childbirth a better experience then.
11
Patriarchy and misogyny and racism are very hard to overcome. We are sinking further and further into these realms.
26
If you are in your 70's or 80's and you read back to back the articles by Maureen Dowd and Kim Brooks in today's New York Times you are likely going to be faced with a completely discouraging feeling that there is not much you can do to avert the disasters roiling through the country as well as thinking as good as a country can be and ours is, have we lost the opportunity to be great. It is more than a dilemma.
It can be downright suffocating!
4
A lawmaker said they shouldn’t intervene with doctors decisions. Yet, lawmakers routinely meddle in abortion and birth control issues. Hypocrites!
53
How do fathers feel about this? Why is there not a single comment from a baby's father going through this?
17
And folks are wondering why women are afflicted with tokophobia ...
Avoidance of childbirth is self-preservation taken to its extreme, logical conclusion.
13
An important subject.
Too bad there is no substance in this story. Couple of anecdotes, and a plea for something not stated very clearly.
Put it on the opinion page.
25
Similar story, I was given too much pictoci when they finally induced me one month after due date passed, had to go to emergency room after hospital release due to too heavy bleeding, also they didn't listen too me about knowing my conception date and baby's head had grown to large for me to push him out, labored for 16 hours before forced forceps delivery with caesarean team standing by, horrifying experience all around and it was my first birth.
11
That women suffer these indignaties is ridiculous. However Alabama’s new law simply respects the fetus when it’s viable. Obviously new medical breakthroughs means the fetus is viable early on. Good for Alabama.
6
Thank you for this important article. My concern is the paradigm that informs its subtext, the idea that women should be pitted against their children in a competition for care. No mother wants her life devalued and no mother wants to lose her child. As the subheading reminds us, we have the technology and capacity that should ensure that we shouldn't have to choose.
I felt that trauma in my first pregnancy, when my doctor treated me like I was a hypochondriac for reporting terrible cramping. She refused to take my symptoms seriously. Eventually the bleeding progressed to labor and I gave birth at home to a perfect, beautiful baby boy, who could not live because he was too young (15 weeks). It was horribly clear that she didn't care about me OR about my baby.
Fortunately, not all doctors are so uncaring. When I faced later pregnancy trauma (life threatening bleeding in two future pregnancies, one during my daughter's birth and one during a miscarriage) I had wonderful care.
12
Thank you for this important article. My concern is the paradigm that informs its subtext, the idea that women should be pitted against their children in a competition for care. No mother wants her life devalued and no mother wants to lose her child. As the subheading reminds us, we have the technology and capacity that should ensure that we shouldn't have to choose.
I felt that trauma in my first pregnancy, when my doctor treated me like I was a hypochondriac for reporting terrible cramping. She refused to take my symptoms seriously. Eventually the bleeding progressed to labor and I gave birth at home to a perfect, beautiful baby boy, who could not live because he was too young (15 weeks). It was horribly clear that she didn't care about me OR about my baby.
Fortunately, not all doctors are so uncaring. When I faced later pregnancy trauma (life threatening bleeding in two future pregnancies, one during my daughter's birth and one during a miscarriage) I had wonderful care.
3
Too bad this doesn't affect certain fathers.
Doctor to Prospective mother: "I'm sorry, but we cannot save both at this time, it's either save the baby or the father, we cannot save both".
I can think of several instances where the world would be better off if the baby was given preference.
9
How about a good story. An overweight mom, past 40, never worked out, who had a long labor going nowhere, then the fetus began experiencing low oxygen. Within minutes she had a C-section, and there were definitely some complications, followed by a lengthy corrective surgery. It was rough for the mom, rough on the baby, but thank G-d this woman was in a top teaching hospital with excellent physicians who followed best practice protocols.
I'm sure there are tragedies in the best hospitals, too. But, as the author points out, each and every specialty, be it surgical or non-surgical, invasive or not, needs to be reviewed/scrutinized. This was and is the standard that the unmentioned hospital used, weekly, for its performed angioplasties, and likely the same for its post deliveries, some of which are high risk.
BTW, in many hospitals and OB/GYN practices, 35 is considered higher risk, and if that was the first delivery for Thea, even more so. This information isn't provided.
15
Articles like this only add to the problem. They make women distrustful of their doctors, most of us who are trying to do the right thing after both listening to our patients and weighing the evidence. What should happen is doctors and patients do shared decision making to come to the right answer. What we find happens all too often instead in obstetrics is the parents plot a course based on whatever junk science that have recently read on the Internet (or the New York Times) or heard from their neighbor and adamantly refuse to deviate from that, no matter what their physician tells them. This happens far more often in obstetrics than other branches of medicine. And it does not make for healthy Moms or babies.
31
Simply put, outcomes improve with less interference with the birth process - for both parent and child. Humans are no different from any other mammal that likes to labor in a private, quiet, and darkened place of safety.
Our bodies know very well what to do and require intervention only in a minority of instances. When birth is commoditized as a medical emergency, that's what it becomes.
Here's my favourite example. Naturally, the placenta takes time after birth to pass all remaining blood to the baby. Outcomes improve when clamping and cutting the cord are delayed, so why is it in our collective consciousness to do this as soon as possible? Jaundice and other health problems result. This is a primary instance where we do not trust the birth process.
I can hear the argument: what about when premature care is required? Resuscitation can be done on the parent without depriving the baby of its blood supply which is circulating through the cord and placenta.
There is actually no such thing as "cord blood," which companies promote as a product to be banked. This is baby's blood that is currently in the cord. The best place to bank it is in the baby.
12
So far, I've rewritten this post 5 times. This is beyond infuriating. I can't imagine dealing with labor and delivery with a physician who just threatened to put me in jail for asking for a chance to go home and pack. It's urgent that as a culture we address what happens when the "unborn" has more value than the woman who is already in front of us and has her own unique and separate needs - listen to women and believe them.
28
Oh and do not forget how doctors “manage” their patients, (translation - ensure that they get in and out as fast as possible) with the use of Pitocin and other drugs to speed up delivery. Yes. This happened to me - a lawyer who then defended doctors in medical malpractice cases - but not after that!
17
This article is a mess. Two horror stories from many years ago -- one where the patient (and she was a patient, and this was a medical emergency) was upset because she couldn't go home for her overnight kit? Really?
Just as a wedding is not a marriage, a pregnancy is not motherhood. Motherhood requires that you put your child's life before your own. You do. You just do. You have to. It's your job.
You're medically vulnerable when you're giving birth, and the doctors are as responsible for the life of the child as they are for the life of the mother. They have to be. They just do. It's their job.
They say, about flying, that any landing you walk away from is a success. Well, any childbirth that gives you a healthy infant is a success. Maybe you don't get the rainbows and unicorns experience you had planned, but you survive, and you get a beautiful baby.
So California has a downloadable checklist, that should solve all your problems.
21
I can't believe I'm reading these stories in 2018 instead of the 1930s on the Prairies. My grandmother never forgot the terror of hearing a doctor say to her husband, "I can't save both of them. You'll have to choose now." And in her haze of pain and trauma, no medication, she remembered thinking, "Pick me! Pick me! How will all these other kids survive without me?" What happened next was barbaric, but she survived.
We have the ability, the knowledge, and the resources to do better by these mothers.
22
My daughter-in-law almost died giving birth. Then the hospital sent her home - TOO EARLY - with a bad infection that almost killed her again. This is a hospital that prides itself of delivering 50 babies a day. It recently received a C rating.
18
That headline phrase, "Richest country in the world in the 21st century" just does not ring true. Perhaps something like the country with the greatest percentage of truly rich and truly poor people might come closer.
I have written so many times about what Universal Health Care does in Sweden for pregnant women, giving details, I am not going to bother this time.
Curious, ask me.
Only-NeverInSweden.blogspot.com
Citizen US SE
16
This is an outrageous situation and one reason I am overjoyed that we elected so many women to Congress. Political power by women is necessary to force all of society to value women's lives.
20
Both my sister and I almost died during our deliveries because of medical errors. I almost bled to deaths and then suffered debilitating bloating and delirium because of severe anemia. I stayed an extra week in the hospital before they figured out I did not have an internal bleed; they had just let me bleed out and never realized it. Delirious and incapable of walking, I could not advocate for myself. Finally, after two transfusions, I began to mend.
My sister’s story was even worse, suffering HELLP. She was in the hospital for an extra week too, missing out on the first days of her babies’ rocky stay in the NICU.
I am still haunted by the laughable level of care I received. It was more keystone cops than modern medicine. I was ignored repeatedly when I told medical staff something was wrong. My sister was as well.
ALL women suffer these challenges because the baby’s life is paramount and we are just silly women who couldn’t possibly know what’s going on with our bodies.
20
Growing up I heard all about how great America was. We were exceptional. As an adult with an inquiring mind and bent to read and educate myself I have found out in many ways we are as bad as the third world. People need to focus on facts and reason in what affects their lives and leave tribalism for your football team. We need to realize that other peoples and countries can teach us if we just humble ourselves to learn from them.
14
Many of us remain saddened by the millions of abortions chosen, too.
Yes, we must protect the health of the mother, but we have to find a humane, life-saving way to protect unborn, human, children-to-be.
A test of being humane is to protect all lives human born or yet to be born.
4
I too almost died shortly after child birth. The birth of my second daughter was so unremarkable and easy that no one would have ever expected I would take a turn for the worse. I seemed so strong, so healthy, so normal. I was released from the hospital two days later and had just arrived home when I felt terrible pain, chills and fever, that I ended up masking with Motrin.
The next day, knowing something wasn't right, I visited my OB practice who didn't even take my temperature much less listen to my complaint. The OB present told me it was my milk coming in. It wasn't. Two days later I ended up in the hospital severely concerned because I wasn't able to urinate. After a basic blood test that showed I had no white blood cells, the gruff nurse told me I was a very sick lady. The ER docs then put me under for an "exploratory" surgery, saying it was my appendix, unrelated to my birth. It wasn't. I didn't wake up after the surgery.
It turns out I had contracted Group A strep (not Group B, which they routinely test for) and it put me into septic shock. My heart failed on the way to another hospital. I was out for 10 days. I spent 39 days in the ICU. It's amazing I am here.
I learned many lessons throughout this experience, but the biggest lesson for women is to be insistent. If you know something is wrong, you're right. Don't let anyone tell you otherwise.
36
OMG this is all too familiar. Doctors today don't feel that it's necessary to listen to women. Personally I feel that doctors are working with so many odds stacked against them. Insurance companies pay way less than they used to but require more paperwork. Hospitals are all about profits and not about the quality of care patients receive. Generally people today have less patience and more. I personally almost received an unnecessary rhogam shot by the birth of my child in 2012. I was in my early twenties (no judgement, it was a personal choice that I don't regret) and the doctors and staff refused to believe my claim that rhogam was not necessary saying that they saw i was a negative blood type even when I knew since the age of 16 that I was B+. Here I was, in my most vulnerable state, post birth, having to argue with medical staff that claimed to know better. They even tried to get my husband to side with them and tell me I don't know what's happening because I am post birth!!! Where is the compassion??? It is horrendous that in this day and age where we claim to have come so far as humans that women today need to argue for good healthcare and are made to believe as if they are at fault if things go wrong. C'mon hospitals, doctors, and insurance companies. You CAN do better!!
14
The one great leveler of women through Time has been childbirth. It can kill us. We risk it for an imperative that sometimes goes beyond reason. Doctors and other medical people owe it to us to at least listen to our fears and judgments of what is going on inside us. I am tired of being told by a masculine voice what I should feel in a pregnancy. Listening is hard, but trust us to tell you what is happening.
19
This is not an ideological issue. It's a doctor-attitude issue. Doctors can be just as arrogant, uncaring, and incompetent under a socialized medicine system as they can be under a private-payer system. Medical schools are now better at training young doctors-to-be to develop their listening and empathy skills, but there are and always will be plenty of self-important doctors who treat patients, of whatever gender or age or race, as worthless hypochondriacs. And that, incidentally, is partly why good doctors -- and there are plenty of those, too, thank goodness -- have to pay for bad doctors' misbehavior through sky-high medical malpractice insurance premiums.
5
The owoman as a vessel thinking seems to be one of the reasons ob/gyms so disrespect woman who are beyond their child-bearing years. Thank God for doctors who select gynecology only and cater to those in menopause. We are treated as a whole person as any woman should be.
7
America suffers from a strange delusion - brined in our self-proclaimed superiority and exceptionalism, we refuse to objectively measure our performance for fear that we learn other countries have overtaken us in important ways. We have made it easy for politicians and their oligarchic masters to keep us poorly educated and bathed in propaganda - shades of 1984?
16
Everyone who takes an interest in this subject is contributing to making childbirth safer & healthier for others.
However, it is important to remember that the statistical charts are of no use to the one family whose "outcome" was not positive.
Furthermore, by making the metric death vs. survival, we overlook the dozens of other consequential quality-of-life indicators that result from sloppy, shoddy or distracted services delivered by care providers to the mom-baby unit.
If a new mother is left incontinent, requiring surgery or perhaps never completely continent again, that usually still makes her case a "good outcome." But is it really?
If a baby winds up with entirely preventable cognitive deficits from Hypoxia, or if bones need to be broken to get her or him out, is that a "good outcome"?
Maternal health has gotten short shrift since the dawn of time. Everyone wants childbirth to end perfectly; most people assume "birth is a natural, predictable, routine process." Some even go so far as to claim, "Healthy women enjoy giving birth!" (Utter nonsense, as far as I am concerned.)
Each case is different. Much more money & time need to be invested to studying the minutiae of women's reproductive experiences. Someone with a misshapen cervix or a defective endometrium or with adhesions from previous pregnancies, or IBS, will not have the same experience as someone without them. Different risks will arise.
Pay attention & learn from mistakes. Suffering is not normal.
13
"Lawmakers claimed that it wasn’t the job of the state to meddle with doctors’ decisions." Be different response if a male issue! Once again, the supposed world's "Superpower" and most "Wealthy" nation, at least for the 1%, cannot provide healthcare for its citizens, this case women giving birth. How does the conservative right justify this, "Personal Freedom" of suffering or even the classic "Religious Freedom" oxymoron? Even worse, the role of racism in it all!
7
If I were a young woman growing up in the USA I would have my tubes tied--for all reasons. Living here as a fertile woman is living in a gauntlet of horrors.
9
American Exceptionalism isn't shown merely by high maternal childbirth mortality: checkout OECD rankings in literacy, longevity, traffic accidents, workplace mortality, childhood nutrition, corruption index, etc, etc, etc: we're Exceptionally low ranking (or middling at best) in most categories. (But we're numero uno in gun deaths!) 'The price of freedom' as Fox News would tell you.
15
The Doctors “were more interested in protocols than people”.As long as the threat of medical malpractice determines how one practices Obstetrics,a maloccurance from not following protocol is a surefire recipe for a lawsuit.
7
The article is shocking and an eye-opener. This comment is about the headline, which is probably not created by the author. On what basis is the US the world's richest country? Certainly not GDP per capita. I hear this characterization frequently but don't know where it comes from. Is there some other measure?
4
A few of the many mothers I know (family, friends, coworkers) had OBGYN complaints (mostly how long they had to wait and how much it hurt) but most were happy with their OBGYN care. I know doctors sometimes do not meet the standard of care, and they often cover for one another, but to headline an article that "American Is Blaming Pregant Women for Their Own Deaths" is over the top.
7
In some Native American cultures, the baby is not seen as alive until the mother stands on her own two feet. The connection between the mother and the newborn is seen as the biggest part of the newborn's health.
17
“Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof...” is a suicide pact for all women by Conservative standards. Instead of scientific standards, or medical standards, Republican-Conservative standards are “Religious”. In Law, fetuses are not persons. The very idea that fetuses are persons is derived from the Catholic theological dogma that first, sperm are complete human beings and second souls exist from the moment of conception. Bad science is coupled with patriarchy as a fundamental belief of Catholics and has become that of Evangelicals since the 1980s (for political exploitation). Women will be subordinated as long as the First Amendment is contradicted by Religious establishment that reinforces patriarchal conservatism.
Obstetrics-Gynecology should be a female specialty. Not all women can shop for doctors but the politics of OB Gyn can be swayed by all women.
These stories are stories of male supremacy and dehumanization of women. My daughters were jeopardized by the arrogance and arbitrary decisions of their physicians and the hospitals. It is appalling that women are still so institutionally mistreated by the male supremacists in medicine and hospital administrations and by the patriarchal religious superstitions that has invaded all political conversations. Religion has no right to impose beliefs on any American. Abrahamic patriarchy is a singular violator of the First Amendment.
6
So glad I birthed at home with a midwife/OBGYN doctor standing by at the hospital. All went well. Perhaps the biggest problem we're dealing with right now, besides doctors' neglect and incompetence, is that women are waiting longer to have babies. The female human body is built to have babies only until 36, and then, only if she's healthy. After the age of 36, women are entering into a dangerous place to give birth so late. Of course, no rule stands for all women. But I had one birth while young and another when older. It's a whole different ball game when you're older...
6
A woman is an individual. She is not a means but an end, a whole and complete end in and of herself, as is a man. However, is that true once a woman is pregnant? A pregnant woman is not an individual. She is a society of two or more. As an individual, she has the right to amputate a limb, poison her lungs with smoke and pickle her liver with booze, however, as a member of a society she can't do that to others. A society has a responsibility not to cause harm to its members. That's why we, as a society, need universal healthcare, education, food, clean air, clean water, and healthy climate. When we don't do those things we are being bad. We ought not to make things worse for each other. If society isn't being held accountable for the harm it does to other individuals that make it up, then why should we blame or punish pregnant women? And if we decide to hold ourselves to a more utilitarian standard, would that mean pregnant woman would have fewer options than the rest of us?
3
Nothing new. America has been blaming females for everything for 240 years, while specifically leaving them out of the Constitution and Bill of Rights, voting rights, education rights, legal and personal rights, employment rights, marriage and divorce rights, offspring rights...
9
The exceptional US has turned childbirth into another male-dominate, profit-making business with a high failure rate despite patients requesting better alternatives. Now, instead of an honest assessment and change, we get the expensive PR push blaming women, This on the same day, the NYT's feature story about the abuse of female prison employees to keep a minimum wage job. And Trump proposes new ways to skirt birth control mandate. How many data points are needed to show US male leadership's disdain/hatred for women?
11
The problem today is that none of the doctors are trained to treat the whole person. They are incredibly narrow in their scope and as a result patient care suffers.
Both my father and my uncle were physicians trained in the old school of medicine. My father was a surgeon and an anesthesiologist. My uncle was a urologist. When my uncle was 92 he was hospitalized with a strangulated hernia. He had all kinds of people wandering in and out of his room. Every doctor and hospitalized prescribed medications and treatments. My uncle's verdict: He called it horse manure medicine. And, that's what it is today. Instead of treating the patient as a human being, and as a whole person the doctors are so narrow in their scope they frequently miss the forest for the trees.
Women have to chose OBGYN doctors who will treat them as people and who will look after the well being of their child and themselves. This is no easy task.
It doesn't have to be this way of course, but the insurance companies and the Federal Government let all kinds of non-physician bean counters make medical decisions.
As my uncle the physician used to say, "It's a great system as long as you don't get sick."
The practice of medicine and patient care should be between the doctor and his patient. Not the Insurance company and one of their non-medical auditors.
Because of this we are forced to take cheap generic drugs made in China and India, and every procedure has to be approved.
3
Here’s a thought: every person who believes that a mother should suffer or die for an unborn fetus should be placed on a donor list for vital organs. If it is okay to force a woman to save another, then it is clearly okay to force anti-abortionists to give spare body parts to save others.
As for the children born because of rape, incest or inaccessibility of birth control - anti abortionists should be forced to pay for lifetime physical and mental healthcare for mother and child.
If you are “pro-life” put your money and your body where your mouth is.
9
Vessels. Didn't you know women are just vessels? For the use, and production of, men.
2
Perhaps we should ask the same question that was on census’s early in the last century.
How many children have you had? How many are still living?
That was how we understood the size of problem back then.
8
Pregnancy dehumanizes women. You are no longer yourself but a container for another life: a parasite that uses your body to sustain itself. At least today we can choose whether or not to undergo this process. Imagine the soul- crashing experience of an educated beautiful woman a hundred years ago whose body is suddenly invaded, whose life is endangered and whose health is ruined! And in addition to the inevitable humiliation of the natural process, we have (especially in the US) the culture that tells a woman that once she has a fetus inside, her own life, aspirations, hopes and desires no longer matter. I gave birth to my first son in Israel. I was only 21 and horrified of dying. I made my-then husband promise me that if he had to choose between my life and the life of the baby, he would choose me. Nothing so extreme happened but when a couple of years later I talked to a rabbi and told him this story, he informed me that Judaism mandates such a choice. If the woman’s life is endangered during the delivery, the baby must be killed to save her. At least in this my religion gets it right!
5
When I agreed to a C section due to fetal distress I got an epidural that, although it relieved the pain, made my breathing very labored. I later found out that the epidural administered by the resident had affected my diaphragm leading to me having to focus very hard on making myself breathe. I felt like I was dying. I was afraid to fall asleep for fear I would stop breathing. Eventually the effects of the epidural wore off, but I will always remember that fear as I was trying to nurse my newborn for the first time. The nurses and doctors just shrugged off my distress.
4
After reviewing comments regarding this article, it seems that two extremes are apparent.
One is that the medical establishment is an evil money making enterprise that just wants to control women and their ability to make their own choices over their own health and bodies. People on this end of the spectrum opine that a hospital is the worst place to deliver a baby due to medical control.
The other end of the spectrum is that the medical caretakers are not proactive enough. Signs and symptoms are missed or ignored by doctors and nurses to the detriment of pregnant and postpartum patients. The inference is there is not enough aggressive intervention.
As a nurse, I can tell you it is a balancing act trying to provide personal and thoughtful care to patients, at the same time considering the medical situation that may be occurring with that individual. Most patients have normal deliveries without complications. Unfortunately, sometimes compromising situations can occur, and as a nurse it is my job to look ahead of the situation in order to prevent emergencies. I have had many patients that need to deliver due to medical situations that may not be readily apparent to them. Before, during and after delivery, I monitor patient condition closely and sometimes have to administer treatments that prevent problems I can see on the horizon. It may not be “touchy feely”, but it prevents postpartum hemorrhage, infection or DVT.
Believe it or not, we try the best we can.
18
It’s been 2 1/2 years since I delivered my daughter and became an addict. After a traumatic birth that started with the nurse telling me that she didn’t believe me that my water was leaking, included being dropped during the transfer to the OR table and ended with a vacuum suction delivery of baby with breathing problems in the NICU, I got postpartum preeclampsia and hospital acquired pneumonia. Pneumonia was followed by pneumothorax on the right and pleural effusion on the left. Five hospitalizations and 2 months later, I was fully addicted to the opioid pain medications that had numbed me both emotionally and physically since that epidural.
I made the outpatient prescriptions last as long as I could, eventually running out and switching to alcohol.
I hope that I never have to tell my daughter how frightened I was during her birth, and how it’s impact has been so severely debilitating. I’ve been to rehab. I’ll go again. I will never get pregnant again though.
8
Both of my children were born at a birth center with certified nurse midwives. The experience was positive for my husband and I. Our children were born healthy. For me, my children's births were physically very hard, but also beautiful and empowering. Full prenatal care AND delivery and post part care was under $6,000. For my second child, my insurance would not cover this. We paid out of packet, and I am glad. We need more care like this, and we need insurers to pay for it.
12
Doctors are generally bad at listening to women. My husband and I go together to doctors appointments sometimes. It’s amazing how doctors listen to him more no matter which of us is the patient.
Perhaps it would be helpful to doctors, if women bring a partner or a friend with them. It means a loss of privacy but it is better than letting pride be terminal.
The American medical system is deeply broken and particularly dangerous for women. So women need to watch out for their own safety. No one else will do it.
15
A well-nourished mother almost never gets pre-eclampsia. In addition to over medicalizing childbirth, the system under-emphasizes nutrition/prevention in medical care. A bad combination.
4
As a health policy analyst I am familiar with the abysmal data on maternal deaths in the United States, which doesn't seem to be improving. Even women don't want to listen to other women about this. Women are safer with midwives than they are birthing in the traditional hospital setting. It seems the perspective regarding women as autonomous beings is still not fully realized, as some states continue the debate on personhood for fetuses as well.
6
As a retired Family Physician I was trained in helping women birth babies in the early 90's. Women were well treated. It is not that women are devalued, it is that all humans are devalued.
Since the advent of for-profit health insurance, the only part of medical care that counts is profit for the insurance company. Remember when Blue Cross/Blue Shield was non-profit? Remember before the investor class decided that health insurance was a good profit source? I do. Now, patients are devalued and so are doctors and other health care providers.
Doctors used to have the final say about taking care of patients. Now it's the insurance company and the lawyers who control medical care.
We need National Health Insurance with every one of us in the insurance pool. But we need to do it clearly understanding the cost. Good health care is expensive. We could make it less expensive if we chose: universal health education required in every junior and senior high school; universal family planning; subsidized medical education; and, yes, gun control. Can Americans get together to reclaim a common-sense health system and a common-sense government? Maybe.
17
I just experienced this horror first hand ... not personally... but with a younger friend, an Algerian refugee, whom I met and assisted 5 years ago when she first came to America. She came here legally, as did her husband, works, attends college and was pregnant with her second child. It was a difficult pregnancy, yet everyone on her medical team kept telling her she was "fine." The result - she was rushed to the hospital with preeclampsia at 28 weeks. She was bleeding profusely and had to have an emergency C-section. Her baby was born at just under 3 pounds and is doing well but will be in the NICU for at least another month. Although I cannot prove it, I can't help but feel that her ethnicity and less than perfect language skills (she speaks 4 languages, but is least comfortable in English) contributed to her doctors inattention to her serious medical issues.
7
Ms. Brooks has written an interesting article, but misses an important point in regards to maternal mortality. While I agree that national maternal mortality statistics are very hard to find in the US, many states and cities do keep track of the causes of maternal mortality. And for many cities, including places like Baltimore and Philadelphia, we do know the leading causes of death in pregnant women: trauma from car accidents, homicide, suicide, and overdose from opioids. So while all L&D units could and should work harder to decrease preventable deaths from hemorrhage and preeclampsia, in many cases the US maternal mortality statistics are a sad reflection of the society these women live in.
11
If CA has developed protocols that have had such a significant and positive impact, why haven’t all the other states adopted them as well? Are we still, in this day and age, expecting/allowing each state to reinvent the wheel on best practices for maternal health care? We repeat this folly of not sharing and adopting research proven best practices in so many areas of American life: health care, Election practices, education, environment, and so on. This short sighted approach is lowering our country’s well being and economic growth.
8
When my baby was born with complications and had to be in the NICU, in the midst of the chaos and fright, my ob-gyn said to me, "You are my patient. I am going to take care of you." It remains one of the most wonderful things that anyone ever said to me.
30
"Lawmakers claimed that it wasn’t the job of the state to meddle with doctors’ decisions." But it is their job to prevent doctors from performing abortions? It is not only pregnancy-related care in which women are not listened to, it is all aspects of medical care, and other areas of life as well. An abnormally high rate of mortality from appendectomies would draw scrutiny because it would affect men as well as women.
If doctors and lawmakers really care as much about the babies as they say they do, they would make every effort to keep their mothers alive to take care of them.
9
America is not blaming anybody, these examples are not representative of America. And if some doctor threatened my wife like that he would be threatened right back. Sued and have all his wealth taken. Second opinions are justified, and why keep a doctor you don't trust. Just more typical biased reporting from the NYT.
7
The reason is not so hard to fathom. It's statistical medicine, of course: protocols that in the age of truncated physician-patient contact and under-staffing by for-profit insurer groups lead to treating each individual as a clinical data point. And while, as a male I can't fully appreciate the travails of a pregnant woman, I have my own example of this trend. Meeting with an nurse anesthetist just prior to minor surgery, I made sure to inform this individual that I was several months into opiate withdrawal after summarily removing the dreaded drugs from my chronic-pain regimen after many years. "Please prescribe something non-opiate for post-surgical pain," I asked. But statistical rather than patient-individuated clinical practice prevailed nonetheless: I was given a prescription for the opiate oxycodone.
2
If we could get the treatment of women and mothers right, every facet of our society would change for the better.
11
Physicians want the best outcome for their patient. In OB, this is especially challenging because the mother so deeply wants the best outcome for her baby as well. The problem is NOT that doctors aren’t listening. They do listen, but they have more to balance than doulas and midwives, who have a different role during child birth. Physicians are trying their best. Let’s not blame them when the outcome doesn’t match the patient’s expectation. Nothing in life is so simple.
15
C-sections are always under attack—we do too many of them; wealthy women demand them to suit their schedules; doctors perform them too readily to suit their schedules. But as I read these stories, I see in so many instances that C-sections should have been done, or should have been done sooner. I am not an advocate of too many, but it is obvious that what is needed is a patient advocate for all women who want one, or for those with at-risk pregnancies. An advocate should be with the mother throughout labor, delivery, and recovery. It is impossible to advocate for yourself when you are laboring in distress. And midwives should be respected partners. Surgery is always risky, and a C-section means weeks of recovery. I had two of them. My mother had three (including twins.) Doctors should focus on maternal health, they should quit acting like gods, and they should always be considering surgery as an option.
3
My friend, an oncology nurse, and her husband, a surgeon, gave birth at a hospital, where they both worked. This was a teaching hospital in a large city. After the delivery (uneventful pregnancy) she started bleeding out, profusely! Nobody seemed to think anything of it. She turned to her husband and said, “I’m going to die, do something.” He yelled to the staff, “you need to type and cross match her immediately.” They did nothing, and said the bleeding was normal. Within minutes,seconds?, she crashed. She had had an attached placenta.
She ended up on a ventilator, transfused 36 units of blood, in the ICU for a week , in the hospital for a month. A year to completely recover.
14
I just read the stats and as usual the opinion section of the nyt tells you half the story. There’s a mixed bag to blame here. Women are having children older and lets be realistic our obesity rates blood pressure rates and diabetes rates are very bad in the us compared to Europe and Canada. You cannot get pregnant then lose weight or then work on your blood pressure. These issues cannot be a little feelings but honest facts. Having children older comes with much higher risks. We are not even discussing mental health issues in this article which are very serious during and after pregnancy. Does this author understand that our diabetes pandemic is a massive burden to our healthcare system? And yes much of this is education and discipline. The other problem medical errors and where you get treatment. Not all hospitals and doctors are equal. Look at your hospital ratings and choose doctors with good ratings. Most patients don’t take the time to review this data, but overall it’s sad that we have to review this data in the US. Childbirth is complex and something actually dangerous. To blame it all of the doctors is disingenuous, but they do have a role here.
15
Thank you for so wonderfully illustrating the author’s points: women are blamed for their own pregnancy-related deaths in ways they wouldn’t be otherwise. As for your preposterous insistence that people should rate and evaluate and carefully choose among dozens of doctors and hospitals, it’s as though you have no idea that there are places where such choices are severely limited, no idea that people’s access is circumscribed by insurance or its lack, transportation, affordability. Suspend uninformed smugness and maybe listen to people’s own experiences.
49
@Location01
I wonder, did Serena Williams have diabetes? Was she obese? One of the MOST fit women on the planet. And you can bet she chose her doctor and hospital with great care. And they still didn't listen to her.
7
@Location01So your point is that it really IS mostly women's own fault when they die in childbirth?
2
This article brought back a flood of memories regarding my first pregnancy which I will not share but I will say that when a pregnant woman is sick, and a pregnancy gone sideways one is gravely ill, the sick person cannot advocate for themselves. My husband was no help. I am going to suggest that to improve our outcomes America's health care system should assign medically trained advocates to all pregnant women who's sole purpose is advocate on the woman's behalf because thirty-five years later I am still amazed my son and I survived. This article is alarming proof this is an ongoing, systemic problem.
17
@G-unit - 50 years ago my son and I both almost died during my first delivery. I'd had undiagnosed pre-eclampsia. I'd gained "too much" weight (4 pounds in a month instead of the 2 the doctor insisted on). at my last appointment, I told the doctor how little I was eating, and he yelled, "Don't lie to me! You're just going home and pigging out!"
Turns out the weight gain was a sign of eclampsia. During delivery I had a seizure and they couldn't get my son to breathe for a long time. Meanwhile, I ripped so badly I needed 63 stitches. And fwiw, I was normal weight, didn't smoke or drink, and got a reasonable amount of exercise. A careless, uncaring doctor is more dangerous to a pregnant woman than any "lifestyle factors."
10
“Lawmakers claim that it wasn’t the job of the state to meddle with doctors’ decisions”. This is a direct quote from the article.
Interesting that these lawmakers do not feel that way when it comes to a woman’s right to choose.
36
Until this article I would laugh at the fact that when my first son was born the doctor was so busy watching a championship basketball game that he let me go through labor without the epidural that we had agreed upon and made we wait to push until the game was over. The pregnancy was fine and my son healthy. Now I realize that the doctor was a rude and selfish man who viewed me and my son as an inconvenience. Thanks for opening my eyes.
28
Even as a physician myself I still wasn’t immune. I was induced and then told the contractions I was having weren’t real since they weren’t being picked up by the monitor and my cervix wasn’t dilating, except, every time I had one the baby’s heart rate started to drop, which wasn’t noted or shown to me until later. I was shamed by the anesthesiologist for asking for an epidural, and told “ it gets much worse.” When finally it was noted the baby was in distress, and I was sent in for emergency c-section, it turned out my epidural was not complete, and I could feel the knife cutting me open. I was told I was feeling pressure, and I had to argue with gritted teeth, after having seen this procedure many times, no, it was a lot of pain, not pressure, and after much sighing, I got put under general anesthesia. After I woke up, I was groggy from the anesthesia, and was told my baby had been in distress but was out in the nick of time and now OK. The nurse then handed him to me and walked away. I told her in my state I was worried I would drop him, as I was very medicated, and was told, essentially, you wanted a baby, he’s your responsibility now. Fortunately my husband came in then and was able to hold him so I didn’t drop him by accident but it was a horrible moment where I has no recourse and was very helpless otherwise, as I was paralyzed below the waist still.
I knew the system and still was gaslighted and minimized, even though I was a colleague. I can’t imagine for others.
59
Stories like this break my heart, truly. I love my job and I take it very seriously. I consider listening to the needs and wishes of the patient every bit as important as my medical knowledge of what to do in a particular situation. More often than not, knowing what to do COMES FROM listening to the patient. I simply cannot understand why you, or anyone, is treated this way.
20
This is an abomination, but unsurprising. As long as our medical system is a profit-making industry simultaneously subjected to legal process will we never be able to provide proper medical care. I was extremely lucky to have both of my children in Switzerland, where doctors and midwives are not treading water beneath the expense of malpractice insurance and can therefore run their practices with care for BOTH mother and child. My appointments were long and detailed and EVERY one included an ultrasound so my doc could check on the baby in the way that he felt most comfortable (and you better believe I was never billed for an ultrasound as part of my exams). In the hospital, when laboring, I was attended by only midwives, who offered by acupuncture, massage, essential oils, etc. It was relaxed and comfortable: I wore my own clothing, I didn't have an IV, etc. Until we fix our broken medical system, these stats will never change.
18
Excellent article. Thanks.
I had my second child at home (with excellent physician backup care) because it was clear to me that as a pregnant woman in a hospital, I have fewer rights than a convicted serial killer under medical care.
28
Immediately I thought of two friends who within recent years gave birth in major hospitals in major cities - Las Vegas and Denver - who nearly died because of gross negligence and failure to hear the patient's words. These stories continue to happen every day in the US. In each and every case, call a great lawyer and sue. Unfortunately that is the only way these tragic tales will cease.
22
There is no excuse for the maternal mortality rates in the US. But like many articles addressing the fact, this one oversimplifies or leaves out realities that make reducing that rate very difficult in this country. For example, the way OB care is paid for by insurance companies—in one lump sum, at the end, with very little attention paid to complexity—is a disincentive (in some regions or practices) to women who are higher-risk getting the additional time and attention they need. As another medical professional noted, while obesity, chronic medical conditions, and lack of prior prenatal care should not be used as an excuse, those things do in fact complicate care, especially in a setting like the L&D unit, where things happen quickly relative to most of the rest of the hospital, leaving (at times) very little time to obtain lab or imaging tests or peruse old medical records before the event in question takes place (delivery or surgery). Interestingly, this article also manages to take issue with not listening to patients in favor of protocols AND then notes that checklists reduced morbidity and mortality in CA. Both are important, but it is a disservice to suggest that the latter precludes the former. What is needed is for women to feel valued and listened to, to have the choices explained to them clearly without bias (induce or not, C-section or not), and to establish a dialogue early on that takes into account their needs and wants in the context of best practices.
16
I also had a very difficult first birth. Labor for 3 days. Had an epidural which was a godsend after 2 days of labor and no sleep. I was given pitocin for failure to progress. Eventually my baby went into fetal distress and the doc came in and said we must deliver the baby now. I pushed for about an hour, forceps were used but the baby would not come out. The doctor said we need an emergency c section and 17 mins from that point to the baby being born. In retrospect my doctor was amazing. both of us - though beat up - did fine. This was at NY Presbyterian. Most of the staff in my delivery room were females, including my doctor. Emotionally it was very traumatic and it took me a while to get past it. I was in such a bad way. I can imagine how it would be so easy to die on that table. You are completely helpless. After hearing other stories including my friends son who had a bleeding brain after a bad delivery. I think the doc saved my baby and me and I feel lucky.
13
I believe that this story is much more complicated than this narrative. There is too much blame on the medical community, and too little discussion on the women's participation in the process. An example is the epidemic of drug addicted women giving birth, which clearly no investment in either their own health or the health of the child. So many of these women have no active participation in their own health, and then make the medical profession the scapegoat.
7
An interesting comment that I'm sure others might be thinking. Could you share more? Do you have data that supports it? Do you specialize in women's health or any related profession such as biostats, epidemiology, or addiction? The stories in the article are about college-educated women who have had traumatic, life-threatening experiences and who are not addicted.
6
With all due respect but what are you talking about? This comment is a gross overestimation and oversimplification of complicated, devastating issue. Women in the US still die in childbirth or are harmed after by often unnecessary interventions such as csections. Shameful! Have you or your partner given birth and been treated disrespectfully or been dismissed by a medical professional? Are you able to share reliable statistics on the epidemic of women giving births with opioid addictions? There is a complete power imbalance here - the medical and insurance companies hold all the power and influence. Women especially poor, disadvantaged women are regularly treated disrespectfully and not listened to. Of course personal responsibility is critical. No one ever disputed that and of course there are caring clinicians. But it is also true that too many women die or are harmed in the US due to complications related to childbirth. This should not be happening at this frequency in our country - no way, no how. Full stop. Women have been giving birth on their own or in networks since the dawn of man. We know how to do this. What we need is a more respectful system of care for women, men, and their families as they go through this journey. And less of an emphasis of how the insurance incentives are skewed to favor expedient care with unnecessary interventions too early and too often. Don’t believe pregnant women, then ask the midwives. This is their field of expertise.
1
what you are saying is exactly what the article is arguing against!
1
See paragragh 12: “The problem isn’t that we don’t know . . . “ This paragraph gets to the crux of the point. After my first child, who was born via an unnecessary Cesarean Section (in my view) after multiple unnecessary medical interventions, I vowed that I would never give birth in a hospital again. For my second pregnancy, I did a lot of research on childbirth methods all over the world, found lay midwives with a multitudes of experience and a doula, and planned for a home birth without telling anyone except my husband, not even my back up doctor. It was an amazing experience! Absolutely the way childbirth should be. Why the U.S. medical practice can’t listen to women and the forces of nature and understand the giving birth is not a disease or malfunction of the body to be treated with medical intervention, but a natural process of the body that needs to be supported with love and caring is beyond me.
13
@LibDev The incidence of death, both maternal and baby, is much higher when one treats delivery as a natural process.
7
As an expat, I can definitely attest to the fact that America is failing it's citizens in both the quality and available of healthcare. That said, regardless of where we live or what state we're getting health care in, each of us is ultimately responsible for our own health. That doesn't mean we shouldn't study the alarming rates of infant/mother mortality, but to ignore the general rapid decline in the health of the average American is also ignoring a big part of the problem.
8
I had a near-death experience at arguably the best obstetric hospital in the country, Brigham and Women's in Boston after a model pregnancy. I arrived at 8 cm. I was left in transition labor for 7 hrs (the range can be as little as 10 min and up to 2 hrs ). My pain and trauma eventually paralyzed me: I couldn't speak, cry out, or ask for help; I was outside my body, looking down at myself. My labor nurse was crying and panic-stricken; she had tried to tell the doctor, who would poke his head in every few hours and ask my vitals and then leave, that my contractions had gone off the charts (this when I could still remember anything). I had a code-blue emergency C-section; racing down the hall with people jumping onto the gurney was like the opening to Ben Casey. it was chaos in the operating room, everyone yelling and the doctor knocking a nurse out of the way who was screaming "I can't find a heartbeat! I can't find a heartbeat." It is wrenching to write this even 32 years later. I thought I and my son were going to die. We did not, but my son, who had to be resuscitated, has muscular dystrophy, a neurological disease for which there is neither treatment nor cure: no family history, but physicians claim it is genetic. But I know better: neurological damage during birth for his being without oxygen for so long. An OR nurse came to me in recovery before she left and said "you're lucky you were at this hospital." Lucky? First, do no harm.
25
I've had 3 babies and zero routine experiences. With my first they gave me Piticin and kept cranking it up despite my pleas to slow it and made me labor very hard which both exhausted me and put baby in the NICU. I felt guilt and I blamed myself. My second was stillborn at 24 weeks and I was induced, the baby was delivered spontaneously AFTER the doctor walked out of the room and the nurse had to chase after him. It was terrifying. For my third I hired a new doctor who was better prepared. I hemorrhaged and ended up in the OR facing hysterectomy. The doctor handled it beautifully. I ended up keeping my uterus and almost needing a blood transfusion but I can't imagine if that had been my first child if the outcome would have been different. I could have died. Everyday women are having scary life threatening experiences and some aren't here today to tell their story. This should be a wake up call.
17
What a sobering story. This country has so much to do to come into the 21st century.
14
There are two conflicting realities about childbirth. The first is that it is this natural safe process that can best be managed in a low tech way. The second is that it is a high risk process requiring rapid decisions and very invasive measures like emergency c sections. The anecdotes demonstrate these two realities in action. The article wants to see this as victim blaming and overstated its case. Care should be more compassionate and patient centered while still being safe.
16
This article and others I've recently read leave me truly disturbed. I no longer have any faith in the medical community. I lost my first child to merconium inhalation. There was no amniotic fluid when I was induced. In the late 80s c-sections were frowned upon. As a result the merconium was pushed deeper into her lungs from the birth. She died one week later. But I will never forget being questioned almost immediately after her birth on whether- or not I was taking drugs....anything....that would have caused this! My next child took 3 days to be born and had an emergency c-section with another epidural shot but my jaw locked up and I could feel them "working" on me. My last child inhaled amniotic fluid during a c-section and was in an intensive care nursery. I went home before him! The next day staff didn't hesitate to tell me that children can die in these situations. I feel truly lucky to have my two sons and that I was here to help raise them. But that the richest country in the world doesn't seem to know how to deal with this or is dragging it's feet is appalling. As I said in the beginning. My faith in modern medicine is GONE.
16
These women's experiences show how women's bodies are still treated as public property, to be legislated and parsed and discussed and covered and uncovered-- and ordered around by doctors and the health care system. Serena Williams showed us how dangerous this can be when it is directed at African-American women, as seems common. You can add this to failing city schools and inadequate public transportation in many cities, and other poor services offered to black Americans, which don't seem to improve much, even under Democratic administrations. The creepy assumption behind this stubborn lack of progress in improving this kind of treatment is that some people are worth less. I commend this newspaper for beginning to provide coverage of the half of the world's population that has long been missing from the news, a silence that has contributed to this and many other problems.
22
It's ironic that in the richest country in the world which spends almost 2 times as much on healthcare than most European countries (where state funded healthcare is the norm) maternal mortality is typically twice as high. (14/100,000 vs 7/100,000
24
In the US, the chances of dying because of pregnancy are at most about 0.00028 percent or approximately 1 in 3500.
Whereas the chance of a pregnancy ending in abortion is quite high, somewhere near 1.1 million are performed each year in the US. Which is more than 1 in 4 of the 3.9 million live births.
8
@hawk - The abortion rate in the US has fallen steadily over the past 30 years. It's now about 600,000 a year, NOT 1.1 million, thanks to more available and reliable contraception. Now Republicans are trying to make contraception more difficult to get.
But this isn't about abortion, it's about deaths or near-deaths in childbirth in the most prosperous country in the world, while the infant and maternal death rates in other countries have fallen and continue to fall.
10
Hawk,
Thank you for this very important information. We must never stop drumming these important facts into the public domain. This tragic abortion rate is so sad and disheartening and hopefully one day we will see it reversed and ended.
2
This article, which opens with an n = 1 anecdote, might serve a useful purpose if it were to be followed up with one or more articles that draw on the data available in the most advanced countries to make careful comparisons.
This phrase is somewhat misleading: "For experts studying the United States’ maternal mortality and injury rates — which are ESTIMATED to far surpass those in other developed countries"
The key word is "estimated". In Sweden 99% of pregnant women, all SES classes, enter maternal health care at gestational week 12 and then receive pre, peri, and post-natal care with the result that the Swedish databases are among the best in the world. The data are not "estimates".
Comparisons might be made of the record in selected Nordic countries, comparing them not with the whole USA but with states with the best data and then states with successively lower quality data.-
I have long recommended in comments that American researchers who focus on African-American women might do well to propose a joint research project with Swedish researchers to learn about the record for the sizable population of Horn of Africa mothers in Sweden. I am translator and editor for many Ob-Gyn researchers in Sweden, and have asked several about the record for this sub-group. Those I have asked have said that they believe that the record for this group may be almost as good as for the general population.
Researcher volunteers?
Only-NeverInSweden.blogspot.com
19
@Larry Lundgren - I have a Somali friend in Minnesota who among other things is an accomplished mother who occasionally has comment on her many Somali sisters who are pregnant or who have recently given birth. This has led me to believe that it might be possible to do a preliminary study of this particular group in Sweden and Minnesota. Now that Ilhan Omar has been elected in Minnesota, perhaps there is even a special reason to carry out such a study.
I also have had Somali friends (Somali Bantu) in Burlington VT and have thought that that particular ethnic group might be used in a comparison with the large Swedish Somali population.
One of the ObGyn researchers for whom I used to work was giving serious consideration to doing a preliminary study but I have lost track of him.
I close by noting that Somalis do not see themselves as belonging to a race as they would be seen or are seen in America.
I think I must try to make contact with a few researchers to ask them if they believe a study might be carried out, first in Sweden and depending on results then with a link to US researchers.
2
I still remember how jarring it was to have my first baby, after months of mostly compassionate prenatal care, and discover that no one had been interested in my well-being the whole time, just that of the baby. Once the baby was out, I was basically ignored. And that was in one of the better health-care systems in the US. I had one baby in California and two in Finland, and my experiences here have been better in nearly every way. We Americans have go a long way to go.
23
I had a high risk pregnancy-older mother, twins. I was taken care of wonderfully and had an emergency c-section at 32 weeks when one of the twins stopped growing. No problems during or after, and the twins were in NICU for 2.5 weeks and then all was fine. However, I gave birth in a private women's hospital in India with an amazing female OB-GYN. She and the hospital were very caring and cautious from the beginning to the end. I don't think I would have had the same treatment or outcome in the US.
9
Whenever a doctor asks me to rate my pain on a scale of 1-10, I first explain that, for me, 10 is having a C-section without anesthesia, and it is a pain I have trained myself not to remember.
9
In 1990, when I put my foot down about an unnecessary induced labor, my ob flew into a rage--told me he'd get a court order to force me to have the baby on his terms. I silently stood my ground and he ultimately "allowed" me to go a couple of days past the due date. Though the story is a bit longer than this--in brief--I delivered naturally with a different doctor in attendance. There were still too many interventions for my liking (including being force to lie on my back during labor).
My second son was delivered in a different hospital two years later. They gave me a promethezine/demerol pain reliever less than thirty minutes before the baby was born. Had they told me I was that close to delivery, I would not have asked. Thanks to the meds, he was born blue and cyanotic and it took them an hour to recognize it. Though he finally improved eight hours later and nursed without issue. they decided it had to be an infection. They spent five days giving him injected antibiotics in his legs (not an IV--in his legs). He is on the autism spectrum and I am confident oxygen deprivation at birth is why.
The next time, I decided there had to be a better, less traumatic way. My last two births were outside the hospital with an amazing midwife. Absolutely no complications, no issues, and no ridiculous interventions. Delivery was quick and both babies were born healthy. A completely different experience.
19
I, too, was traumatized by perfect storm of medical negligence and the contempt of a obgyn when I delivered my first daughter. Through a series of mishaps that began when the obgyn gave me an epidural against my will (by yelling, shaming and threatening me—the face of the nurse who heard this is something I’ll never forget) my cervix stopped dilating. After many hours of labor, the baby went into distress, and a c-section team got busy. The surgery was clumsy and cause a post-operative ileus that, along with side effects from treatment, kept me—a healthy 30 year old woman—in the hospital for ten days, four of them wired to a bunch of machines. I needed to hire a doctor to mediate between myself and the doctors in the obgyn clinic that were treating me. When I finally left the hospital, I was told I had dissolving sutures. Several weeks later at my follow up exam, I asked why my incision was assessing. Oops, said the doctor: it’s not dissolving sutures. He removed them. His face was bloodless because he knew I had them. Too bad I was too traumatized to sue the X out of that practice. Yes, I’m healthy now, and my daughter is, too. But, the experience was unnecessarily difficult and dangerous.
19
In general, women are often dismissed as panicky and hysterical no matter what the medical issue. As pregnancy is unique to women, is anyone really surprised?
38
The maternal morbidity rates in our country are indeed reprehensible. I am appalled that so little has been done by American doctors to scrutinize their own practices in order to improve them. I also believe life begins at conception, and I see no reason why believing a fetus is a human life should result in low-quality care for a pregnant woman. If anything, it should increase the quality of obstetrical care.
5
This is reported too anecdotally to be convincing. I realize it is an opinion piece, but it is also trying to tell an important, and possibly real, larger story. Why, in 2018, have everyone's personal stories and personal "truths" become more important that real data? Is it because Oprah says so? I had one bad delivery out of three, and I absolutely think the OB/GYN made bad decisions from the beginning to the end (the baby was born healthy, thank goodness), but I do not induce from that any large scale general trends. The trends may be there, but from my one story, I'm not competent to describe them.
18
@RE
Data and trends on delivery experiences and outcomes can be combed from the stories, but only if we have them. Of course, access to the doctor’s report in the medical file for corroboration helps as well.
In today’s idealized motherhood, many women feel abject shame if the tiniest aspect of their delivery goes awry, or if they are subsequently unable to breastfeed. When women feel shame, we under report because we don’t want to admit that there was “something wrong” with ourselves, even when that aspect is completely beyond our control. Coming forward, even in the white-hot spotlight of that shame, makes every story worth collection for data purposes. Every story withheld or not reported by a hospital skews the data.
8
@PGHplayball - Another generalization here: "many women feel abject shame if the tiniest aspect of their delivery goes awry..." All the women I know talk openly, and in great detail about the tiniest aspects of their deliveries going awry. Yet again these are simply the women I know, another anecdotal record. Where do all these "many women" statements really come from? But again, in the case of women I know, we talk about those very imperfect deliveries much more than we all talk about "perfect deliveries." The whole idea that women are inter sectionalized into shame and silence is another myth that I'm not so sure is really true.
5
@RE - I think the point of all the many posts on here detailing dangerous, horrendous deliveries is that we SHOULD be collecting stats on maternal mortality as well as on deliveries that go very wrong, even when mother and child survive.
4
I would argue another side than that presented in this article. Imagine Thea goes home with low fluid to pick up her bag. During that time, the fetus rolls over on the umbilical cord and compresses it due to the low amniotic fluid. The fetus dies. Thea returns to the hospital and is now diagnosed with an IUFD. Whom do you think she will be suing for failure to adequately counsel her on the risks of low fluid and not keep her on continuous monitoring? Who will be at fault for the unfortunate death of her unborn? Not Thea. Americans threaten to sue at the drop of a hat. I am certain it makes all providers practice defensively. It is not excuse for a poor bedside manner or failure to communicate effectively, but I suspect fear plays an important role in much of the counseling of pregnant women. I recall one of my patients with an ectopic pregnancy begged to drop her one car off at home for her family to use before her emergency surgery. She promised be driven straight to the hospital. I gave in. She showed up 2.5 hours later bleeding in her belly. If she'd needed a transfusion, it would have been on me for failing to impress upon her the seriousness of her condition. She was fine, but let me tell you while I paced in preop waiting, I imagined her bleeding to death on the side of the road. Women are my patients, but I am terrified they will blame me for anything that goes wrong. One of the reason we follow protocols, is deviation from them is ground for a lawsuit.
36
@hart
Thank you. This op piece infuriated me. The 'protocols' are actually evidenced based care. Talk about 'Doctor shaming'!
8
Since CA knew how to correct much of this with simple common sense steps, we know this is a failure of will and a lack of a sense of outrage over the care of women. My experiences in both of my childbirths mirrored some of these stories. Female OBGYN friends have told me that they would never have handled things as they were handled in my case, with no regard for my pain or my health. This sort of reminds me of how we handle gun issues in our country. We know from other countries what the answer is to that too, but there is no political will or sense of outrage over our dead children and loved ones.
11
We've come a long way since the days when midwives delivered ALL the babies, with plus and minus results. We have more dependency upon equipment to monitor vital signs, and more drugs available for emergencies. Still, there are too many stories of women in labor being treated like objects instead of humans. If I were pregnant, the first question I would have about my doctor would not be "Where did s/he graduate?" but "Why did you become an obstetrician, and then "What do you like about it?" If you don't like the answers, look for a more humanitarian alternative.
5
You don't get it, do you? Once the child is conceived the mother devolves to simply a life support system for the child. In this view the child is the important entity and the mother is expendable. This is just how it is.
Didn't say this is how it ought to be.
9
As such be said, I be classified, as an (American, From America) there is great offense taken from this article. As an American, it provided quite simply, The entire country is not blaming Pregnant Women for deaths, for if I represent that of the country and I am not blaming, the statement is hideous and inaccurate. The Country is not to blame for any and all, thereby unless every person in the entire country acts in the same way and declares the same things. We ought to hold a higher aim, Be specific with regard representation. May the world and its people come of witness a day when people stop using broad reference to depict, to describe, to detail. The article if based in fact would have provide the persons and or specific organizations drawing such conclusion, reverse blaming the entire country for some small minds. This is not the 'America' I represent, nor the 'America' that with which I identify. Journalist could provide to reflect improvement in how their writings are portrayed on final edit if they have that such say/ability, that such power and if it not be so, the person in whom such ability and power reside ought to revise material which reflect inadequately/inaccurately upon that of the writer and the mass multitude of person in the public, it certain would derive personal and emotional offense. The Public sentiment expects a higher standard of reporting, along with that of solutions in remedy and that of eventual the hope it be positive results. May God Bless.
1
Can we please finally put an end to using the term “pro life” when referring to the Republican religious right’s position on pregnancy. They are NOT pro life because they value the life of a fetus over the life of a mother. If they were pro life they would be fighting for women’s health issues, which would include contraception. They would fight for gun safety laws, health care for all, and climate protection policies. The term “pro life” should never be used when referring to those whose support of life is limited to nine months.
61
As a medical researcher, there will limitations when records are solicited from patients and their families but one way to get around hospitals refusing to share the medical records of pregnant women who died is to put out a call for families who suffered a death to give the researchers permission. The next-of-kin has a right to those records as far as my understanding of federal law. They also have the right to ask for an investigation into a death.
5
With all due respect I don’t like drawing conclusions from two anecdotes and an aggregate statistic, particularly when there’s a question about how accurately the aggregate statistic has been measured over time. I do believe our healthcare system is broken and I wouldn’t be surprised if maternal mortality is a problem, but this feels pretty thin.
13
@George Mitchell It doesn't just feel thin. It's microscopically thin. The data shows that obesity is a risk factor. I wouldn't be surprised if age over a certain level is a risk factor too. With the obesity epidemic and increased maternal ages, people want to hear a message that their life choices aren't part of the problem. This article and the linked one are just examples of journalists selling outrage to those who want to buy it.
16
@Think Strategically - Apparently you've chosen to ignore the many responses from women who weren't obese, weren't drug users, weren't older mothers, and didn't have any of the risk factors you describe, where because of medical mismanagement, their pregnancies went very wrong and it was only with luck that they and the infant survived.
5
When I was in labor 30 years ago after 24 hours and evidence of meconium staining( evidence of fetal distress) my doc recommended a c-section. I begged her to give me more time to do it "naturally". Thank goodness, I gave in. My sons umbilical cord was wrapped tightly around his neck. I could not have delivered him alive vaginally. My need to have a "natural" birth could have killed my son.
17
The WHO reports that maternal mortality rates are higher in developing nations than in developed nations. I wonder if this problem is less common in countries that have national health?
3
I am an obstetrician and this is an exceedingly important topic. One that many people are passionately devoting their lives to correcting. And I believe that the system we work in is flawed from top to bottom in ways that create serious gaps for low income and low resource patients. But I fear the author is doing a disservice to this topic by equating these particular terrifying outcomes with poor care by doctors and that this is the problem with maternal mortality. These two anecdotes don’t highlight this crisis particularly well and only fan the flames of the anti-medicine/anti-doctor rhetoric that gets in the way of caring for people. When I propose a treatment plan to my patient that is based on evidence, safety, experience and what I hear are her wishes and she still distrusts me we get into trouble. There are bad doctors with stories like this just like there are bad nurses or plumbers, but it’s the system that is failing people not the individuals.
32
Absolutely on target. My doctor was irritable and my labor long. In the end, at a very prestigious hospital, it was good enough. My daughters situation at the same hospital was far more disconnected. She too had a long labor w doctors and nurses lecturing her on the necessity for a cesarian, very uncommon in my lifetime and unknown in my mothers. The nurse took me aside and told me that I was an irresponsible mother not to encourage my daughter who want a natural birth to get the cesarian. A cesarian is far more intrusive and problematic. She eventually did. Following the procedure, the doctor refused to let her breast feed claiming formula was standard procedure. He too was intimidating. The hospital staff disregarded her obstetrician who was part of a woman advocacy group at NYU. We were all put off by this medical autocracy. After speaking to several of her friends, cesarian, a much more expensive procedure is common and formula is perhaps a business decision.
7
My mother had five babies in the 1950's and for each one she was given general anesthesia and she was totally unaware. And, of course, no breastfeeding. That was a no-no back then. I was born with crossed eyes and my mother swears it was because the nurse held her legs closed while they waited for the doctor to come in from the golf course. (I doubt if my eyes were messed up by this but I've always remembered the story).
My one child was in the wrong position and I labored for over 24 hours (no drugs) when it was decided I needed a C-section. And then...everybody left me! I remember a young student nurse with the longest, reddest fingernails sitting with me after they gave me pitocin and then the waves of contractions were too difficult. By the time the doctor got there and I got the epidural, I was vomiting and shaking uncontrollably, more pain than I had ever experienced. I remember the relief I felt from the epidural. It was like going to heaven. And, luckily, I didn't feel any knife. But I sure didn't feel listened to in the process, at all.
7
@sophia: my mom had three babies in the 50s, and all by C-section. She also breastfeed all three of us! she was aware it was not as popular as bottle feeding, and she was a standout amongst her girlfriends for choosing this -- BUT I think it is an exaggeration to say it was "no no". In fact, her doctor was very supportive of her desire to breast feed her babies!
I too was born with a crossed eye -- ambylopia -- and OF COURSE it is not caused by crossed legs. It is caused by a weak muscle in one eye.
Honestly, it is a sad commentary on medical professionals if they do not explain to a parent why a child has a weak eye and how to treat it properly.
1
There is so much anger in these posts! And so many statistics in this one-sided opinion piece. Anger at doctors, at insurance companies, at the system as a whole. There is a large lack of education about childbirth, pain relief, and potential complications. I see this daily in my practice as an Anesthesiologist. It would seem that Obstetricians need to do a better job of educating their patients, taking the time to explain exactly what can/might transpire before it happens. Medical centers need to concentrate in certain specialties in order to give the finest care possible for different areas of medicine - every hospital should not be doing every procedure. All patients need to understand that they bear a great responsibility for their outcomes in every aspect of medicine. One cannot expect to show up massively obese, drug/alcohol addicted,non-compliant with medical therapy and have an uncomplicated procedure - pregnancy, delivery, or even appendectomy. The for-profit medical system is highly flawed, and the public might be better served by a national health service. I suggest that this author spend months researching the issues here, following patients and doctors at a variety of medical centers. Only then should she report on the facts as they exist in the real world.
20
She did report on the facts as they exist.
The US has a higher maternal mortality rate than any other developed country.
While such mortality was reduced in other nations, in the US it rose.
Those are facts.
You seem inclined to blame the women, rather than the care they are supposed to receive.
29
My wife gave birth to a child on campus at Stanford, where the pre-eclampsia protocols were established according to the article. They missed hers until very late, almost killing her and the kid.
However, since we were at the hospital - the reasonable place to be for a dramatic procedure that can potentially go so wrong - she was able to pull through. The idea that "women know what's best' in some natural way, as suggested in the article, is wrongheaded. My wife would have died if she'd made the now routine choice to determine her own care path and have the baby at home. We know as much about this as the appendectomy mentioned. This feels akin to the vaccine craze - something that's been so safe for so long that folks now don't feel the danger associated with deviating from the well-worn path.
This data needs to be broken out more effectively to avoid being misleading. What effect does our old age at first child play? The role of so many mother's now being single (who do they bounce severity of pains off of)? The role of extreme obesity hitting younger and younger? Our opiate problem and pregnancy rates among adicts? How does the very high fertility rate in developing countries among women surviving first childbirth (ie. proved fitness for the task) skew the numbers?
The univariate analysis isn't helpful, it's like saying "teams wearing red white and blue are more likely to win the super bowl." It's true over the past 15-20 years, but it's not really useful information.
20
My labor and delivery went about as well as could be expected. I was allowed to go into labor naturally at 41 weeks. I had a really fast labor and started pushing almost immediately after arriving at the hospital. My doctor started giving me warnings that she was afraid that baby was going to get stuck and we might be heading for a c section. After an hour more of pushing we all agreed she was right and baby wasn’t coming out. Everyone calmly transitioned to our “emergency” c section. Not ideal and I have a lot of anxiety about the c section in general. However what helped TREMENDOUSLY was being talked to like I was capable of understanding and given a choice about what was happening. It isn’t difficult.
26
Perspective is everything. For many years I managed birth injury lawsuits against a large hospital system. These were tragic cases where babies suffered birth trauma with devastating outcomes. The children suffered lifelong and profound deficits. In some cases, mothers and fathers had delayed induction or had very strong opinions against cesarean births, and the outcome was very poor for the baby. Based on my experience, the medical decisions do need to put the baby first. After the fact, if your child suffered profound lifelong trauma because you wanted to second guess the doctor, I think most parents would regret it. Maternal death statistics are horrendous and we have a problem in the US. We need better healthcare access and pre-natal care. But, I don’t think the problem is the philosophy of putting the child’s needs above the mother. This is, after all, what motherhood is all about in my personal experience.
13
Nurse here - I love this article, but the tricky thing is this: If Thea hadn’t gone to the hospital, and instead had gone home to get her overnight bag, and something happened that caused the baby to die (which you’re at a higher risk for with a low amniotic fluid index), she could have lost her full term baby. That is so devastating. She likely would have wished someone would have warned her, no? Imagine that heartbreak. In healthcare we may make it seem like it’s all about the baby, but that’s often times because the fear of a stillbirth weighs so heavily on us. We feel caught in the middle.
21
@Kayla Tab Yes, but there's a difference between warning and threatening. Instead of telling her she had no choice (which is also what the doctor told me), the doctor should have taken two minutes to explain why this was the best choice. Nothing Thea did suggested that she didn't want to do the best thing for her baby. She wanted to know that it was the right decision. She also would have been devastated if she let a doctor make the wrong decision without questioning it.
11
It was a sad day for Americans when medicine and profit entwined. Decisions are too often driven by the concerns of insurors and stockholders. Add a little misogyny to the mix, and this is what we get.
21
The definition of maternal mortality can skew these numbers as well. The author should consider adding the definition(s) Nationally and internationally and from the various governmental organizations so that the reader can have some perspective of how complicated the statistics can be.
3
If you are pregnant, be sure to read up on and understand all the labor and delivery procedures and when they are appropriate. My experience in Washington state with the first gynecologist was suboptimal - I just trusted her judgement and she did her best to induce and rush the delivery because she wanted to 1. Maximize revenue by minimizing time with each patient, and 2. Had a ski vacation planned for the weekend. My family practice GP for the next three kids gave me way too many options (ex. Do you want to break the amniotic fluid sac even though labor is progressing normally, do you want an epidural etc). When you are in labor and pain is it the right time to start learning. The time is several months beforehand. Learn as much as you can. Then if you have an emergency and the doc says - do you want a c-section or forceps say, you can ask about the circumstances and make the correct medical de idiom that is safest for you and the baby.
7
A side note, this information is readily available and has always been available, in America all medical records are coded. On discharge, all records are assembled, coded and maintained, this is the function of Health Information Management.
Skilled Coders read the medical record to determine the principal and secondary diagnoses and procedures after study. Therefore in these specific records delivery and cause of death would be coded. This is an important step and must conform to the testimony of the written record, generated by all care givers, include all tests, Discharge Summary, Operative reports, Pathologies etc. All medical records are than assigned a specific ICD 10 or previously an ICD 9 codes.
These codes are used Nationally and Internationally and therefore consistent. By searching the codes, maintained permanently in the HIM medical record data base, specific records are retrieved that conform to the diagnoses and procedures of the inquiry.
3
This is typical Trumpism, always blame the victim.
3
Oh stop, who else is to blame?
4
The sentence that stood out for me: “Lawmakers claimed that it wasn’t the job of the state to meddle with doctors’ decisions.” Unless the woman elects to have an abortion- for any reason-or needs birth control or prenatal care; then suddenly these lawmakers become the decision-making guardians for these women.
50
Why is any of this a problem for anyone? Once Nancy Pelosi is Speaker everything will be rainbows and unicorns.
If only she had been Speaker before!
5
We are the most anti-family country in the planet and now we are finding out that being pregnant in this country is really bad for your health. Don’t have children!! Certainly not in this country
10
If you consider yourself Pro-LIFE, you most likely vote Republican. But, your Republican politician votes AGAINST Medicaid for all, Food Stamps, Subsidized Housing, and Free Public School Lunch. Somehow it makes sense to people that they do everything they can to make a fetuses come to term, yet they vote to undermine the safety and security of those very children. Please make sure you aren’t supporting this nonsense. Make your politician be consistent in their support for children. Don’t just vote blindly for a ‘pro life’ candidate who doesn’t support the life while it’s being raised as a child. Thank you
29
@SFM: Thank you, SFM! My sentiments exactly.
Now I must teach my daughters (along with):
1) Never go to a Catholic hospital if you have been raped or are pregnant.
2) NEVER be pregnant in Alabama.
What are the voters of Alabama thinking? Unconstitutional amendments to their constitution... or are they *trying* to strike down Roe v Wade?
19
This article brings back so many horrible reminders of my son's birth. When my water broke, the amniotic fluid was a greenish "meconium" color, so the hospital nurses hooked me up to a machine which took my unborn baby's vital signs. I was not aloud to sit up or stand or MOVE while hooked up for several hours. They finally gave me an epidural, which allowed me to rest since I'd been up for 24 hours, and then after 3 hours and much pushing, my beautiful and healthy (thank God) son was born. But about a week later, I began to hemorrhage, with blood eventually pouring out of me. Even with two large towels, I bled all over the ER waiting room waiting to be helped while my husband spoke with the intake staff about our insurance (they do have their priorities!). Luckily our son was sleeping throughout this hell. They said my organs were beginning to shut down, did a last-minute D & C, gave me blood transfusions and sent me on my way 2 days later (stitches upon stitches). I felt like a gutted deer. No - more like an almost-dead almost-roadkill deer. Terrible. It's amazing anyone is having babies with our current system and now I read that some insurance companies don't cover maternity. WHAT??
27
@Karen Cormac-Jones
Don't cover maternity. Well, that's really pro-life and pro-family, isn't it?
How about letting pregnant women to choose????
2
I had both my children in the US. I had a c-section for breach with my first baby, second time around wanted a natural VBAC but got so much push back from the OB, once she had made clear how annoying my questions were (and how I was endangering my baby's life and risking 'catastrophic' injuries), that I switched at 35 weeks to midwives - best decision I ever made those women actually listen and actively want to help you have a normal birth. Successful VBAC eight days over due, no drugs, en caul birth. There is no way an OB could have stood back and let the birth happen without breaking my water forcefully, my midwife said if doctors could just leave well enough alone en caul births wouldn't be so rare! Interventions = $$ that is the root of the problem.
9
"America Is Blaming Pregnant Women for Their Own Deaths"
Terrible, alarmist headline.
15
When I was born, in the US in the 1950's, my 19 year old mother was told that she had to come to the hospital early to have labor induced because her doctor had planned a vacation. So I was premature, weighing barely 5 lbs! My parents were very young and did not question the doctor's instructions at the time. In my case, concern for the health of the mother AND child were not prioritized. I was a sickly child during my early life, likely due to my premature birth since the immune system fully develops in the 3rd trimester. https://www.aboutkidshealth.ca/Article?contentid=1778&language=English
Note to Women: Choose your doctors wisely. Add a midwife, doula, family and friends to advise and advocate on your behalf. Don't rely on only one opinion.
8
Poor maternal and reproductive health, high infant mortality suggests a community in crisis. The main reason being the mechanism that managed all those risks have now been discarded, ─the traditional two parent American family. Like poverty, crime, ill-health, poor education, lack of longevity─ for example among the African-Americans are caused by the crisis in black American family life. More than 75% American-American children born out of wedlock to fatherless families. The government has to step in to manage the risks an exorbitant cost. Lack of normal family life exposes black women and children to whole range of risks and insurmountable set of disadvantages. And as the traditional family disintegrates, throughout, all American families are becoming like black families─ gripped by poverty, full of risks and disadvantages, ill health, marked by high maternal death rate and high infant mortality. The government is forced to attempt to manage these multiplying risks, with massively increasing the burden on American tax-payers.
4
I strongly object to the generalizing and incendiary title of this article "America Is Blaming Pregnant Women for Their Own Deaths". Why do NYT editors come up with titles that one expects to see in a tabloid?
18
Huh? The headline says blaming pregnant women for their own deaths and the author kicks if off with an anecdote about a woman peeved because she wasn't allowed to fetch her "go" bag? Not compelling.
14
Some doctors in the system try to change it but risk being fired. A friend (OB/GYN) was fired for objecting to some of the practices used in the story. He had to sign papers saying he’d never talk about how the hospital dealt with pregnant women (as their procedures were done to guarantee revenue) & he couldn’t practice in the same state anymore.
He had to move 3,000 miles to get a new job; doctors should be very afraid of bucking the system.
10
How very typical of the US...hide the facts, disbelieve the patient and salt with a healthy dose of "Doctor Knows Best".
And hide the records of death...what could be more American?
4
It astonishes me why the American feminists in the media, academia or in politics have never been interested in real life and death issues that's impacting American women. Those destitute migrant women who try to cross the southern border illegally have better reproductive health, fewer maternal deaths and better infant mortality than an average American woman.
2
In the '50s I grew up in a very religious Catholic neighborhood, Young pregnant women never wanted to have their babies in a Catholic Hospital because the life of the unborn took precedence over the mother's life. How catastrophically cruel that women must be ashamed of wanting to live.
521
@Em I grew up in a neighborhood like that and made the same observation when my friend's mother had a sympathetic doctor who removed her perfectly healthy uterus after a difficult 7th pregnancy because the church forbade birth control and her husband just had to have unprotected sex. 1958.
Wild animals have more sense. Mothers who live can have more babies. Babies who are orphaned have diminished chances to thrive.
I am so grateful to my father for dumping that church before I was born.
110
@Em As I was being born in Raleigh NC in 1937 at Mary Elizabeth Hospital, my mother had an agonizing long labor. In the hall, the doctor called my father aside and said, "Your wife or the baby, I can't save both." Dad said, "Save my wife. I can get another baby, but I can't get another wife I love like I do Leila." Doc said, "I'll have to save the baby. I'm Catholic." And Dad said, "I'm not Catholic, so save my wife." Doc said no, and Dad threatened to beat him up if my mother died. At that moment, I was born, and my mother survived though with serious consequences. Or so I was told.
57
In July of 2000, the local hospital had a production-line quality about the whole labor process. My wife's obstetrician was terrific, as were most of the other professionals. And yet the gestalt of the experience was such that the old Warner Bros. cartoon tune Powerhouse blaring in the background would have seemed appropriate. And the breast-feeding specialist tried her damn best to starve our autistic boy to death. She wouldn't listen to either my wife or myself that he wasn't getting sufficient nourishment. (That the finicky, stubborn little guy would NEVER breast feed seems retrospectively characteristic of him - he's healthy as a horse now, btw).
I suppose our experience with our boy was representative of the cases cited by Brooks, in a way. My wife wasn't being heard. I suppose that had the circumstances of her pregnancy been different, the local medical community would have blithely let her suffer and nearly die as well.
12
The “ epidemic of preventable deaths, that has long been ignored in…’should be considered beyond maternal mortality. The view that, in part,“nobody knew what was going on…The data we had was bad, and people weren’t studying the data” can be considered to be part of an ongoing culture of personal/professional unaccountability. In many areas of daily living. And at all levels of people licensed to…, elected to…, selected to…! Enabled by complacency of many. Of US. Enabled by complicity. Active and passive. What is/can be the relationship between adding a box on a death certificate to note that the “cause” was pregnancy mortality, the Ob-Gyn’s, and other staff’s involvement, institutional resources and policies, the pregnant women’s various roles and behaviors, as well as other knowable, documentable parameters, and lowering rates of maternal mortality? And decreasing daily rates of personal unaccountability? In a daily culture which enables, and in many ways, tolerates and fosters willful blindness to ongoing harms. Enumerating, for example, the increased % of maternal mortality rates of Black pregnant women when compared to White women- holding in abeyance other relevant parameters- doesn’t result in moving from generalizable data to needed derived knowledge which is transmuted into qualities and levels of useable understanding. Which is used! Willful deafness to a live person. Not heard. Who then dies. As a BEING? As an object. Insured or not. Willful ignorance about…
When I was pregnant just over a year ago we discovered that my daughter was breeched so my doctor gave me the option to either try to turn the baby or do a C-section. I opted to try to turn the baby but it was a horrifying experience. I noticed the baby's heart rate dropping and it was extremely painful for me so told the doctor to stop, but he wanted to keep going. If it wasn't for the nurse speaking up for me, who knows if my daughter would be here today. Then after my C-section I had to beg nurses for pain meds because they kept forgetting to bring them to me. The nurses also forgot to take off my bandage which gave me a very painful rash that lasted weeks and could have caused a serious infection.
I have a great respect for doctors and nurses, but I do believe sometimes their main focus is delivering the baby which can cause harm to the mother. I recommend talking to your partner or family members prior to having a baby to discuss your plans on how to handle those situations.
12
Even though it was 31 years ago since I gave birth to my daughter, I can never forget the horror. I was diagnosed with toxemia at 6 months. Bedridden and hospitalized, I suffered from depression with little support. At 8 1/2 months, I visited the hospital to have my baby’s heart monitored and ended up having a Caesarian section that evening. To say it was a botched operation is an understatement. The anesthetic did not work, so I was forced to push the baby out of my stomach, there was immense amounts of blood, I suffered the shakes and shivers, allergic reaction to demerol, morphine and phinabarb. My hips were so swollen from morphine shots I could not walk. I suffered from hallucinations, blackouts and hysteria. My nurses laughed and made fun of me. One if them uttered “I have a real nutcase in this room”
After 8 days I was released from the hospital.
I have a healthy, successful, loving 31 year daughter now, but my treatment was inhuman.
41
@Avra Myers
That is horrible. It is hard to believe something like this could happen.
1
After reading many of these horror stories and considering that hospitals frequently operate under religious affiliations, one thing seems obvious.
Laws must be enacted to make the health and safety of the mother the first priority — regardless of the circumstances or personal beliefs of attending staff members — unless she stipulates otherwise while in a non-medical environment.
Hospitals fear lawsuits more than they fear whatever god they believe in.
14
Baby's life before the mother is, I believe, common in Catholic Hospitals. I do wonder, is childbirth more risky than abortion?
8
Yes, childbirth is far riskier than abortion.
23
@jeff - Childbirth is 11 times more dangerous than abortion. 2 -3 women die a day in childbirth in the US, and hundreds more a day suffer complications that result in lifelong health problems or disability.
Many abortions today are simple medication abortions, and most of the rest are simple D & Cs. It's exceedingly rare for an abortion to result in complications that require hospitalization.
2
Childbirth is much more dangerous than abortion. A woman is about 14 times more likely to die from childbirth than from an abortion. https://www.ncbi.nlm.nih.gov/m/pubmed/22270271/
Blame the mother is the long standing altitude at every hospital. The medical staff is always looking to cast blame on everyone but themselves. Minority’s mothers die in childbirth in the United States at a higher rate than in other countries. So what does that say about the slob by medical care they receive.
The majority of residents, doctors are arrogant and it is found in every department of a hospital. From the doctor who can only spare a few minutes and tells you what is wrong with you no conversation needed. Which is why many people refuse to go to the hofpitsl unless they are dying on their feet.
16
The reasons why so many American women are dying or experiencing life threatening emergencies have long been known. Many books and articles have examined what is essentially the sociology of childbirth and its uneven power dynamics. Check out the following sources:
Ann Oakley: Women Confined: Toward a Sociology of Childbirth, and The Captured Womb: on the History of the Medical Care of Pregnant Women.
Barbara Katz Rothman: In Labor: Women and Power in the Birthplace, and Recreating Motherhood: Ideology and Technology in a Patriarchal Society.
Suzanne Arms: Immaculate Deception II
Also check the website for Advocates for Pregnant Women. This is a legal advocacy group which represents women who are accused of various crimes against their fetuses and jailed. For example, women are treated as criminals for refusing a cesarian delivery when the posted Patients Bill of Rights allows a patient to refuse a procedure. Pregnant addicts can also end up in prison even if they sought drug treatment but no program would take a pregnant woman.
Serena Williams was a prime example of how women are not listened to when in labor and delivery; it is more likely if you especially if you a minority and poor. There is much that needs to change about birth in American hospitals such that more women leave alive.
13
Or they could show some personal responsibility. Nah, that’s too much to ask.
6
@TW
I really hope that you are talking about doctors, not women.
Was it my personal responsibility that a female OBGYN missed a crucial finding that was spotted by a male colleague reviewing the information one week after my visit (while she was on vacation) that caused the spiral of activity that resulted in death of my healthy son at 34 weeks and my near-death experience? Was the fact that I followed every doctors’ advice with precision and was still ranked by my extremely experienced emergency OBGYN as one of the top 10 sickest she had seen in 20 years of her current job?
Was it my personal responsibility to live when they told my poor husband that I likely had minutes left?
Was it my personal responsibility not to have children when the condition I have is only exacerbated my pregnancy hormones and I wouldn’t have found that I had it until I was in the 3rd trimester? That the markers are easy to miss and often misdiagnosed, even going beyond far the typical bloodwork?
Is it my personal responsibility when people have cruelly tell me that childbirth is safe because people “like you should have died off and the gene pool should be safe by now”?
I consider it my personal responsibility that my second living child can use (and spell) “populous” in a sentence at 6yo on her own volition and happily do math 2 years beyond grade level so she can fight the nonsense of your prevailing opinion with grace and ease.
27
The patriarchal attitudes of oh so many doctors is really working against us. Thea’s story - how she was told she’d be arrested for going home to get her overnight bag - is truly shocking. Any doctor talking to a woman that way should be taken off staff.
16
I told my daughter to choose a female OB, and only a female. I had three easy births but had enough condescension from male doctors to make me think only women should be OBs. I have reached an age where I speak up and won't take any disrespect from a doctor
14
Hate to tell you, I've had plenty of condescension from female doctors. I don't think it's the gender of the doctor as much as the patriarchal beliefs they ascribe to.
18
California's methods should be copied and if the numbers don't improve there should be an analysis/investigation. Oh but we can't afford that! Really? You can't afford to save lives? Let's have a look at the money spent to save premature babies including some of the awful results. But making a baby an orphan? We can't afford to make an effort even when the state of California and many other countries know how to reduce the rate of maternal deaths. It's a disgrace.
7
Lawyers and doctors and businesspeople run the country for profit, and everything else is secondary. Money talks (too much) in this country, but the average joe seems to be fine with that, look at who they elected president. May the middle class voters reap what they sew.
4
@Will Hogan You are SO right, except I don't know that it was middle class voters we have to blame.
1
I had a lot of trouble with labor and delivery though the pregnancies were otherwise easy. I had my first at NYU hospital 37 years ago. It was a very complicated delivery due to the baby being very overdue-10 months !. It does happen and is provable by the sonograms. She was posterior presentation-not breech but still turned around so that every contraction drove her poor little head into my tailbone instead of out the front. She was also pretty big by then.They gave me Pitocin to give me contractions. Such contractions are unnaturally powerful and painful. It took 20 hours and I had a terrible laceration from the use of the mid forceps.. The baby was safe and healthy but distressed.But the forceps had been placed around her eyes and one of them was bruised , contused and purple. She cried so much they refused to keep her in the nursery.
Afterward there was no concern for my comfort and healing. They left me in a bed, with a terrible laceration-you really can't even sit up, much less lever yourself out of bed and walk to the bathroom with that many stitches. They brought me no water. I was so dehydrated that my throat closed up and I could barely croak out the word "water" to the doctor who came to check the patient next to me. She was enraged and made the nurses bring some. Complete neglect. I think it cost $25,000 even then.
9
Well, geez. Doctors don't listen to patients or their advocates about anything, so what else is new? Pardon my bitterness; I watched them essentially kill my mother in one of the supposedly best medical systems in the country (NYC).
But--also in NY--I had very good care with my first and only pregnancy at age 39, delivering via induced labor at 40. But I'd prepared myself and my child's father very well for conception, and I used the OB/GYN practice I'd used for over 15 fifteen years (and whose senior doctor had delivered both my HS friend's child, and her, too!).
I was my own first and best resource; I was not a silent or intimidated recipient of services.
Why in the heck did Thea stay with an obstetrics practice she wasn't completely satisfied with? What were the conditions under which she conceived her child? Etc. etc. etc.
Stop talking about "prenatal" care. Start with preconception health and start that from childhood, if you want optimum outcomes for everyone.
1
Some people don’t have the luxury of switching practices due to insurance restrictions or time left in the pregnancy. It’s cruel and high BP inducing, but sometimes you have to trust the system, even if you don’t trust your immediate OBGYN.
12
@SCA
So interesting that you would fixate on Thea's lack of empowerment as the issue. Also a preoccupation with the circumstances of the conception is openly brought forward for our consideration. Well we could ask more questions along those lines : about her college degree or lack thereof, where did she matriculate, how much did she weigh, her ethnicity, her language, did she have a husband, etc. Disastrous labors happen even to professional, degreed mothers married to professional degreed husbands at top medical centers. In your universe I think that you would say people who did everything right ? By the way there are many paths in life and no one does everything right. But hold on to your assumptions. Since nothing needs to change from your catbird seat ( a Texas expression) well then nothing needs to change.
4
My first baby was delivered by a guy who joined the practice the week before, his first “real” job. He did not suction my daughter properly after my C-section, so she had a collapsed lung.
My second baby was delivered by the top doc in the 6 person practice. I asked if a doctor I did not like was on duty, could another doctor come in. I was told yes, if I had at least 3 doctors that were considered acceptable, which I did. Fortunately, two good doctors were on duty: one when I arrived and the top doc when I delivered. We managed to skip the C-Section by having my husband tell me when I was having contractions which I could not feel due to an epidural. Nurses said it wouldn’t work, start a C-Section right away; doc said he is the doctor and it will work. And it did. Thank you Dr. Merrick!
My third baby was in a new area. I changed practices THREE times during her pregnancy. The first did not want me to exercise or take prenatal vitamins or ask questions. The second was more interested in my kids than in me; on a hospital tour the nurses said the doc would agree to V-Back (Vaginal Birth After C-Section) but never do it. So I changed practice again and had a great delivery, again a V-Back.
Learn as much as you can about pregnancy and delivery and about the doctors and hospital you might use. Be pleasant but firm. You will not get all your desires, but you can make the experience better for you and vaby by communicating each visit with your doctor. Bring lots of questions.
13
Nothing intimate about childbirth in this country. It's so medicalized that it's horrible. It just shouldn't be like this!
3
When are we going to admit that doctors are greedy jerks that care more about processing patients and racking up the DOLLARS. I love the doctpr that comes into the examination room and keeps his hand on the door knob JUST to let you know he is in a BIG hurry!! Yeah, you are right up there in his list of important things to do, ha, ha, ha, ha!
8
Yeah that’s it.
Blame the so-called rich, greedy doctors.
Unless you have an MD or DO after your name & have actually done the job, you have no clue whatsoever what it’s like for most physicians in America to practice.
Find a simple scapegoat for a complex problem.
And Serena Williams is a horrible example. I’ve read her personal accounts of some of her major medical ailments over the years. Some of them (especially accounts her 1st PE & toe/foot injury) sound incredibly exaggerated & don’t make any medical sense when one compares her own descriptions of her conditions with the various activities she was apparently able to engage in soon after the events despite claiming that she had just “literally been at death’s door” (or whatever similar phrase she used...)
As for her post-partum complications, those are not likely the fault of her physicians. She had a history of blood clots & pregnancy increases that risk. No surprise there. She seemed to think that doctors should just immediately put her on powerful blood thinners without any confirmation of a blood clot/pulmonary embolism despite just having had a c-section with the risk of post-surgical bleeding.
When a clot was confirmed & she was placed on blood thinners, she ended up with some complications that were to be expected given the blood clots in her lungs, the blood thinners & recent surgery.
14
I had a normal delivery at 41 weeks after a long labor. It was 1968 in a rural hospital. I was determined to have a natural delivery until the end when the nurse talked me into a pain killer injection in the midst of a strong contraction. I passed out after the delivery to sleep through the night. I don't know if that injection affected my baby or not. She seemed sleepy the next morning and I had no trouble nursing her with my colostrum. The same doctor treated me when I was ready for birth control. He inserted the new device called the Dalkon Shield. He told me the device was so ugly it scared all the sperm away. I was not an idiot and deserved a better comment. Four years later the device failed and became pregnant, then miscarried and bled for a month. A class action suit was filed against company that produced Shield. I did not join because found out about it after it closed. Thank goodness because of women's movement we are not treated as idiots yet we still have to remain vigilant.
12
"America" is doing no such thing. The medical profession, some states, etc., yes. Honestly, the headlines in the Times are really deteriorating.
3
The maternal and infant death and injury rate is higher throughout most of America. State and Federal government made no attempt to analyze the problems and did not even have pregnancy on death certificates until very recently.
Legislators have not examined this issue...even though all other countries have, and found many ways to dramatically reduce death and injury rates.
Hospitals are blocking investigations into deaths and injuries during pregnancy and delivery.
Doctors are not held to best known standards. They can continue to follow methods that are known to cause problems with little monitoring.
This is a systemic major problem in the US. ALL the major groups responsible are ignoring the issue even exists... except in California.
The dramatic INCREASE in pregnancy and delivery death and injury rates in America while other countries have dramatic decreases is wide-spread, not caused by a few bad doctors or hospitals.
The fact that California has the only decreases shows that appropriate action can save lives and reduce medical costs.
Obama had medical groups research best practices to determine what actions led to the best outcomes. Trump stopped the research because doctors should do whatever they want.
19
It’s all about AMERICA.
It’s AMERICA that was ok with many WOMEN paying extra fees for pregnancy-related insurance coverage pre-Obamacare. This was despite the key role of MEN in most pregnancies.
Many “pro-life” AMERICANS (especially GOP men) are cool with that & would like to bring that disparity back. Why should any man, or even one that’s “pro-life” contribute financially to the healthcare costs associated with pregnancy, etc.?
Any clue what percentage of pregnant women in the USA are covered by Medicaid?
Aware that in many cases, Medicaid doesn’t even cover the costs of care provided by doctors, hospitals etc.. Think about how that must affect care.
That’s a CHOICE America makes to underfund healthcare for the very poor.
Those just above the Medicaid cutoff may have no insurance at all!
Meanwhile, insurance coverage of very expensive non-medically necessary things are mandated by state/federal govt.
AMERICA also chooses to shortchange kids beyond the womb by underfunding education. We import foreign teachers as wages are so low in some areas. We have schools that are literally falling apart. Teachers pay for basic classroom supplies out of their own pockets. Millions of American kids are barely literate upon graduating from high school- if they make it that far.
But the MONEY spent by AMERICA to battle birth control, sex education, abortion, gay marriage, gay rights, etc. is ASTOUNDING!
This is AMERICA!!!
10
I am not a fan of these "doctors are evil" articles that pop up occasionally in the press. What is it this time? Ah yes, the medical establishment is patriarchal and racist.
It's not clear to me that medical professionals should "listen to mothers". In fact, I feel that this is just one more example of the brand of dumb populism that the NYT is increasingly pushing.
One thing we can be absolutely sure of is that modern medicine has improved the outcome for pregnant women massively along every dimension except, maybe, "being valued as a human".
6
Yeah - but it actually is patriarchal and racist. You might not like hearing it. It might offend you to hear it. You might wish for all of the black women to shut up and stop saying it. But that doesn’t make the statement untrue.
12
Readin', writin' and 'rithmatic are the 3 R's of American education.
For women's health care they are Religion, Racism and Recrimination.
18
Mother and child should equally be considered important, isn’t it ? Ifn’t how can the child survive without mother ? It’s just a blame game and nothing but escaping one’s responsibility. Doctors need to behave responsibly. Unfortunately some don’t. That’s the problem. The irresponsible doctors should be punished by all means. There should be no room for escape.
4
Please talk, too, about how dysfunctional care around childbirth affects victims of sexual assault. As many are only discovering in the wake of #MeToo, millions of women have been assaulted and wind up never coming forward, never speaking of if for decades.
Now think about how we make women give birth. Spreadeagled and naked on a table under lights, with strangers coming and going, often with a door to the hallway wide open. Women's bodies cut open or medicated or hooked up to bags and machines without informed consent - or with consent obtained by bullying and threats. Women held down by their shoulders in the pushing phase. Doctors and nurses who can be gruff at best - even (often) hostile, snarky or downright mean. Snide, eye-rolling nastiness about doulas, or birth plans. Being told that the desire to control what happens to our bodies in labor is selfish, that we are baby murderers and idiots. And - of course - whatever happens to a woman in labor, it is her fault.
How many of those things do you think echo what it's like to be a victim of rape?
18
The USA is not the wealthiest country in the world. Millions are suffering for lack of health care. I wish writers would just stop saying the US is rich - it is not. A few people in the US are rich.
24
Look at these pregnancy outcomes (Wagner et al):
Achieving 40-60 ng/ml (100-150 nmol/L) blood serum levels:
-59% lower risk of preterm birth
-60% lower risk of preterm birth in twins
-Virtually eliminates pre-eclampsia
-Supplementing up to 6400 IU/day is safe and effective during pregnancy & lactation
-Reduction in many conditions of pregnancy – Gestational diabetes, bacterial vaginosis, post-partum depression
-Eliminates racial disparity – In the US the preterm birth rate among African American women is 1.5 times that of Caucasian women
Benefits to baby
-70% lower prevalence of common cold
-66% lower prevalence ear infections
-62% lower prevalence lung inflation
-Improved language development
-Reduction in type 1 diabetes (in adulthood)
And that's just ONE nutrient.
1
@C WolfWhat miracle nutrient are you talking about?
Minor correction: Ranked by GDP per capita, adjusted for purchasing power, the U.S. is the 19th richest country in the world (see https://www.cia.gov/library/publications/the-world-factbook/rankorder/2004rank.html ).
Singapore is far wealthier for example, and spends only about 4 percent of its GDP on health care (compare to 17 percent for the U.S.). Ireland is also richer and they spend nearly 8 percent (World Bank data; see https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS ).
10
This is a primary example of why we are not the richest nation in the world. Richness is measured in far more things than the total material wealth of a country controlled by a very few.
Institutionalized misogyny should count for many minus points in assessing the wealth of a nation.
5
Why perpetuate the falsehood of "the richest country in the world?"
We are not the richest financially and certainly not the richest spiritually.
We are not the happiest, nor the most righteous, nor the most democratic, nor the most just.
We don't even have the most toys anymore either.
7
So many want hype, not reality.
In so many ways, America is not so Great anymore and is getting worse.
Instead of falsely demanding we are superior, we ought to be improving ourselves.
3
When I gave birth, hospital personnel treated me as a medical object, not consulting me on decisions, and making some bad ones themselves, like breaking my water before the baby descended and presenting the doctor with a sideways baby. Later, a doctor did a circumcision without consent "because everybody does it", and he thought I was practically degenerate to object. A nurse insisted I sit in a hot water bath hot enough to scald, and I refused and got a nasty lecture for not following orders. My body and decisions were taken over as though they were no longer mine, and the baby was treated as though it had no parents. As a result, I decided then and there never to have another baby, and when that inadvertently slipped out, they thought I needed counseling, which I rejected. Since then, I have avoided the medical profession as much as possible, (except to get birth control) and do all I can to solve my own health problems, and prevent them in the first place. It's working well. I'm seriously considering planned suicide in old age rather than submit to the medical profession again. You're even more vulnerable then, and trapped in a system run by "people who know better". What a horror.
Women's health care in the US needs a lot of improvement, starting with getting political busybodies out of the discussion.
17
Yes because we always have to blame someone when medicine fails. It must be someone’s fault. People don’t just die. Call a lawyer and punish someone who chooses health care as a profession.
4
People do just die. Childbirth is risky in all medical systems. But rising maternal mortality and morbidity in the US is a very serious concern, and it doesn’t mirror trends in other developed countries that face similar issues with weight gain and increased maternal age. So it must be something we’re doing systematically, and some reviews of case reports suggest that issues like high rates of nonessential C-sections and a failure to recognize and treat conditions like hemorrhage and preeclampsia promptly contribute. Whether that’s because our medical system generally prioritizes babies over mothers and consequently ignores mothers’ concerns and reports of symptoms or not is maybe a different question, but many women have similar horror stories in which they were left out of the decision making, whether the doctor’s recommendation was evidence-based or not.
22
Sadly, your response encapsulates the root of the problem the author is discussing. The point of view you express makes the doctor the victim, seemingly without concern for the patient. Given a choice, most people would likely prefer excellent care and good outcomes over having to sue a doctor for malpractice. The lack of affordibility of follow-up medical care after something goes wrong is a major reason why a lot of folks feel the need to sue. If doctors dont want to fear what they deem to be "frivolous lawsuits," they should back comprehensive national health reform and a single-payer system. But let's also understand that doctors, hospitals, and healthcare entities are not infallible. When things go wrong, who exactly is there to hold them accountable? How can they be held accountable when they hide behind "privacy" or refuse to collect data to analyze their own practices? If they resist self-examination and they refuse to even collect and share the data that allows others to analyze and evaluate the effectiveness of their practices (beyond the financial efficiency concerns of insurance cos), then they should expect criticism and lawsuits. As professionals in a science-based profession, all doctors should welcome scrutiny of their methods and practices. They must continually self-reflect and study to improve their ability to effectively treat and care for their patients. And they must get off their imagined pedestals, listen to patients, and publish their outcome stats.
9
You fail to understand that California and most other countries of the world have decreased deaths. Yes, this is the FAULT of our entire medical system for not putting into place best practices. Lawyers only help one person at a time after death.
For some reason, many of the commenters on this article seem to want the old archaic methods that increase deaths.
5
So this is how Ms. Brooks, whose credentials are only described as "writer" views maternal deaths.
In the first lecture in OB/GYN when I was in med school in the late 1980's started with the question, how many women do you know died in childbirth? The point was that maternal deaths were very rare and almost unkown.
A web search for trends in maternal deaths in the US will show an increase in maternal deaths starting around 2000. NYT 9/21/16 reported how this increase was opposite the decreasing maternal deaths world wide with even Iraq, Vietnam and Russia experiencing declines. If Ms. Brooks is right, then it must be women were respected more in pre-2000 USA and in Iran, Vietnam and Russia. How crazy is that?
The evidence is that maternal deaths are seen in women with chronic diseases, namely obesity, diabetes, heart disease, hypertension. Certainly the epidemic of obesity and diabetes are well known and publicized.
It's shamefully simplistic to call this "blaming the victim." Certainly lifestyle choices affect health, but we also have industries pushing sugar, there are food deserts and there is unequal access to medical care.
It's important to listen to patients if only to establish mutual respect so that I can educate and guide them towards healthy lives. But obesity, diabetes, heart diseases will remain risk factors for pregnant women as well as for all of us throughout life.
In sum, this article is such nonsense and shame on the NYT for publishing it.
5
@citizen vox What about the evidence that California's maternal death rates decreased while the rest of the nation's increased ? Or the evidence about the US maternal death rates vs. the rest of the world?
10
@Been There: The answer to your question is in the article. California instituted a system-wide set of protocols addressing the most common causes of maternal mortality. Other regions are following suit.
3
@Been there, done that
Thanks for the response.
But what about the evidence? What is the point you're making?
2
Good heavens! This is crazy. I am one of those who nearly died in child birth as a result of Pre-Eclampsia HELLP . Ironically I delivered at Stanford in 2000 5.6 weeks early. I have no sympathy whatsoever for Thea. She comes across to me as entitled and ignorant.
I don't think these situations need to be so "black and white" in terms of decision making and process. And although I certainly came close to dying and became incapable of making many decisions during child birth, I am responsible for making decisions beforehand and for finding the right place to deliver which shd have the appropriate staff.
5
Shame on you. Many women do not possess resources to have the choices in healthcare that you seem to have had when giving birth. To call another woman you dont know "entitled and ignorant" betrays you as exactly that. Some rural women have to travel many miles to a doctor, and often a doctor is not even available so they see a PA or NP. These trips cost money and time. Many women in urban areas are faced with doctors who dont take their ins or medicaid, and are wrestling with the cost of public transportation among other expenses. Please try to imagine what life might be like for women in widely different circumstances from your own and have some compassion.
12
I live in California and my doctor suggested I take a Bradley class. It’s a 12 week 2 1/2 hour class. So, I knew a lot going into labor but even my doctor admitted, I was going through something none of them had experienced before. They didn’t know what to do. We were trouble shooting. In the end, I had a c-section. What really bothered me was how everyone was so dismissive of me afterwards. After he was born, the nurses would come into my room and say, “I heard what happened. Thank goodness you had a healthy baby” Like the trauma my husband and I had endured didn’t matter. And when friends came to visit and hear our birth story they would say, “most importantly, you have a healthy baby”. Uh, yeah, duh. Of course. But our experience was important too and needs to be talked about and not brushed under the rug. How dare we be in shock and disappointed. Great, my baby is healthy, too bad I’m too depressed and traumatized to feel connected to him.
13
You can thank Sandra Day O'Conner for much of this when she changed the Blackmun formula in Roe to one where the needs of the fetus are co-equal to with that of the mother.
That is when we started see these "fetal personhood" bills in state legislatures.
Politicians don't want this dirty secret broadcast for fear more information would have more women chose abortions and for many Republicans that would cost them the evangelical vote and the future of their party.
4
Proponents if "fetal personhood" should consider thus: If fetuses are persons then the embryos stored in IVF clinics are cryogenic prisoners. Such laws will inevitably lead to the banning of this important therapy.
2
I do consider myself truly lucky... I delivered all three of my daughter at a hospital in Minnesota and I can not say enough about my OB , he was wonderful and even came to the birth of my second daughter even though he was not on call. It was with my third daughter though that things went not as planned. First I started hemorraghing after giving birth and from what I remember was treated with all the care in the world. But the thing that really rocked my world was that my newborn daughter had a cleft palate and the way they reacted was incredible, overwhelming but incredible. The doctors and nurses were so supportive and they are what got me through a couple scary days. I just took it for granted that everybody got this type of care. This is why I love Blue state of Minnesota even more...BTY. My daughter is 16 and is an incredible girl!
8
Lawsuits have played a big part in making hospital births a really bad experience for some. In our country, every bad outcome has to have a perpetrator who has to pay, even if the truth is simply that it's nobody's fault.
7
@Working mom - In the 34 developed countries with universal health care, lawsuits are very rare. In those countries, no matter what the medical injury is, everyone knows every penny of the injured person's medical care will be covered for life. In the US, victims need to be able to cover lifelong medical care and other accommodations, because they themselves will be expected to pay for it.
This very article is precisely why I wonder how on earth a woman, any woman could possibly vote for a Republican. The Republicans at the behest of the evangelical right, in order to garner votes, are responsible for the draconian laws being passed in states like Alabama. As soon as Roe vs Wade is overturned the newly passed Amendment 2 in Alabama will trigger and go into effect. At that very moment the lives of pregnant women in Alabama will be in jeopardy. Other states have similar mechanisms in place if Roe vs Wade is overturned. With Kavanaugh now a Supreme Court Justice, that possibility is now very real. We will see an even higher maternal mortality rate as a result.
God help the woman in Alabama who miscarries. She will probably have to face an inquiry, and maybe be jailed if she did anything deemed as a contributing factor to her miscarriage. Slavery never ended for women. If you cannot control what happens to your own body, then you are enslaved by others.
9
“ women smoking too much or getting too fat or on their failure to seek prenatal medical care.”.
Of course women should be held accountable for the above choices. We are adults. We are rational. We are not children. Who should be held responsible when a pregnant woman smokes, drinks alcohol, ignores nutrition and doesn’t go to clinics? Society? I don’t think so. Unfortunately it is often the child who pays the price.
3
I was treated like a pariah when I was pregnant because I am fat with a moderately risky pregnancy. I was informed that I would be induced at 36 weeks because of hypertension. When I pushed back, asking if I could refuse as long as everything was stable I was told I would be “medically risky” and that my choice would be taken from me. Keep in mind I wasn’t even half way through my pregnancy at that point and I was doing everything I needed to control my blood pressure. I was told by a perinatologist that I was no good dead. I fought tooth and nail for appropriate, non-shaming care through my pregnancy. It took a toll on me, but even worse, my son gestated steeped in stress created by thoughtless practitioners. Eventually I found the care that worked but not after endless upset and tears. The system stole my pregnancy from me. They stole my peace of mind and turned my body into a threat to me and my son. Every birthing parent deserves care that does not come with shame or blame. We deserve decency and to not be told we are the biggest threat to our children. We deserve peace.
8
It is deeply upsetting to read about Thea's treatment in the hospital. I too was very late - 40 weeks - and induction had not worked. The doctor told me to go home for the weekend, and I went into labour on Sunday. I live in the EU.
1
Not to contest what anyone specific has said, but this is an area in which anecdotes abound and everyone is an expert. Care can certainly honor family preferences, but needs to be within a safe envelope of evidence base decision making.
5
My third child was born via c-section because my first child was also a c-section and I was told I was too high risk for this hospital, the only one in my local area, to risk a VBAC. My baby and I would die if I hemorrhaged.
The c-section went fine and my child was born safely, but afterward it was scary to me when my doctor asked where the bleeding was coming from and why couldn't they stop it? They also had a conversation about losing track of how much blood loss I had experienced either a liter and a half or two liters. They called in an extra doctor and an extra nurse and it still took two hours to put me back together. I was so glad my baby was safe, but was assuming I'd die; strangely, I wasn't particularly worried about it, just glad I'd had the c-section since at least one of us would survive.
Propublica had an excellent article about why California has so much better a maternal survival rate, comparable to other developed nations, than the other states, some of which are as low as developing nations.
https://www.propublica.org/series/lost-mothers
5
Unfortunately these types of errors don't just happen to the disadvantaged or people of color in small community hospitals. I had two near death experiences in my family. My wife and I were both medical students and she had a Harvard Ph.D. when she gave birth at a major Harvard teaching hospital. When our son had signs of fetal distress during labor, the OBGYN recommended an immediate C-section. I was present in the delivery room and as the delivery was completed my wife's BP fell and the anesthesiologist noted a cardiac arrhythmia had developed. The OBGYN seemed unconcerned until her BP fell into shock territory and her heart arrhythmia became much worse. Then they panicked and in the process discovered that the surgeon had severed a major uterine artery. Luckily this was repaired in time to save her life.
I also had a sister who was sent home post delivery with a large cervical laceration. When she began exsanguinating (bleeding to death) at home, my mother quickly had her returned to the hospital by ambulance. She lost consciousness on the trip due to blood loss and shock. It took emergency surgery, six units of tranfused blood and a week of hospitalization before she was recovered enough to return home.
Hopefully advances in medical science and record keeping and the issuing of guidelines by medical societies will help to alleviate some of the problems in labor and delivery. It would also help if OBGYN providers were more open to change and improvement.
12
This is upsetting but not surprising. Having a baby should be a joyful experience not one fraught with pain and worry beyond how to ride out the next labor pain or when the baby will be born. What I see here is a pattern that is evident for anyone who is female and in need of medical attention. We are not listened to. Our symptoms are not treated seriously. Nor are our concerns or questions. And this is even when we aren't pregnant. I still recall the pain that arose one New Year's eve. I called the gynecologist and his response was that he believed me. Gee thanks. You mean the fact that it happened on New Year's eve meant that you realized I wasn't making it up to get attention? I never went back to him.
He's not the only physician or male not to take me seriously because I'm female. Whenever women speak up they are not listened to. We're ridiculed, told that it's in our heads (and sometimes it is but that's ignored too), or to let someone else handle it. No one else is going to have your child when you are pregnant. The real problem in America is getting the wealth care industry to do something other than line their pockets at our expense and possible deaths.
Other countries know how to deal with pregnancies. They know how to deal with illnesses and health. Why can't we learn from them?
9
I had my first baby at the peak of HMO insurance. Friends joked about "drive by deliveries" and we debated how to squeeze an additional 12-24 hours of hospital care out of our HMO.
By my third and fourth babies, the environment had changed drastically. The level of prenatal screening and protocols was staggering. Yet anytime I had a question or experienced anything abnormal, OB/GYN and midwives alike had almost no interest and no information to offer.
And when I questioned any of the standards applied to my individual pregnancy or baby (for example, when I questioned the need for additional testing when screening results were within a normal range, albeit the higher end) I was threatened with loss of authority over my own body and baby if I didn't "comply."
The impression I got was that as long as the caregiver checked every box for standard screening/protocols, they felt confident they couldn't be held responsible for any bad outcome.
So it's no surprise to me that women who are experiencing life-threatening conditions are often ignored, or met with ignorance, or bluster--until it's too late.
12
My sister almost died in childbirth and my niece with her, because the doctors wouldn't listen to her.
She knew something was wrong, and she said so. She had strange pains - she'd given birth before and this was different.
They told her she had a kidney stone.
She kept trying to tell them, no, something is WRONG. Finally they did (I think) an ultrasound and discovered placenta abrupta.
When they cut into her body to rescue the baby the blood spattered the walls. She and my niece lost almost 1/3 of their blood.
Can you imagine? Those two beautiful creatures could have died that day. And my niece has always been in delicate health - no wonder!
17
As a labor and delivery nurse who works with a hospital affiliated with Stanford, I can tell you that we definitely practice differently than the stories that have been related in this article. We are all very aware of the risks for pregnant women, particularly with preeclampsia and postpartum hemorrhage. We have specific protocols we follow and examine every patient’s risks for both of these in particular.
I have also found that when we all work collaboratively; doctors, labor and postpartum nurses, and midwives, patients get much better care. Part of decreasing maternal mortality means that institutions need to be more proactive in training and educating staff in an ongoing basis. In addition to that, the same institutions need to staff appropriately for the unforeseen possibility of changing patient conditions.
I hope other states look at how California is changing pregnancy care for the better. It is based on science, statistics and data. I also hope it helps Congress to realize that pregnancy is a normal condition that can be high risk and even life threatening for some women.
With that in mind, forcing women to continue every pregnancy is not appropriate and contraception can also be life saving if it prevents pregnancy related mortality. In the United States, women should not be dying for someone else’s religious convictions.
49
If men could get pregnant ... all this would change. Yesterday.
100 years ago. Somewhere in that range.
Unbelievable. I never had kids, but just reading this is hurtful and so sad and scary for these women.
My niece 'was awfully pale' said her own mother after birth of 1st child/grandchild. I know she bled, a LOT, and required transfusions afterward. Terrifying.
2nd child was induced, with niece's okay, but of course, on the doctor's schedule. Therefore, on a Friday, and not on a date of family's choice, which was somewhat stressful and disappointing.
A super-fit, exercising 30-something, both pregnancies and deliveries had a lot of problems. So much for her creating her own problems!
I know my niece wouldn't trade either child despite any of the struggle and trauma of each round pregnancy or childbirth ... but wouldn't it be nice if her memories and experiences weren't so traumatic???
Or life-endangering.
We have a long, long way to go to treat expectant Moms with the care they deserve.
12
I was with my daughter in a highly rated hospital for ob/gyn in Boston for my daughter’s second child’s birth. Perfect fast natural birth without aesthetics and great apgar score. Then within 24 hours, fever, delirium, sweating, hot and cold chills for my daughter in post labor care on a regular ward. I keep saying this looks like signs of shock, esp. toxic shock. No one believed what I was reporting even while the nurses and doctor all visited. I went to the nursing station complaining all day all night. Nothing. Finally the next day, they began to take action... diagnosis Not Strep B but Strep A. The old demon of birthing in hospitals. My daughter had a prenatal testing for Strep B, nothing, but it did show she had Strep A. She also had a regular prenatal process. The UK has preventive antibiotic protocols for Strep A, but not the USA. CDC is still studying this one. Meanwhile my daughter went to the ICU, waiting with high end intravenous antibiotics to stop the toxicity infection. Too late she had a partial hysterectomy,and baby also ended up in ICU for sub par oxygen levels. My daughter survived, but the family will always remember not being listened to after more than 18 hours of begging to have our daughter attended to for symptoms of septic shock. The infection control team came by and I told them what happened. Strep A, the old killer of maternal deaths is still here!
29
My mother gave birth to me in 1963 and she still remembers the nurses and anesthesiologist saying we would both die (she remembers it as an out-of-body experience). The epidural had been administered at the wrong vertebrae.
Thankfully her family doctor walked in, told everyone to be quiet, and somehow saved us. Mom is 90 now and recalls it all clearly.
5
@ChefG Your mother had a "spinal", not an epidural in 1963. Spinal blocks are rarely used today unless there is a very complicated pregnancy/delivery. Spinal's had many very unpleasant side effects.
3
"some doctors on the panels said they didn’t have the resources, and that hospitals don’t like to (and aren’t required to) hand over their dead patients’ charts."
You cannot be serious... That really happens in the USA?
In Europe, you (or after death, the executor of your estate, i.e. family) have an ABSOLUTE right to your medical chart - or, in fact, the information that ANY private organisation (and all but the most sensitive, eg law-enforcement, public ones) holds about you. Such organisations have 40 days maximum to release the information, are permitted to make redactions in only the most carefully regulated circumstances and can only charge you a minimal fee for providing the data, no matter how much it costs them to obtain it for you. Non-compliance brings large fines - several million dollars in the case of a hospital and potentially, criminal charges.
Data transparency is so ingrained in Europeans that we pretty much take it for granted. It's when one hear stories like this, one realises that other societies, even ones that are very forward, can be very backward, too.
20
In any discussion of abortion, women's right to control their own bodies, and neonatal care, men--senators and congressmen--must NOT be allowed to vote, to comment, to quibble. But, as I've asserted previously, when men are able to become pregnant, the Vatican will make abortion a sacrament. Dr. Leslie White in his essay, "The Symbol," stipulated that a child is NOT a human being until it can participate in its culture. His illustrative example was Helen Keller. Keller born into a wealthy family and was able to hear and see until she was about one and a half years old; she developed a fever--rheumatic fever--which ended her abilities to see and hear. And as she grew, her family allowed her to act like an animal, grabbing food from adult plates at the dining table. But when her teacher arrived and began pressing symbols into her hands, Helen finally understand that those symbols had meaning. And, of course, her intelligence was unaffected by the fever. With Sullivan's guidance and instruction, Helen was able to dine with the family by sitting in a chair at table and using tableware to eat. No right thinking individual would even consider something called "personhood." A fetus, an embryo, a zygote, is not a person. I wasn't a person until age 5.
6
It doesn't help that Feminism has been trivializing pregnancy and motherhood for decades now. The fact that you might give your life to create another one should magnify the importance, not magnify your own importance. This is a fundamental difference in what being a woman is, that you carry a life within you, and then presumably raise that life, and it is give-and-take the entire time. It is the reason women are exalted and respected, not for being equal to men. Birth rates are too low for the exclusion of motherhood from sense of self to continue.
2
Feminism does not trivialize pregnancy. Quite the opposite.
20
I think you missed the point of the article.
6
@LiberalAdvocate
In Europe I have never seen these problems, although surely they exist. Nor have I heard of such harrowing pre-natal care and births.
I had my daughters naturally--regular pre and post natal care, normal labor - no pain killer. One had her two children with no trouble. The other had some trouble with the second child delivered by Cesarean at the last moment and the year old twins, delivered by scheduled Cesarean. All had monitoring monthly during pregnncy and the children had examinations beginning soon after birth.
Perhaps this has something to do with the fact that the doctors are salaried by the government and there is no charge for having a baby in a public hospital which most are. Pre and post natal care is part of the health insurance.
9
I have been a victim of these problems in Europe. Kept telling the midwife I was losing too much blood, she didn't listen until she panicked and sent my husband run for help. One of the reasons I lost so much blood was that I was given a lot of fluids intravenously, got an epidural, and nobody thought of emptying my bladder, which pressed upon my uterus. The midwife also failed to notice the placenta was incomplete. When the full team arrived and dealt with the problem, it was quickly solved, but I had already lost a lot of blood. Had the midwife listened to me, my life would have been completely different. I had been on bed rest for months, and the loss of blood made me much weaker still. I could hardly get up for days, an was so weak I have almost no memories of my child's first months.
It is not gender-related in my experience, and it can affect all professions, but arrogance in medical professionals can kill, and it unfortunately knows no borders. Maybe the emergency procedure in France was more efficient than it would have been in the USA, and of course I stayed in hospital for over a week, so complications would have been quickly dealt with, but, sadly, I think we universally train medical professionals to be dismissive of patients' concerns indiscriminately. I, for one, told my midwife I was hemorrhaging. I wish she had listened.
3
Doctors in some countries are concerned above all with providing medical care to the persons who are their patients. In America, they are likely to instead think of themselves as serving a grand abstract deity, "health," with which their own profession is identified, as it sets the norms of treatment in light of which doctors make decisions that affect people's lives but that can be made without their knowledge or consent. You give up most of your rights when you submit yourself to any kind of medical care, including rights of participation. An obvious case of this is psychiatry, but it is too broadly in the system.
Patients are given what they "need" according to their doctors. "Need," like "health," is a norm that can easily be determined by an expert and contrary to what you want. Even people paying much for a service find that it is as if they are working for the doctors, and not they for her or him.
If health care serves goals decided by doctors, why can't they decide that a pregnancy is "about" the child, and not the mother at all? Abortion laws often say this, too.
Our society is largely governed by a professional-ocracy of experts, and most organized activities devoted to doing any good are corrupted by the rule of profit. What people "need" is decided accordingly. As a result, institutional and social life is non-democratic, and the provision of needs is reduced in the name of efficiency and of what may be the wrong objects or goals.
1
I also had a traumatic delivery for my first child. Neither myself nor my husband was consulted regarding treatment decisions. We were told what was going to happen. We were never given other options, and we weren't fully informed of the potential dangers of the doctor's chosen treatment. As later found out, the treatment the doctor chose was the one that best indemnified him, in the event that we sued.
12
What happens to the doctor when patient A wants XYZ, and a bad outcome occurs? Does patient A waive their right to sue if XYZ goes wrong?
Pregnancy is a high-risk event. If a patient wants to increase their risk should doctors agree?
6
One after another of my friends had long-standing problems after having episiotomies. So it was my turn to have a baby I insisted on no episiotomy. What should have been an easy request turned into a nightmare. I had to argue with every single medical staff to the point of kicking one permanently out of my room.
Today Obstetricians view episiotomies as not necessary in routine births. But women have known this for a long time. Why did the medical community wait until 2005 to change their stance on episiotomys? I think the answer is tearing a woman open to pull out a baby is more important than a woman's long-term health.
21
It’s horrifying but true: a lot of OBs - not all, thank god, not even a majority - regard women as the meat wrapper that the baby comes in. Telling them to get the baby out without tearing the packaging just annoys them.
5
Could it be that a medical industry being run for profit, where the bottom line is more important than real, attentive care to the patient is incentivized to be uncaring? The patient has no real voice in this game unless it is through litigation. Therefore, an adversarial relationship between those that deliver healthcare versus those that receive is a distinct possibility.
Some tout the American healthcare system as the best in the world. I do not believe that. European healthcare is better. Why?
They are not as incentivized by money.
Too many doctors and hospitals in the US emphasize money to too great an extent. That degrades the profession to the level of clicks on a computer screen, number of incisions made in a day, scans performed, pills prescribed, tests run. The patient is merely a thing that responds positively or negatively. And, if that patient has bought a Cadillac insurance plan then more clicks, cuts, scans, prescriptions and tests are exacted.
The failures of the American healthcare system is greed, all the way from the halls of congress, who are lobbied to prevent a universal healthcare system, to the hospitals and clinics where bed turnover and volume is a high priority.
9
Too often health care professionals don’t listen to women, especially when we are pregnant. First race, then gender, and finally our condition make us less competent humans, it seems.
I have watched my mother’s doctors ignore her wishes and then push her into accepting what they wanted to do or not do, partly because she goes to a Catholic practice. I left that group because they refused to provide appropriate birth control when I asked for it. They were willing to give me birth control pills to “regulate your period” and told me that hormonal contraceptives did not cause depression or migraines as side effects, despite my suicidal ideation and debilitating headaches while on them. It was “all in your head” the female doctor told me. I switched practices.
When I was pregnant with my second daughter my OBs, both men, missed that I had pre-eclampsia until I needed to be hospitalized. They gave me so much magnesium sulfate, once there, that my blood pressure dropped to barely measurable. The nurse expressed amazement I was still talking. Once I did give birth, they gave me codeine even though I was allergic to it, and that allergy was listed in my chart, then dismissed me when I pointed it out.
Politics further complicates our care. Maybe in another century things will change. I have little hope that we will be taken seriously any time soon.
13
After my son was born vaginally my OB began to stitch up my episiotomy without even local anesthetic. I was literally screaming STOP STOP STOP, alongside several words I cannot print in the NY Times. My husband was wrapped up in how our son was doing, and no one else in the room seemed to care how much pain I was unnecessarily experiencing (I know it was unecessary because when my daughter was born in a different city with a different OB I was given a local.)
I cannot imagine the terror women with far more serious situations must feel, certainly I was absolutely treated as a non-person who’s medical needs were nothing now that my baby was safe.
I never went back to the doctor, did a follow up with a NP and found a new gyn the next week.
42
The same happened to me in UK. The attending dr sent my husband away and proceeded with the episiotomy without anaesthesia. 30 years later, I still recall the feeling of powerlessness while screaming in pain, and the (male) dr telling me not to make a fuss. I never had another child but chose to have an abortion after that experience.
8
Girls and women are sexualized, judged and sometimes punished for unplanned pregnancies and then treated as conveyor belts for babies who are planned and eagerly anticipated. Kim Brooks writes that Thea ' still finds herself feeling guilty for that fear, for “caring about myself and my mortality.” This, she wrote, “speaks to the way I, and probably many other women, was dehumanized and demeaned during the delivery,” and told that “our babies are much more important than we are.”' This says it all.
31
I'm a Neurologist and treat many folks with migraines, some of whom are pregnant women. To all the people who say 'Just treat me like an individual person" - I respond, I wholeheartedly _want_ to do that but the fact that many migraine meds are untested/presumed dangerous re: their effects on the fetus renders that completely unrealistic in our litigious environment...... So yes, I would _love_ nothing more to ignore the fact that you are pregnant and simply treat you to the best of my ability .... but guess what: if your child has a developmental disability down the road - and I gave you a medication during your pregnancy that was not already proven as 100% safe for the fetus - you will sue. I imagine this same phenomenon is at play for all subspecialties, not just neurology.
22
@GBR I do not buy that pregnant women come to you and say "Give me the best drugs for me and ignore all effects on my fetus." Of course they do not say that. More likely they want a discussion of the pros and cons of treatment, rather than an imperious dismissal of their symptoms with a paternal pat on the head and a soothing admonishment the health of the baby is the supreme concern. Perhaps if you recognized their agency in their own treatment you could provide better care.
8
@KW- It would be tough for me to offer a "paternal pat on the back" since I'm a woman. Another incorrect assumption of yours is that docs somehow care more for the fetus than the patient. Perhaps some rabid "pro-lifers" do , but most docs simply recognize that it's inappropriate to offer a patient something for treatment of pain that could cause lasting damage to the future-person that patient will love and want the best for.
3
@GBR It is the medical industry/profession that is paternalistic, patriarchal and especially dismissive of women. The increasing presence of women providers, unfortunately, has done little to change that. In order to succeed in medical school and training, everybody tends to take on those attitudes, which also pervade our society at every level. A "paternal pat on the head" doesn't have to come from a male provider, and medical arrogance is widespread.
1
My mother, a mother of three, nearly died delivering my younger brother after a very long labor was followed by a botched Caesarean section.
I was nine years old at the time and this was the first time I had ever seen my mom sick or in the hospital. My introduction to the natural act of giving birth turned into a terrifying experience for me just as I was entering puberty.
I have never been pregnant or given birth and I will never. There are many reasons for that, but my my mother’s injury during my younger brother’s birth is a big factor in that decision. The woman who is not telling her daughter about her horrible birth experience is doing the right thing.
13
@Jo
I wrote in earlier sharing an anecdote about how my own decision never to become pregnant or give birth was shaped by growing up knowing that my maternal grandmother had died in childbirth, as did the twins she was carrying. A male doctor made the choice to sacrifice her life in a futile effort to save the premature fetuses.
Maybe I missed it, but I don't think my comment was published, perhaps because I included an aside linking the subject matter of Brooks's essay to the broader politics surrounding women's control over our own bodies, including choices the NYT editorial page has made regarding which regular columnists to feature.
Where I differ from you is that I'm glad I grew up knowing this family history. I am lucky enough to have two adopted daughters. If they choose ever to become pregnant, I will support them, but I absolutely want them to read every word of this essay. Sure, it's mostly anecdotal, but anecdotes will get their attention and jumpstart the process of doing the sort of careful research needed to make informed decisions about their reproductive futures.
7
No I don't think she's doing the right thing.I never had kids but I bad abortions. I feel embarrassed saying this but a big reason why is because of fear of extreme physical pain and death. My mom didn't have an unusually difficult child birth but it sounded bad enough to be in labor for nine hours. What if her daughter winds up dying or has life changing complications giving birth? What's so bad about never having kids? Too many people on this planet as it is.
1
@UI
"Anecdotal" means it actually happened to a real person.
This article illustrates something that has bothered me for a long time. It seems that many Americans are so obsessed with believing that we are always and in everything the best, better than everyone else, that we fail to take advantage of what we can learn from others.
Other states can learn from the example of California (a state that many love to hate), and our nation can learn from the example of countries with lower mother mortality rates. Best practices are already out there. Why aren't we learning from and following them?
57
My pregnancy story is similar to many here....Induced birth, which led to emergency c-section (quite common, apparently, and what does one do when they are told, “the baby is in distress”.) Then, severe hemorrhaging, which led to many transfusions (7?), and then an ileas, and then a decision to only feed me with a N-G tube, and then, because potassium levels were off, instead of eating a banana, needing potassium (super painful) in the IV (which was attached for the 7 days of my hospital stay). The baby was perfect, no issues, which of course I am thankful for. But the hospital treated me poorly (I was on maternity floor, but the maternity doctors had no experience with my type of issues, thus, poor decisions like no food or liquids). I was not able to breastfeed, or hold or take care of my baby. (Connected to tubes and monitors). I had a straightforward pregnancy, no diabetes, no obesity, no high blood pressure. My amniotic fluid was not low when I was induced; in fact it was a bit high. I was advanced maternal age, but that was not a factor in the severe hemorrhaging. The whole experience was traumatic and did not seem like there was any reason for it. And afterwards, the way I was treated at the hospital was shoddy. All in all, women/mothers deserve better.
36
Being pregnant is no picnic. And - surprise! - the whole time I was pregnant I was actually a real, whole person, not merely a vessel or a fulfillment of a patriarchal fantasy. I am all about the sanctity of life. My own.
65
Another reason I always ask about my friends when they deliver. Everyone's all focused on the new baby (who I know is getting top notch care), but I worry for my girlfriends--they count too, and endured so much to bring this life into the world.
My feeling is this just goes back to how we treat women like 2nd class citizens in many areas of life. It's a shame.
39
As I read the comments, I could not help but think back to the early 70s when I had my three children. I went to a doctor, who was an obstetrician, not an obstetrical practice. I knew him, and he knew me, including my educational level; I knew barring unforeseen circumstances, he would deliver my baby, and I knew he would listen to me and not dismiss what I was saying. After every exam, I got dressed and went into his office; and we talked. My daughter’s and daughters-in-laws’ obstetrical practices didn’t seem to establish that kind of rapport or offer the same kind of support. Maybe that is why women use nurse-midwives and doulas. Back in the day, an obstetrician who did not establish rapport, did not listen to his patients and whose staff did not offer the support would not have had a very good practice and would not have earned very much money. Oh yeah, and not so many women died in childbirth.
19
Particularly for the states that continue to push for rights of a fetus to surpass those of the mom, they have a vested interest in NOT looking at this data. It might force uncomfortable truths. At the very least it would be expected to show that access to prenatal care, especially for low income women in this country is insufficient. Which then makes cutting taxes which help fund public health initiatives and planned parenthoods more problematic.
26
I nearly died giving birth to my first baby in 2011 when the hospital botched an emergency induction. I was absolutely terrified of giving birth again - I was not afraid of the pain or the process, only of having to deal with the medical profession which harmed me so badly. Of course, I managed to survive despite the best efforts of the hospital, so I am not counted against those maternal mortality statistics. I'm sure, if I had died, they would have found a way to blame me for my own death.
23
Perhaps the writer could also emphasize that childbirth actually can be an extremely dangerous event, and occasionally bad outcomes will and do happen and are unavoidable. Every bad outcome is not due to malpractice, or negligent care. Truly terrifying events happen in an emergent fashion on the labor and delivery floor that human care providers can struggle to overcome. Occasionally (not always) patient modifiable lifestyle factors, such as patients with severe morbid obesity, do make these emergencies more dangerous. If the expectation is that care teams can rush into critical obstetric emergencies, make agonizing and instantaneous life or death decisions for the health of mom and/or baby, then the reverse potentially fatal physiologic processes for mom and/or baby while always keeping a smile on their face and being touchy feely about it, then maybe expectations need to be reset.
Having a doula will do nothing to lower the risk of a patient with morbid obesity and a difficult airway that requires an emergent C-section under general anesthesia because their baby has a prolapsed cord. What will save that patient's and their baby's life are care providers that are highly technically skilled and efficient, not care providers that are nice or warm.
Biased anecdotes without objective medical information aren't terribly helpful.
29
@Scott, if you're suspicious of anecdotes, why not look at the objective medical information? Our maternal and infant mortality rates are well above those of other developed countries. Alabama doesn't have three times the maternal mortality rate of California because its women have three times the health problems. It simply hasn't put the effort into studying and lowering these rates.
You're engaged in victim blaming. We're not talking about morbidly obese mothers--we're talking about the general population, including healthy mothers.
Instead of dismissing the problem, look for solutions.
45
The statistics that were provided were not biased. That the lives of two women who suffered were used To illustrate the statistics is simply good journalism.
Your dramatic examples of “bad women” Is a good example of the bias against women the article demonstrated. Since you have medical knowledge, or appear to, perhaps you can explain why we have the worst mortality rate of any developed country.
2
Scott,
You missed the entire point, there, but you certainly got that “blame the mother for her own death” part down pat. When you give birth to your first child you get back to us in this, you hear?
4
My HMO discontinued prenatal care in my area during my 5th month of pregnancy. As a 33 year old I was considered to be of advanced maternal age, especially for a first pregnancy. I found a team of midwives within 2 weeks and contracted to work with them, since my health plan had NO plan whatsoever.
At 40 weeks, with no signs my baby was ready to be born yet - no contractions, no dilation, no show - I met their supervising OB, "just in case." At 42 weeks (yes, quite overdue), he said he'd let me go over the Labor Day (ha!) weekend, but Tuesday morning was "D" for delivery day. I started pitocin at 9 a.m.; Friday at 730 p.m., I delivered my son by C-section. Three and one-half days of pitocin and osmotic dilators did NOTHING to shake our kid loose. He'd gone from 9.5 pounds (give or take 1/4 lb.) to 7.75 lbs., but he was in great shape. We were ecstatic (especially me...).
Our situation could easily have been disastrous, but careful, watchful professional caregivers made my labor and delivery work out just fine. We talked easily and earnestly about what was best for me, and for my baby, without any specter of guilt or demeaning of my worth.
I realize my experience was exceptional. But no woman should ever have to be at war with her caregiver over her own health and safety.
20
When my daughter was born 22 years ago, the doctors ruptured the amnion and induced me at 38 weeks as it was almost time. Pitocin is a mean inducer. Pain is unbearable, and I opted for an epidural. My husband was too chicken to witness needles so he waited out. With the first epidural shot, I went blind and told the doctor that. She removed her needle hastily and injected once again. This time around I could not feel my leg. But the labor pain was so great, if someone had suggested amputating my leg would have helped, I would have given them permission to go ahead. By the time she hesitantly asked if she should try a third time, I was ready to push. She gave me a shot of useless stuff and I had my daughter anyway, thankfully without further complications except for the docs arm right inside me trying to hang on to the placenta for dear life. Eight years later, with my son, I had my husband in the room for my epidural. It seemed like nothing much had changed, as my amniotic fluid was really low when I was admitted and they knew it only because I was weepy and felt something seemed off with my baby. I shudder to think we might have waited another week without knowing the environment the baby was in. The same Pitocin, the same conditions as my daughter. Except for the quality of the ultrasounds, absolutely everything else was static in the maternity ward.
Perhaps, we need to ask why women are so low in the priority of medical evolution.
44
I have yet to be pregnant, but everything about this country's healthcare system makes me want to go elsewhere when I am. I had just spent 2 years in Europe, paying out of pocket (cheaper than you could ever imagine) for the BEST and most attentive care I have ever received. I was never rushed, never felt like I was being pushed into medication or testing that was unnecessary, and was able to be a part of the conversation about my reproductive care WITH my doctor.
Now I'm 30 years old and back in the US healthcare system. Not only is the cost more than I can manage, I just had a "wellness" GYN visit. The doctor spent maybe 10 minutes with me, stared at a computer screen typing the whole time, never asked about my past/present/future medical concerns, never asked if I was happy with my contraception method or if I might consider starting a family at some point (I am married). Instead, she pressured me to get the HPV vaccine that was recently approved for women up to 45, and a host of other genetic cancer testing that may or may not even be necessary. It seemed like she was throwing a blanket "standard of care" checklist at me, rather than having a discussion about the best method of care for ME.
Considering that my husband is from Australia, where heath care and standards of living are far higher, I only hope we make in there in time to start our family and I don't end up stuck (or worse) in this absolutely disgraceful system.
70
I realize this is an opinion piece, but there is very little scientific support behind the argument and way too many personal and terrifying vignettes that make it impossible to take seriously. I'm 32 weeks pregnant with my second child and an epidemiologist focusing on infectious disease. What was the purpose of this article apart from giving people a platform to share their traumatic birth stories? Where are the action items and movements within the scientific and OB communities?
33
You have dismissed, with just a few, cursory sentences which are thrown into the middle of this piece and which are essentially devoid of argument, a wide body of medical literature. This data shows that maternal obesity, hypertension, and diabetes are very important risk factors contributing to maternal death during childbirth (as well as negative outcomes for the child) and to the disparity between the US and to other developed countries. It isn't the whole story, but it's a huge part of it. This absolutely does NOT mean that it is the fault of a woman that she has hypertension or diabetes or obesity, or any other medical issue, despite widespread attitudes to the contrary both inside and outside of the medical community. And you're surely right that the medical community's role in maternal deaths should have been evaluated more closely in the reports you mention. And without a doubt we must all reevaluate how our society reduces mothers to little more than that. But the medical reality of a high-risk pregnancy is not victim blaming.
27
@James, I think the author's very valid point is that we aren't studying the reasons for high maternal mortality rates in the U.S., and until very recently we weren't even keeping adequate records. Hypertension, diabetes and obesity are risk factors for any operation, including appendectomies, but we don't see the same skewed outcomes with appendectomy patients. I don't think the women in California are one-third as likely to be diabetic or hypertensive as women in other parts of the country, but the outcomes in this state are three times better because maternal mortality is being studied and addressed.
Of course we need to address obesity and diabetes. But as long as we dismiss our outsized mortality rates as unavoidable because of lifestyle factors, we're going to keep losing more mothers and babies than other countries.
19
It is shameful to blame the victim except in those rare cases when the victim is woefully neglectful of her own and her child's health.
Two seconds with the relevant health data identifies the primary driver of child and/or mother's deaths are morbid obesity.
We can do a lot of things with modern medicine but we can't overcome the self-inflicted wound that derives from morbid obesity coupled with pregnancy.
5
@SteveRR, we're not talking about morbid obesity. We're talking about preventable maternal deaths.
The attitude expressed in your comment is the same as the attitude in the nineteenth century that accepted maternal deaths from infection as normal and unavoidable. If society doesn't think there's a problem, it doesn't look for a solution.
According to a recent study by the CDC Foundation, 60 percent of maternal deaths in the U.S. are preventable. Your claim that morbid obesity is the primary driver is false.
High maternal death rates are a public health problem that we need to address through science. The two primary causes of maternal deaths are preeclampsia and hemorrhaging, both conditions that are very treatable. For a better understanding of the problem:
https://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger
6
Why doesn’t this happen in other countries? They have better healthcare & food systems. The less well-off in the US subsist on high calorie food...because it is cheaper. What else can someone making $10 per hr afford! We need to look in the mirror & figure out where our priorities lie!
1
I tried for years to convince my fellow physicians to count things in medicine that mattered. Pregnancy related deaths of women matter, just as neonatal mortality--which we have long tracked--matters. Annual counts these women ought to be published, and each death should be investigated the way we investigate plane accidents, fires, and all other catastrophic events. We need to learn from these investigations, the goal being to decrease pregnancy-related deaths to zero.
24
One of the main issues into why this happens, is the quality of care related to whether competent people are in charge of women who are in labor. We know of one case of a friend who wife, was young, and in labor 24 hours out in Yakima, Washington, who died, the child lived but with severe cerebral palsy. Had she had her baby in Minnesota, it is doubtful that this would of happened. The other issue with pregnancy, is the fact that a majority of young women start out as users of drugs, and are obese, which only adds to the underlying conditions that can raise blood pressure, cause gestational diabetes etc. and other conditions. Also, over the last two decades more and more older male doctors got out of delivering babies, especially in smaller rural areas, as their malpractice insurance was cost prohibitive. They had years of experience delivering babies, and most were men. Now, most of those who deliver babies are females, but that alone doesn't insure any benefit to the pregnant mother, as experience, and competence, of those attending to those in labor, and the natural health of the mother before pregnancy all matter.
5
It's not just Alabama. Another State, OHIO, just made the fact of a fetal heart beat a mechanism to deny a woman an abortion.
I am glad to read that California leads the nation with finding and applying pre-natal care for both the mother and the growing fetus.
But I have to say, that the medical establishment in the U.S. suffers from MALE PRACTICE.
My best comment is that Planned Parenthood provides excellent to superb medical care for women seeking to conceive, have a safe pregnancy, and give birth.
I would rely upon Planned Parenthood first and foremost.
34
@RR I believe you have overlooked the fact that over the last 30 years, obstetrical care has changed from male dominated to almost exclusively female provided. There are very few male obstetricians in training now.
3
@Dr B The presence of female practitioners does not change the paternalistic nature of the system. The entire body of ob/gyn knowledge assumes that women are unable to make informed, intelligent decisions about their own bodies, and the standard of care reflects that, no matter the gender of the practitioner.
4
But I did have get a chuckle reading a dude exclaiming that a field that is still dominated by men by 64% is almost exclusively female. I guess it must feel that way when 30 years ago the field really was almost exclusively male. Equality doesn’t have to hurt! Guess what? There are still way more male urologists and I expect that trend to continue.
3
This needs to be looked at closely.
One wonders if the war on Planned Parenthood has made it harder for some pregnant women to receive high quality medical care. People have argued against making it generally hard for Planned Parenthood clinics to provide medical services on the grounds that they provide a wide range of reproductive health services.
We must look into the causes whatever they are in any case. But it’s particularly unconscionable to burden a major provider of women’s health care for political reasons and then look the other way when there’s an unexplained rise in maternal mortality. Whether there’s a connection or not, find out what’s going on and address the problems.
22
America has long been the land of pedestalizing motherhood, yet having among the fewest benefits for mothers of any wealthy country in the world. Not only is this bourn out by maternal death and injury rates, but by the rates of mothers with no health care, no childcare, no housing, no access to college or jobs. In other words, why are so many mothers and their children living in poverty in the U.S.?
35
@CH Why are so many mothers and their children living in poverty in the U.S.? Because they choose to have children without a caring father and without the resources necessary to raise a child. The strongest predictor of poverty for children of any race is to be born and raised by a single mother. That is a choice that the mother makes, not anyone else
1
These statistics and stories are downright sickening, but the article ignores the deplorable fact that the US is also 44th from the top in the world in infant mortality. We are losing them at both ends. All of the reasons stated in the article are true, but are only part of the larger picture: The health care in the US is in large part inadequate because of the inequity in providing what should be a universal right for health care. It is not a coincidence that most of the countries ahead of the US have the dreaded "socialized medicine.''
35
1.Many of the states that have the highest maternal mortality rate have the highest infant mortality rate. Surely this is evidence against this absurd post-modernist language of the mother being "no longer considered a person." Just to be sure: are the states that have highest levels of maternal mortality and infant mortality "dehumanizing" both mothers and children? Paranoia.
The article links to the study about the rising maternal mortality rate across the states, the article itself says two really interesting things that readers should be away of:
1.Many chronic conditions and diseases are associated with pregnancy complications. Rising rates of chronic disease such as obesity, hypertension and cardiovascular disease have contributed to the rise in maternal deaths. Operative word: rising.
and
2. 31.9 percent of maternal deaths from 2013-2014 occurred in women aged 40 years or older [6]
The average age women in the us are having children has changed. The later a woman gives birth, the higher the *possible* risk of complications. Do these statistics play any role in the rising maternal mortality rate? More women are having children at a riskier age and the rates of dangerous conditions are rising. Or is it as many commenters have suggested, simply "white men" who have caused this issue?
I hope citing these two possible statistical alternatives to account for the rise in the rate in maternal mortality is not "victim blaming."
16
@Dave, I think it's a bit paranoid to think most people believe this is a problem with white men. It's a public health problem.
Maternal age is rising in every Western democracy, but maternal mortality rates are falling. Why? This problem deserves our full attention since, according to a recent study by the CDC Foundation, 60 percent of maternal deaths are preventable.
We are succeeding in drastically cutting infant mortality rates in the U.S., which is a scientific success story. Let's put the same effort into maternal mortality instead of assuming that we can't do anything.
For further information: https://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger
5
@SandraH. thank you for your reply.
One of the studies cited by this article says this: “By 2013–2014, the maternal mortality rate for mothers aged ≥40 was 269.9, 18 times the rate of 14.7 for 25–29 year olds (p<.001)... Although rates appeared to decline slightly for women under 25, and increase slightly for women aged 25–39, none of these changes were statistically significant. In fact, there was no statistically significant difference in the maternal mortality rate for women <40 across these two time periods (p=.38). The increase for ≥40 age group (p<.001) accounted for all of the overall increase in maternal deaths between the two time periods.”
The increase is so sharp that the paper goes on to say that is more likely due to “over reporting.”
This is a complicated issue that emits of many solutions, including taking a real hard look at our healthcare system. Yet, Comment after comment here insists that either white men or republicans (read: white men) are the nasty, mendacious people behind the scenes causing the the death of mothers. That type of simplistic anti-scientific, anti-statistical attitude is both poisonous to our discourse and ultimately destructive to our democracy. Intelligent people reading the ny times actually post that they believe women “cease to be a human being” when she is pregnant. What happens to a society when its brightest start to believe conspiracies like this?
1
@Dave I should also note here, that I have been unable to find any studies done on pregnancy/maternal mortality and America's rising opioid epidemic: which claimed 70,000+ lives last year. This could be another factor in this very complicated issue we are faced with here.
I am a millennial woman who would like to be a mother soon. These stories press on my thoughts more than I admit even to my closest friends. In my (thankfully) limited experience as a privileged woman seeking medical care, I already know I'm not being heard by the medical professionals I've been in contact with. I can't imagine how this would be in the delivery room and after.
13
@J The recommendation of one parent based on personal experience (yes, a dad not a mother, and this is an anecdotal as it gets): Consider using a midwife.
2
@J
Really, try Planned Parenthood.
1
@J I'm a 75 years old woman and we all know that old people are "invisible". But I have multiple doctors who give me all the time I need, listen VERY carefully to what I have to say, and are respectful and very kind to me as well. And I'm a cranky old woman who does not suffer fools gladly!
If one does not like ones doctor, find another! There is no insurance plan on earth that limits one to only one physician (unless one lives in such a remote are that there is only one physician there!).
But there is a BIG difference between "being listened to" by ones physician and being "in charge" of ones own health care. Your physician is "in charge" as he bears the responsibility, both moral and legal, for your health. If you refuse to follow his recommendations (which are nearly always based on "standard of care"), then don't expect much sympathy from him. You're not the one with MD after your name, are you.
1
The solution to the lack of medical care that emphasizes the health and life of the pregnant woman is not the following:
"Women know what they want when it comes to labor and delivery, and it turns out the things they want (midwives, doulas, fewer unnecessary interventions and cesarean sections) are less expensive and produce better outcomes.”
That is going back to cave dwelling.
No, demand that physicians, obstetricians, gynecologists, and hospitals are better trained and regulations are put in place to ensure that excellence in standards are met.
ALL women need to become more vocal about their care whether pregnant or not.
12
@Mimi Midwives, doulas, fewer interventions, and C/sections do nothing to prevent the primary causes of maternal death, which are Embolism (20%), Hemorrhage (17%), Pre-eclampsia and eclampsia (16%), Infection (13%), and Cardiomyopathy (8%). There is not a single midwife or doula that can treat those disorders, and in all cases of pre-eclampsia and eclampsia, a C/Section is the cure for the problem.
6
The fact that pregnancy holds the potential to harm the health or kill a woman is the reason why no man or man made law should ever be passed that takes full power and control over female bodies and their reproduction, from contraception to abortion to labor. It should all be up to the woman and her choices alone.
48
Blaming the victim is the first response. Why not? It absolves one and all of any responsibility in dealing with the issues and problems. We need to make medical care a right for all. We need to be governed by kindness not fear
465
@Slow fuse
In making ERs provide emergency services no matter what, we have gone as far as we can toward healthcare as a ''right.''
We have made some of our most awful mistakes as a nation when we over-reacted to things we didn't understand.
Let science take its course. Even the most conservative thinkers do NOT want to see these women die.
There are the three nevers: radiation, lead, mercury.
There is human failure including memory.
But we don't even know how to handle every case of heart failure when it happens. A lot of heart conditions can't be predicted with testing or screenings.
How many sconds do we have once a heart stops? That first guess had better work.
4
@Slow fuse so people have no responsibility for themselves? It's an oncologist fault that a three pack of cigarettes a day smoker comes in with cancer? Or the local skateboarder fractures his skull? Or the 400 pound woman down the street dies of heart failure at 38.
Perhaps we have different ideas of victimhood but mine doesn't include someone killing themselves four years being considered a victim. It doesn't include a woman whopl fails to follow simple prenatal care, who becomes pregnant while morbidly obese, who does nothing to take care of herself and then has the audacity to complain about the doctor and childbirth. Those aren't victims. Victims are people who had no control, people who were caught in a circumstance whereby
nothing they did had anything to do with what happened. I'm walking down the street minding my business when a tire flies off a car and kills me. I'm a victim. I'm walking down the street in broad daylight in a safe neighborhood and somebody robs me. I'm a victim. I walk down a dark alley in a bad part of the neighborhood at 3 in the morning and I get robbed. I'm stupid. I'm not a victim I'm an idiot. If we did a little bit more victim shaming maybe people would be a little bit more aware of doing the right thing instead of doing the wrong thing and then everyone throwing a pity party for them. Yeah we need kindness but a lot of people also need tough love.
4
@L'osservatore Can you, or someone else, explain how this comment has anything to do with Slow fuse's post?
26
It is important for patients to be informed about their family medical history at a minimum before they agree to use their physicians's services. Physicians carry with them rote algorithms that are triggered in response to a few cues upon meeting their patients. Except for patients who can show a modicum of knowledge about their own conditions, physicians generally rattle off from their algorithm of the moment answers that may or not be pertinent to their patients's actual history. It is the responsibility to be aware of the limitations of human knowledge, especially knowledge in the medical sciences and arts, which is by its very nature intrinsically uncertain and replete with errors. Buyer beware!
90
@S. L This is absolutely true. I learned after my first pregancy went a week past the due date, that late delivery can be hereditary. I was 3 weeks overdue and weight 9 pounds, 3 ounces and was 17 inches long--like giving birth to a bowling ball; my older brother 2 weeks overdue, and weighed 8 pounds, 9 ounces. In the 1950s, they didn't do C-sections as often. But such large babies left my mother with lasting health issues.
23
@Katz,
In the 1950s, movie fare in Paris was sparse and at age nine, a childhood friend and I were sent to see a documentary on giving birth by her parent in possession of a large family of her own.
Now. I do not remember the graphic details, but for some reason, we remained childless at a more mature age with no regrets.
At the time your mother was giving birth, another era, you might have been labeled as 'Lazy Babies', and if a woman was in need of a C-section, it was considered serious. Serious enough to be told by the medical profession that she could never have a baby again.
There is a popular British series trending on Netfix 'The Midwives' for the Courageous among Us.
12
@Katz All four of us were 10 pounds something at birth in the 40s and 50s and Mom was health and hearty till she died at 85. And no C-sections. She was also a white woman in Toronto, Canada - that might have been significant in the baby birthing lottery.
3
Medical truth #1: people can still be harmed if doctors make their best choice which later turns out not to have worked. There's no fault or crime here. Welcome to humanity.
Are wwe causing doctors to do so much paperwork for governments and insurance companies that they don't have decent prep time or sleep to be ready for what the next day brings?
We already know that many or most doctors can't just hire another clerk, train them in how to do this accounting work for outside funders, and also service their student loan debt from college - we saw that here not too long ago.
Fixing the tort system will really help on this. Taking the casino effect for attorneys out of medical care would help a lot.
5
@L'osservatore Thank you for saying this. I recently attended the funeral of a 8 year old boy with childhood cancer. In this case, the family was extremely educated and had significant resources and social capital. They sought multiple options at two or three of the most prestigious child cancer centers in the nation.
I'll never forget the mother delivering the eulogy, agonizing that this was a case where even the experts disagree. Ultimately they made an informed decision.
Would their child have survived if they had gone to hospital X instead of Y? No one can know. The point of the matter is the tragedies happen, medical science is not perfect, some issues are unforeseeable. Even the best, brightest, and resource-rich of us experience terrible medical outcomes.
12
@Factumpactum, no one is asking medical science to be perfect. The hope is that we can achieve the reduction in maternal mortality that every other Western country has achieved. Why should preeclampsia be so much more lethal in the U.S. than the U.K.?
Preventable deaths are not something to be philosophical about, any more than plane crashes. Federal investigators figure out why the plane crashed, and use that information to improve the system. Shouldn't we do the same for women giving birth?
6
@L'osservatore, your comment changes the subject. Paperwork isn't the reason for higher maternal death rates, and obviously eliminating civil suits would have a negative effect. To understand why civil suits are helpful in pushing reform, please read the following:
https://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger
3
Figure out how to use that ER episode. I can remember it viscerally what—25 years later??
1
@Maureen Kennedy you mean the one titled “Love’s Labor Lost”? I remember it too and it was brutal.
Claire's story reminded me of my own. My pregnancy was uneventful and full term. Once at the hospital, though, everything changed. The Resident on duty insisted that I NOT push because I wasn't fully dilated - for three hours. By the end of that time I was so exhausted I could barely push. Then it was discovered that my daughter was occipital posterior. The team wanted to attempt to turn her manually. The anesthesiologist, who had been hovering like a bird of prey, finally got his wish to give me the pain medication I'd been refusing. When turning her failed, I was advised to have an emergency C-Section. Exhausted, and with my daughter starting to show signs of stress, I agreed.
Somehow between Labor & Delivery and the OR, my medication catheter kinked. When the surgeon began to cut me open I said "I can feel you cutting me." He condescendingly assured me that "what I was feeling was 'pressure.' I continued to insist that I could feel the blade cutting, while the OR anesthesiologist - another Resident - frantically pumped more doses of pain medication into the catheter, not noticing that it was kinked and I wasn't getting any medication. That was finally discovered when the attending anesthesiologist finally showed up - but not before he dressed down the Resident for paging him more than once. With the tubing unkinked, I suddenly got multiple doses of meds, which knocked me out for hours, causing me to miss my daughter's first few hours of life.
422
@Lisa The NYT needs a "sadness" button to click on. I definitely do not "like" what happened to you. I nearly bled to death during my first pregnancy.
100
@Lisa
I know that it is not much help but thank you for the description of the battling Operating Room professionals. You did a great job of drawing the scene.
I am sorry for how the medical community treated you, and nearly killed you.
I am glad that both you are your daughter are alive.
66
@MLChadwick Or one for anger. I'm seething after reading that.
55
Many women experience the "cascade of interventions" while pregnant and giving birth. I was very fortunate to have my two children delivered by Certified Nurse Midwives who were in practice with traditional ob/gyn doctors. The doctors and CNMs were mutually supportive (it seemed to me anyway). I felt the midwives had my and my children's best interests at heart every step of the way. I gave birth in a hospital and am glad I did (because of postpartum hemorrhage).
175
If the USA were less misogynistic, less racist, in short, more humane in the way it delivers health services to women as a whole, more women would survive with less trauma. I see this not only as a medical issue, but a cultural one. Yes, there are compassionate doctors and midwives out there, but they are few and far between.
23
"America" is? Truly? Guilt-tripping much, and also, loading a few into a redefined "American women"?
In 1978 I had the good fortune to read For Her Own Good by Barbara Ehrenreich and Deirdre English and decided I would never give birth in a hospital.
Forty years later things don’t sound any better.
8
The treatment of pregnant women is a major reason I am childfree by choice. I've been around too many pregnant women, heard too many labor and delivery horror stories, and judging by what I've read in the comment section those horrors are common. What a nightmare. We must do better.
9
That’s a shame. It’s your choice of course, one I hope you don’t come to regret. Maybe you’re listening to the wrong people. Most American women have pregnancies that end happily and go back and do it again!
1
I accompanied my wife into the delivery room at UCLA Hospital. She was to undergo the first Swedish suction extraction delivery in that hospital. Like the other ten or so men in the room facing my wife on the delivery table, I was dressed in green scrubs, not distinct from the others. "Come on, Charlie (ficticious) give her a C-section, I've got a tennis date in fifteen minutes." said a voice. "Maybe we ought to let Charlie give her a Swedish suction extraction, not a C-section, that's my wife." Charlie elected me to be the pumper, creating an air vacuum in what looked like a shiny houselhold galvanized bucket, with a plastic dome pver it and some tubes running to what looked like a toilet plunger. I kept pumping, at Charlie's request. Out popped my son, a hematoma on his head, somewhat lopsided. "Don't worry," said Charlie, "the hematoma will gradually go away." It did. I wonder though, if the green-scrubbed resident standing beside me, ever got to play tennis.
8
You're just creating more consumers for the endless treadmill that serves the people who devalue you. Maybe stop it?
1
Rather than an article on concrete set of approaches to improving outcomes, the author laces the article with the social commentary of our times. I'm surprised the it didn't start with a full on complaint of the White Patriarchy. The author repeats multiple times, that "Women know what they want when it comes to labor and delivery" and the system is not listening to them. Some additional fact based data - 5 leading causes of infant mortality - #1 - birth defects, #2 - Pre-term/low birth weight, #3 - SIDS, #4 Pregnancy complications #5 - injury. While there is a correlation to race, it is really a Black woman issue. Hispanic and Caucasians have equal infant mortality rates - (5 vs 4.9 /thousand), Asians are lowest 3.6/thousand. Black Women /infants - 11/ thousand. Finally, the problem is focused in the south eastern non-coastal state with roughly double the infant mortality rate of the west coast or north east. Net, net this is a combination of delivery systems and targeted populations
6
@Chris, I'm surprised that two male commenters take this article as an attack on men. Where does the author ever mention men? She's talking about a public health problem--maternal mortality, which is going up. (Infant mortality in the U.S. has been drastically reduced.)
The U.S. has higher maternal mortality rates than any other Western country, and it doesn't just affect black women or one part of the country. California is unique in trying to address the problem, and it has succeeded in reducing these deaths by two-thirds.
Here's a thorough discussion of the problem, along with concrete steps for addressing it:
https://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger
3
I've had negative experiences when my children were born, too. Even with women doctors. One sent me home because she thought I wasn't in labor, and the baby was almost born in the car as we rushed back to the hospital from home. One almost blindsided me with an episiotomy even though the baby was on the verge of delivery and there was nothing to indicate a need for such a thing (the baby was born before she could go through with the unwanted act, and it had never been mentioned through all of my pregnancy and regular trips to these doctors). One nurse told me to stop screaming because it wasn't doing me or anyone else any good (she should see if she would scream if she were giving birth without any anesthetic at all, after going through labor in the front seat of a subcompact car). They treated me like an animal with no brain, wishes, feelings, or understanding of my own body. That was decades ago, but it doesn't sound like things have gotten better. That was my experience, and I was/am white and middle class. I can't imagine how much worse for those who are poor and non-white.
25
In so many ways, large and small, our Amrican society tells women that they are unimportant. I really cannot imagine what it is like to experience that through out ones entire lifetime.
The same can be said for minorities and those living in poverty.
Unfortunately, so many people in America oppose efforts to improve people's lives.
21
Medical student here. Yes, the specific cases in this article are failures of physician care - for example, Thea's doctor did not obtain proper informed consent by threatening her and failing to discuss alternatives. However, I do take issue with the author's claim that equating factors like smoking and obesity with increased maternal mortality and morbidity is "victim blaming." There are research studies that have found a statistically significant correlation between maternal obesity and risk of many different complications during pregnancy and delivery which can lead to maternal death. Additionally, average maternal age is increasing, which has also been shown to carry a higher risk of complication. Of course there is a severe lack of research into maternal mortality and the rates in the US are shocking, but these contributing factors cannot be ignored.
237
@Future Female Surgeon Dear Medical Student, Not all women who have these problems smoke or eat too much. And I speak from personal experience on that.
122
@shar persen That is certainly true, but that doesn't mean those aren't contributing factors to the recent rise in mortality rates. From a population standpoint, they absolutely are. For example, obesity is a risk factor for developing hypertension, but that doesn't mean all people with hypertension are obese.
53
@Future Female Surgeon
Except the factors you list are common to other developed countries which have far better maternal mortality rates than the US.
We also have obesity, older mothers and smoking as issues in the UK which sees around 9 maternal deaths per 100,000, not great but much better than the 14 per 100,000 deaths you see in the US.
& there is plenty of evidence around maternal mortality from countries such as Iceland (3 deaths per 100,000) or the Netherlands (7 deaths per 100,000) both with previously much higher rates.
The weird thing to an outsider is that your country can't be bothered to track the data, even when you're being forced to pay and outrageous amount for maternal care that might kill you.
248
Good god, the men in charge of this country are just monsters.
12
@NFC, sarcasm noted. This was an article about a public health problem, not an attack on men.
Good grief.
2
When I had my firstborn back in the early 70’s my doctor was educated in England and had been involved in the development of the shot you get if you are rh negative which was lucky for me. He was supportive through out. When I arrived at the hospital in labor he was leaving to meet me at his office. I was his first patient that morn. He never left my side except to call his office and cancel his appts and to prep for delivery. Perhaps his attitude was that way because he went into OB because of his mother’s death.
10
My wife wasn't in danger during her labor, but the arrogance of her doctor was striking, and contributed to what I'm sure was bad decision-making. (I mention that she was a woman only because we thought having a female ob-gyn would result in more nuanced, empathetic care.) My wife was induced on a Friday at the doc's insistence--now, I realize, to avoid getting called in over the weekend. We went along because we didn't realize how rough the pitocin experience could be. The doc was barely ever in the labor room, was dismissive of my wife's statements of her condition, etc. It was reminiscent of what my mom tells me about her doctor when I was born in the 1960s—they wouldn't listen when she insisted over a period of hours that something was wrong, but finally did an emergency C-section that saved both our lives. My wife and I used a midwife for our second child and it was a far better experience. Night and day, really.
20
In my middle 60s I had some vaginal bleeding and since my maternal grandmother had had uterine cancer I immediately checked with my regular GP who sent me to an OG/GYN in Savannah, near where I was living at the time. This doctor wanted to take a biopsy which was done without any sort of anesthesia whatsoever. I should have known what to expect when they strapped me down, including my hands and feet. The pain was horrendous since it involve scraping my uterine lining. I told the doctor afterward, that if I hadn't been strapped down he would also have been in deep pain from the kick I would have applied to his sensitive anatomy!
21
Not sure I've seen anything in the comments that speaks what used to be (or still is??) the position of the Catholic church. Your article and these women's stories made me immediately think of the film, 'The Cardinal', from 1963. I remember watching it a very long time ago as a young teen. At the time, the thought of having a priest decide that if only one of us could survive, mom (and his sister to boot!) would die and baby would live, seemed insanely wrong (as a 15 year old non-Catholic). Woman as vessel for brand new Catholic on the planet.
12
Treated like cattle indeed with moral terrorists such as La Leche League or random strangers passing judgement on women who do not breastfeed, and other strangers passing judgement on mothers who breastfeed for years.
Society is the problem.
Add the fact that this is a litigation nation.
My experience (3 pregnancies in NY) versus my sister (2 in France) is light years away: she got to spend almost a week in the hospital after her 2nd birth, whereas with mu third I got kicked out after 48 hours (and not from when I gave birth, from when I was admitted). We are indeed treated like cattle, yes, the kind no one gets up for in the crowded subway. I remember riding the 4 from Tribeca to the UES , around Union Sq a woman walked it, she looked even more pregnant than me, non one got up, I ended up giving her my seat.
This is what is wrong: SOCIETY.
17
@MargeThe La Leche woman who came to my room made me feel terrible. I was so I’ll, had given birth 8 weeks early, and had no milk. She harassed me so much about how I was going to hurt my baby. Finally a male doctor told me to stop trying because it was more important for me to sleep. My daughter is very healthy years later. I appreciated my doctors and nurses.
13
@Marge I was happy to leave the hospital after 24 hours. The nurses and doctors were very nice, but there's no place like home. With my third child they had a policy that everyone stayed at least 48 hours. I would have rather been home.
3
@Moira Rogow You have identified a critically important issue - Was the policy change to a mandatory 48 hours driven by evidence and best practices? Or by the hospital's legal counsel. Something tells me this decision was driven by litigation, not patient care.
1
When I attended Johns Hopkins nursing program in the 70s the United States had just begun to approach other developed countries in Infant Mortality Statistics. Looks like we need to now emphasize Maternal Mortality Statistics as a separate category. Devoid of politics and corporate liability interests. I find it very startling that this is accepted or tolerated.
10
This sort of thing sounds like Donald Trump mischief. He hates women and blames everything on them. Probably because most women find him repulsive and he himself think he is the hottest thing in the world.
3
"Through a large-scale international effort, maternal mortality was reduced by 43 percent worldwide during that period, and by almost 50 percent in developed countries. Meanwhile, the rates of American women dying from pregnancy rose."
You can thank Republicans in Congress for that. Their goal is limited or no contraception; forced pregnancy; denying that healthcare is a right in a civilized society and preferring healthcare as a luxury for those who can afford it. All concern about the fetus in the womb; no support for the mother.
20
Yes! And very little support for the fetus or its mother after it is born and qualifies as a child, particularly if the mother is poor and unmarried.
1
This is a multi-factorial problem. A number of posts note that male O-Bs often do not listen to their patients until the problem(s) reach a crisis stage. Another is access to care. My state has maternal mortality rate a little above the national average and like the national average is rising. But, if you break it down and look at the counties east of I-95 the rate is half-again higher than the NC average and the rate for African-Americans is more than double. Access to care and proper pre and post natal education is poor in this area as is education in general. The only high risk O-B care and delivery is in Greenville and some live hours away, assuming that they have transportation.
And finally, several posts point out that once a woman becomes pregnant she is no longer an individual with rights, just a vessel for a new life. Those who oppose abortion are NOT "pro-life", rather they are "pro-birth" and don't give a flip about the mother or the child. And that explains why infant mortality rates are climbing and in some areas surpass our Latin American neighbors.
There is no will for change other than to make reproductive services more difficult to obtain.
7
I have participated in a maternal mortality review committee and agree that they should scrutinize medical care, but very often these deaths can’t be directly attributed to mistakes that providers make. A maternal death is defined as a death that occurs within a year of the end of pregnancy, so it’s a mistake to imply that the mother is always dying during delivery or that a provider could have always done something differently. Our health is determined by so much more than the medical care system. This is why it’s so critical for review committees to look at underlying factors that are associated with a woman’s death. The public health departments that lead these review committees don’t see it as “women smoking too much or getting too fat”. They see it as a failure of the public health system to create an environment in which women can be healthy, and they use that information to implement policies and evidence-based programs focused on primary prevention of maternal mortality and maternal morbidity. I support the intent of this article in raising awareness about maternal health, but unfortunately it fails to capture the true picture of maternal deaths and the real strengths and weaknesses of review committees.
14
time is money for Physicians particularly OB gyn's. many years ago I was a planner for Hospital. when the OBGYN started driving Porsches I knew something was awry and the multiple marriages. the disregard for Professional Standards and prudence among certain specialist is indeed reprehensible.
1
Then you have the maternity care deserts as in Georgia where the closure of rural hospitals, or of the maternity wards, have meant in an emergency the patient has to travel long distances to reach effective medical care.
Obviously the huge increase in Texas of maternity deaths was due to the closure of as many women's care clinics as possible.
That isn't even saving the baby at the cost of the mother. That is losing both. This is exactly what happens when total strangers in government -- Republicans -- dictate their ideological or theological views on all women and don't care at all about the health of the women or the health of any resulting children who may then be deprived of infant nutrition and necessary aid.
16
With America's swing toward clerical fascism, it will come to pass that any miscarriage will be investigated as a possible murder.
Hopefully we put a brake on this on 11/6, but mountains of work and several election cycles remain to be won before this is turned around.
5
Here's the real problem: Many doctors mistakenly assume that they're on the same level as God Himself.
--
Their argument goes something like this:
1. "God knows everything." [true]
2. "I'm probably as close to being like God as anyone in our society." [true? maybe, but...]
3. "Since God Himself isn't always available for consultation, I'll just have to act alone, in His place." [Whoa!!!]
--
And here's the kicker:
We as patients buy-into this argument, 100 percent(!)
And after all, when we're sick or injured, we really have no choice, do we? And doctors *do* know more than we do, most of the time.
And without their "help," we probably won't get well.
--
So we end up being stuck, “with an elite group of well-meaning fat-heads,” [my caption] of our own choosing, and continue to take our chances.
—
The solution? Marry a doctor.
Or at least, find one who has your wellbeing, and *not* his or her reputation and career, in mind.
2
@ppromet, if your doctor doesn't treat you as an equal partner in your health care, find another doctor. If a patient lacks faith in her doctor, she'll be more likely to be noncompliant. No competent physician wants to be the only voice in the examining room.
1
Whoa! Is this an article about women dying in childbirth or about their right to an abortion? The two appear to be intermingled, both in the article and in the comments.
I find it peculiar that in the article the two examples given happened 13 years ago, and 26 years ago. Why on earth would someone use examples from such a long time ago?
Also, when you describe conditions that states found that have led to the death of a mother during childbirth ("...many state committees emphasized lifestyle choices.... They weighed in on women smoking too much or getting too fat or on their failure to seek prenatal medical care.” You called this "blaming the victim".
A morbidly obese woman who smokes and has chosen not to get prenatal care DOES share the responsibility if she dies during childbirth, just as a man who is morbidly obese and smokes shares the responsibility if he has a heart attack! It has nothing to do with being a woman - these lifestyle choices (and no prenatal care) put both mother and baby at a very high risk.
I had my children in 1970 & 72. I chose to do the Lamaze method of childbirth. My OB guided me toward a class at the hospital where we were taught this. When I went to the hospital to deliver my baby, I was in labor for 24 hours on a pitocin drip - baby was "sunnyside up". It wasn't the most pleasant 24 hrs of my life, but I was not traumatized and was well treated. I was not "dehumanized or demeaned". All this hysterical talk is poppycock.
10
@India, extended use of Pitocin contributes to hemorrhaging, a leading cause of maternal deaths. It happens rarely, but women should be aware of the risk.
The author isn't talking about abortion. She's talking about preventable maternal deaths that occur during labor and the year following childbirth.
2
@India
I'm always puzzled by people who have the viewpoint that if it didn't happen to me, it couldn't have happened to anyone else. It's awfully myopic to assume that your experience is what happens universally.
Smoking, obesity and lack of pre-natal care do impact pregnancy but arrogance and insensitivity on the part of the doctor should not.
4
@India
So basically what you're saying - Since you had a certain experience when you gave birth over 40 years ago, all women who gave birth since then must have had the exact same experience, since all births are identical and medical practice is the exact same over 40 years. Therefore any women who has issue with her birth experience is "hysterical"?
Thanks for completely illustrating the author's point about pregnant women being demeaned and ignored.
5
Back in the primitive 19th century, Ignaz Semmelweis made the mistake of suggesting the high death rate of expectant mothers in the maternity ward was related to the doctors who refused to wash their hands after studying cadavers in the hospital morgue.
Instead of proving Semmelweis wrong by simply washing their hands, his highly insulted peers attacked and ostracized him.
It appears the profession has a tradition of graduating pompous types who have a problem grasping the implications, and the irony, of the saying, "Physician, heal thyself!"
9
and he died in an insane assylum, possibly being beaten to death. read "the cry and the covenant". tells his story but I don't remember much about his own death. I did have an induced delivery, my choice because I had a 5 year old son at home. after delivery I had pain and finally the resident called my doc and it was back to the or to remove a hematoma. I had a spinal and I remember singin"im back in the saddle again" on the table. all was fine and said baby is 51 years old. but I admit I do have a sense of humor in adversity.
Appalling! Sorry, but this boils down to built-in cultural rascism.
It's the brown and black babies that die. Oh, forgot the poor white ladies and rural isolated women folk.
As a man who loves all babies; I say: can it be all right to let this go on? Why are we alone as Americans in a wealthy society allowing this to happen? Can one have enough insurance to confront these issues? Maybe not.
Misfeasance, malfeasance, and just nonsupport of women when they need the most help and attention.
The powers that be say "let them die in childbirth or even after rather than abortion". Then, it's if they live we will deny foodstamps, nutricion, and post partum health care just to prove how inferior they are.
The white rich have moved this agenda. right? Anyone else?
If it's "right to life" then it's alright to die under these circumstance when women are at fault just for becoming pregnant.
Surely not; please it just can't be the American way any longer.
8
A lot of what is described here seems to be a combination of arrogance and malpractice, which would include refusal to allow the patient to exercise informed consent.
Of course the doctors and hospitals want to avoid any real scrutiny.
2
Thanks for this article. I had induced labor with pitocin because of a loss of amniotic fluid, and almost bled to death after giving birth as well. I was a healthy 29 year old at the time. I was never listened to when I told the doctor I was very sensitive to drugs and might need less than others. Pitocin caused me to vomit incessantly even without food in my stomach and nurses seemed angry when I could not dilate. I INSISTED (forcefully) that they decrease the pitocin and allow me to rest with an epidural. 5 hours and a rest later when I told them the baby was coming NOW they did not believe me. She arrived within minutes and then I began to hemmorrage. No one warned me about the side effects of pitocin. This is the first time I have ever heard about it. I am VERY sceptical about medical practice in the U.S. and always question doctors and if the doctor can't take the pressure and give me intelligent and respectful answers, I will not see them. As a pregnant woman, I did not feel I had that choice. The doctor seemed good and caring until it was time to give birth and then no one listened to me, until I screamed bloody murder and forced them to do what I asked. That feral instinct probably saved my life.
16
I don't it has anything to do with them valuing the childs life over the mothers. They just use that as an exuse to get away with what they are doing. If laboring and birth doesn't go well they are putting mother and child in harms way. It possibly could have been prevented had they just listened. The way they sometimes treat women about their pregnancy is borderline abusive and controlling.
3
I almost died after a miscarriage. Went in for a check up, and immediately knew something was wrong after conversing with the nurse about things. I shouldn't have been bleeding still. Doctor performed a D&C and the bleeding got worse. Listening to them panic as I started to slip was scary. Thankfully, the first medication they lined up for me did the trick. Uterine antony, where the uterus doesn't contract to stop bleeding like it is supposed to. You bleed out very quickly.
I was told that I was lucky that the bleeding only got heavy during the procedure, that it could have happened at any time before hand.
And this was just a check up after a miscarriage.
6
@Jen
Sorry about what you experienced and sorry about your miscarriage.
5
Just in case you weren't aware, the job of the obstetrician is not to treat the mother, but the child. And there is no grey area on their part. They are NOT the mother's doctor. Perhaps that clears up Thea's apparent confusion.
4
@MR Are you sure about that? I mean, the whole time a woman is having prenatal visits, is she not the patient? Her blood pressure and weight are checked, her insurance is billed. Is she not the patient as she is assisted through labor?
3
@MR I hope you're being sarcastic. (Sincerely, I hope - I'm not being snarky.) The pediatrician is supposed to look after the child; if the obstetrician doesn't look after the mother, who does?
8
@MR
Let us know how you feel about that when your daughter is pregnant and has complications.
6
The article states that black women are 3.5 times more likely to die from pregnancy.
It's essential to properly diagnose this problem in order to fix it.
In my opinion, this article denies the primary role of lifestyle choices--i.e., the victims are largely to blame, and need to be educated-- and instead promotes an ideologically-based misdiagnosis of this problem. It will delay fixing it. It will cause a lot of deaths.
4
@Freddy
Or it could be the way doctors treat black women?
Read Thea's story again.
2
@Freddy you are exactly right The Stanford article doesn't mention this phony "you don't listen to women " charge . The major problems are older mothers, massive obesity especially among African Americans, long standing hypertension and other cardiovascular disease and a non standard protocol to address problems and emergencies. And btw the mother is the patient of the OB doctor and the neonatologist takes care of newborns .
I think this "me too " movement has made people crazy.in that its always about men vs women
4
@Freddy So . . . you're saying that the fact that black women are more likely to die means that it's lifestyle? Could it be any of the many other factors that affect black people in this country more than white ones?
Trust me - those of us (including me) who are obese or otherwise violate the standards of judgy society are aware of our transgressions. Not focusing *solely* on those erroneous ways does not mean that people will not be counseled or encouraged to lose weight, eat better and exercise.
But given the reluctance to study the situation, how do you know that these factors are the cause? You don't - because no one does.
And we can educate people on healthy lifestyles AT THE SAME TIME that we look for other causes.
4
I had gestational diabetes, and in the hospital after my daughter was born the OB told me they weren't checking my blood sugar any more because it was "probably" normal, and anyway "the baby was their patient, not me." I wasn't worth a 3-second finger stick once I had fulfilled my function as a vessel for the real patient. I always thought it was just me....
18
Who actually thinks that America is the richest country in the world? On what metric? Not health and lifespan, not education, not average wage... so richest in terms of the opinions of Americans about themselves?
10
The article should mention INFECTIONS that can be transferred to the mom during the hospital stay. Something all women should be aware off during the delivery.
2
I don't get why people are so enraged that a woman cannot legally endanger her child. This seems like a good thing, that should be completely apolitical. A baby is just as much a human as the mother, and therefore should be protected to the same extent. This is one of several articles lately on the Times that have for some reason demonized laws that protect children of many different ages from abuse and neglect.
1
@American Patriot
The point is that a woman should have at least equal standing with her child. In many of these stories, the mother's (woman's) health was disregarded entirely. Moreover, in so many cases, the woman is endangering the child only because the woman's own life is at risk - and sometimes she is blamed for things that are actually being done TO her, so she is both a victim of the situation and blamed for the impact that the harm done to her does to her child.
If the self-righteous folks who care so much about babies actually cared about the babies, they'd care about the mothers first (not only, but first), because the best way to protect a baby is to protect its mother.
11
@American Patriot Good grief. The problem is that a woman can be accused of harming her fetus because she disagrees with a doctor. There is a lot of room for discussion here.
4
Hey there, AP, shouldn’t the medical profession be able to treat women as human?
I so wish men could get pregnant. If that could happen, this would not even be an issue.
The maternal mortality rate is a symptom of the general lack of respect women endure in all spheres in this country.
3
Thank you reaffirming my decision to have a hysterectomy. While losing the organ that supposedly classifies me the most as a woman was a rough process, it has also afforded me a whole new identity I associate as freedom. Anything female is subordinate and hated. Tragically, becoming less-than, losing what makes me a woman, means I can be more of a person in this world. Thank you for advocating for us.
4
I knew this instinctively 25 years ago when I found out I was pregnant which is why I was so frightened. I found a brilliant, compassionate, and wise FEMALE!! ObGyn and there were no male nurses allowed near my room during delivery. If I even saw a man I screamed and my husband (at the time) made sure my directives were followed even as I drifted in and out of consciousness on Demerol.
Whatever precious rights we have in this country as women are a gold standard around the world and how crazy is that. In NYC when I was directing a Pakistani cab driver on how to get me to my destination he threatened to punch me in the face and forced me out of his cab. He probably came from a place where women did not give orders to men. There are many places in the world where women are little better than cattle. That is the reality that all women face when we are stripped bare of our privilege and our protective spouses. There is no answer to this except to stop having sex and/ or children.
6
@Susan Murphy
So sad really.
1
Your belief about the superiority of woman doctors is misguided and possibly sexist. I shared the same illusion myself, until I trusted a female surgeon to do a gynecological surgery on me. Although my gynecologist recommended her -as the doctor he'd send his own wife to, and she was highly rated she mutilated my body during the surgery, leaving me disabled as a result. Her understanding of the emotional and physical toll this operation took was nil. Just being a woman does not make someone a good doctor, or more understanding of our issues, and it certainly doesn't make them better than a man.
Rejecting a nurse because of their gender, or any other physical characteristic? Substitute "Black" for "male" and you'll see how your demand that your husband chase male nurses out of the room looks to the rest of us.
7
@Susan Murphy I wonder what health care workers not personally with your case were thinking. Some hapless male (nurse, orderly, maintenance staff) is directed by his superior into walk into or pass by your room, and sees a shrieking woman, apparently unstable. I personally would have avoided your room like the plague until discharge.
If it isn't one stupid medical decision it's another. My wife with major allergies at the time (1980s) had a private room specified in her medical orders and written clearance from the insurance company. Once our son was successfully delivered and healthy the hospital staff happily announced she was going to a 3 bed room with 2 other new moms because there were no private rooms that had been cleaned. Short version I looked around the delivery room and commented this room will do fine until a private room can be cleaned. Push back from staff the the room was only for delivery got the response there are not enough folks on staff to remove us from this room. Private room was provided but it was in the older part of the hospital. Moral ANY patient in the hospital needs a personal advocate involved.
7
The poor women suffer the most by far. The US cuts medical help to them in order to incentivize them to do better economically. And consistently vote for this strategy, because anything else leads to worse results.
3
None of this surprises me. In 2015, I almost died while in labor with my second child in what is considered one of New York City's top hospitals. I was healthy, in my 30s, and in great physical shape. My husband was even an employee at said hospital at the time, and we were both highly educated on research surrounding childbirth and delivery. None of this benefited us in the delivery process. I have never felt more like a number or more ignored by a health professional. Even my trauma at almost dying and nearly losing my baby was dismissed in the aftermath of the experience. Post-care surveys from the hospital focused entirely on the baby and whether I was breastfeeding without interruption. Obstetrics is being treated too much like a business--with liability risks, flawed stats, and patient hours in the hospital driving too much of the decision-making. None of this is new. Prenatal classes hosted by the same hospital even warn you about various things you may be pressured into (often in opposition to what is best for you) because of hospitals' business and liability concerns. This conversation has been happening for a long time, now, (e.g., "Business of Being Born," which came out in 2008), and the field of medicine has been obstinately ignoring the root of the problem in the same way it has ignored the mothers affected by this crisis.
9
One of my aunts became pregnant well into her forties. She originally thought she was suffering mid-life symptoms, then was rushed to hospital with emboli in her legs and lungs. The doctors told her and her husband that the best choice was to end the pregnancy, which they did. She later told us that she couldn't think of anything but leaving her young daughter without a mother.
That was in Canada.
6
I still remember the high risk baby doctor's words to me around 6AM as I begged for some intervention: "I don't have time to deal with you, as I am giving a paper at ACOG today. You are pregnant and having contractions." But actually, I had an obstructed bowel as manifested by excruciating pain, vomiting black bile, and a pinging bowel for the past day or two. I felt I was dying. I had an emergency bowel resection in the late afternoon and my son was born at 34 weeks at the same time by c-section. Ya think this doc could have and should have done better? A nurse finally got me some help around 4PM by forcing the attending doc to come see me. Bless her soul.
568
@JoanneTypical for a careerist doctor. Like who gives a damn for the patient! Sad to say you're not the only one.
47
@Joanne
He really didn't need to present his paper because he clearly didn't know what he was doing. His paper must not have been worth much. A dead and dying bowel was putting the baby and mother at risk. After 72 hours, you were dying. Your blood stream was full of inflammatory cytokines that could easily have killed you from multi organ failure. You should have had an emergency C section 48 hours prior as an effort to preserve enteric integrity.
50
@Joanne , I've had 30+ bowel obstructions in my lifetime, and I gasped when I read your post. I can imagine few scenarios worse than the excruciating pain and vomiting (and fear) of an obstruction during a pregnancy--especially so far into one. I thank God that I managed to make it through my own pregnancy 20 years ago without one of those awful and unpredictable things coming on (I still live in fear every day of getting another one, and it's a near-certainty that I will). Being dismissed by your obstetrician under those circumstances is even more unthinkable. I'm very glad that you and your son were okay in the end, but I'm so sorry you went through that. I hope that you at least wrote him up in no uncertain terms on one of those websites where you can write reviews of doctors.
55
This article made me ponder the fact that I am pretty much unable to bear children. I dont really want them, so it never really bothered me.
But now I'm glad that I never have to face the prospect of being treated as a fetus incubator.
The thing is, even if you cant bear children, you are still treated like a fetus incubator, only a defective one. I once had a woman say "Are you sure you just don't want kids because you couldn't have them anyway?"
I then had to explain that no, I don't want kids because (reasons). I have no drive whatsoever to raise a child or give birth to one, even if I physically could.
But I've seen it all. Looks of pity, the "Oh, I'm soo sorry" (why?), the acting as if I'm missing something.
Until women's choices about anything are treated respectfully, this isnt going to change. Its more than a maternal issue, its a respect isdue.
8
A round of applause for successfully talking about the serious problems pregnant women endure without devolving into an abortion diatribe. Pregnancy is not an either/or war between mother and child: we must treat both with dignity, respect, and integrity.
6
So, I am a doctor and am involved in childbirth regularly as part of my job.
How can you compare U.S obstetrical mortality with other countries?
Our typical patients in labor are 5'2'' and weight 220--300lbs.
They frequently have diabetes and hypertension.
Also, addiction to opiates is common. They use opiates even while they are pregnant!
So, I don't think the maternal mortality rate among typical NYT readers is anything like this article suggests.
9
@JAG "America is blaming pregnant women for their own deaths." Literally the title of the article. Thanks for providing additional confirmation.
By the way, wasn't it American physicians and the medical and pharmaceutical industries that precipitated the opioid crisis in the first place?
5
@JAG
Do you ever recommend birth control to these women and their spouses/significant others? Do you pay attention to what their lives are like that they are drug addicted? Do you advocate for these babies who are born addicted and will be a drag on society for their entire lives? Or is it easier to just get paid for what you do and criticize these "patients" for their weaknesses?
I am a graduate of a Seven Sisters college. One of my classmates was from a wealthy Texas family, but she died in childbirth in a Dallas hospital. No diabetes, hypertension or drug addiction involved.
10
This is my objection to the article as well. This article and a lot of the comments are smearing an entire profession with a broad brush. Laypeople (or even internists like me) have no idea what it entails to train for years to learn a profession which includes safely delivering babies, nor what extremely hard and demanding work that is. Many if not most OB’s, anesthesiologists, and family practice doctors are caring, hard-working people who deserve thanks rather than this heap of scorn.
1
Interesting that many of the unfortunate situations would not have occurred had c sections been performed earlier. I had an emergency csection when I gave birth to my only child. Probably saved both our lives. No regrets.
3
The traditional model for medical care delivery is what I'll call the "masters of the universe" model. Independent practitioners accountable to no one except the legal system delivering care in accordance with their own judgement. With the rise of evidence based medicine, this is no longer adequate and especially in the private world many physicians are delivering substandard care. Standardization of care is the key. The masters of the universe model doesn't work and it needs to be replaced by a more hierarchical organizational model like those in virtually every other industry. That means large medical centers with on-staff physicians and integrated clinics directly overseen by their peers.
4
Maybe women should stop using the services of doctors to have babies. Just take care of yourself and don't worry. Women had healthy babies without the use of doctors for thousands of years. My own mother had me and my 3 siblings at home, with a midwife. Both of my sisters have had their children the same way. No hospitals. No doctors. No C-sections. Healthy babies and healthy mothers. Just say no to the medical intervention of doctors who treat women like they're the least important person in the process.
3
Actually, over the last 100 years maternal mortality rates have dropped by 99%.
Most of the time, i agree you dont need a doctor but when you do, the situation may spiral downward very quickly. I nearly died both during my oebirth (born without a heartbeat) and while giving birth (nearly bled to death).
You need to do whatever makes you comfortable, but labor is still one of the most dangerous experiences a woman is going to undertake.
7
In 1984 in Harringay in the London Borough of Haringey, when my wife became pregnant, she/we decided to have a home birth, which our local GP Dr Rubra offered. When my wife went into contractions, I rang the midwife who arrived first. Dr Rubra arrived later. It was a long, painful birth that my wife endured without any painkillers. Conditions were fairly primitive. It was our flat but it was old and unheated. It had unsanded floorboards because we couldn't afford carpet until later. There was a big hole in the exterior bathroom wall at shoulder height where part of the brickwork was missing.
Our son's birth had complications. My wife bled more than she should have. Dr Rubra and the midwife handled everything with cool professionalism. When everything was sorted out, my wife went upstairs to bed to sleep with her newborn infant in her arms.
We did the same thing for the birth of our daughter. Dr Rubra arrived a bit late for that one. The midwife delivered her as I ran downstairs to let Dr Rubra in — although I had left the front door unlocked and ajar. Again there were some complications, which the midwife and Dr Rubra addressed. After the birth — again no painkillers — my wife went to sleep with her second newborn, while I looked after our son who by then was two and a half.
Oh, and did I mention that neither home birth cost us a penny?
7
@Colenso Might you have had painkillers? There is very little “we” in giving birth.
1
This is not just a problems of hospitals, doctors, and public policy. It is also a problem of social demands that anything a woman desires for herself - autonomy, respect and physical wholeness - is also "selfish".
Get a group of new mothers together and eventually they will start to tell their birth stories - the joys, horrors, indignities, pain, and subtle/not so subtle misogyny. In the midst of this "safe space" it never takes long before a woman in the group will say, "you have a healthy baby. That's all that matters."
Doctors, hospitals, and most of society will have you believe that anything a woman asks for to preserve her own dignity, health, and happiness, will take something from someone else. A pregnant woman who asks for anything is by that very fact endangering the health of her child. This can only happen in a society in which women are constantly devalued.
No. It's not all that matters. It's not a zero sum game. It's not healthy baby OR health mother. It's both. We can have both.
22
I also think we need to look at baby friendly hospital policies. I was all for them when I heard about them on my hospital tour. Who doesn't want a hospital that is friendly to their baby? And I wanted to breastfeed and rooming in sounded like a wonderful thing.
Then I labored for 27 hours and needed every intervention except a C-section. And when the baby was declared fine, I was left to tend to an infant on no sleep for 27 hours and no experience. Sure, a nurse checked on me and my baby every three hours. But I got almost no sleep until my mom got to the hospital the next day. Not sleeping for 30-odd hours was not good for either my baby or me. I was also in considerable pain and I kept wondering if I was ok.
Thankfully I was, my mom commented when she had a baby, they took the baby to the nursery so she could sleep and brought the baby back to be feed. My mom is a nurse and commented the hospital is likely saving money by not having to staff a nursery. Oh, and the hospital charged me $8000 for a day and a half of 'care' for my baby. That doesn't include the pediatrician coming by too. Hospitals and medical staff are so focused on being baby friendly, they forget to be mom-friendly. I'm lucky we are both ok and my stories is mild compared to other women's, but I think it is a good microcosm of the problem.
21
@Kj Baby-friendly is a poor choice of words. While it may seem like it isn't mom-friendly, it is intended to also be mom-friendly by making sure you don't have more problems down the road with breastfeeding. I am not suggesting that it is okay for you to be sleep deprived, but that putting babies in nurseries where they would get bottles and formula while you sleep can cause you real struggles with breastfeeding for various reasons. One of those reasons is that babies suck on bottles differently than they suck on breasts and can have problems latching if they get bottles early on. That can not only be a long drawn out hassle but painful for you. Also, studies show there are other benefits to babies not being separated from their mothers (or even a loving family member or friend who can hold them) after birth. While this may seem like a focus on baby, problems with the baby make your life much more difficult.
Things were not better for moms back in your mother's day. While our maternity care system needs a lot of improvement, and you are right that babies get more attention than moms, Baby Friendly is an attempt to correct some of the barriers that made it difficult for moms to breastfeed. It has gotten a lot of unfair press lately, but I don't think folks make the link between problems that show up and leaving babies in nurseries.
3
@Crystal
Did you read what I wrote? My mom had her babies brought from the nursery so she could feed them. I am a believer in breastfeeding; in fact, I just got done nursing my five week old. But I don't think going a nursery is going to cause all the problems you describe. Requiring moms who just went through a major medical event to leap into full time baby care without support is ignoring mother's medical needs.
5
@Kj Taking babies to the nursery is not the answer. Even short term separations from their mother are traumatic for newborns. More support for moms while they room-in with their babies would be a nice compromise, but it would cost hospitals more money, so it's unlikely to happen.
1
Maternal obstetrical deaths are well studied, uncommon ,and in most women Can be identified and treated. Post partum death is usually caused by a”systems problem” and is not commonly caused by individual incompetence.
In most cities, such high risk pregnancies are referred to obstetricians who limit their practice to high risk pregnancy. In small towns and rural counties such services are often unavailable.
In the 1980s, serious trauma also had a high mortality rate. California established a state wide system of trauma centers and mandated that the trauma patient be stabilized “in the field” and directly transferred to a dedicated trauma center. “Best practice standards” for diagnosis and treatment became the professional norm. The mortality rate from such life threatening conditions was substantially reduced.
Routine pregnancies are well cared for in general community hospitals and mothers who are at high risk for complications or death are often diagnosed antepartum.
Organize a nation wide obstetrics system for high risk obstetrical care analogous to the trauma center system in California and the maternal mortality rate will also fall. It should assure every high risk mother has antepartum access to a institution with obstetricians skilled in uncommon high risk deliveries. For those mothers who encounter unexpected difficulty during labor, immediate transfer to an affilited Hospital Obstetrical Center must also be available.
7
@Thomas Pregnancies that appear very low risk can change to high risk quickly. All obstetricians need to be skilled in what to do when things go awry or certainly to know when they need to call in the heavy hitters.
9
@Thomas
Thus spake the male in the room
The most tragic of the many ironies contemporary maternity care is that the recommendations proposed in good faith to improve outcomes for babies and women has ended up killing them.
This is particularly true in the case of maternal mortality. For years the conventional wisdom has been that outcomes improve as interventions are reduced. Indeed, most midwifery academics and some obstetric academics have insisted in the strongest possible terms that reducing the C-section rate is the key to reducing the maternal death rate.
Sadly, the data has shown precisely the opposite. Women die from lack of high tech interventions, or lack of access to them, NOT too many interventions.
Unfortunately, this article makes the same mistake. Women don’t need more doulas, more midwives and more listening although all can be beneficial.
The two greatest threats to women’s health in and after childbirth are low index of suspicion and reluctance to deploy (or lack of access to) high tech interventions in a timely fashion. That’s why California has had success in reducing maternal mortality. They’ve gone back to basics, recognizing that childbirth has always been — in every time, place and culture — one of the leading causes of death of young women and that only technology liberally used can reduce the death rate.
38
@Amy Tuteur, MD
Yes, I agree that interventions to both save lives and reduce pain are miracles of modern medicine. I can't help feeling that ingrained misogyny, in both men and women, accounts for this idea that a natural aka painful and dangerous child birth is morally superior. Even non-pregnancy related gynechological procedures like IUD insertion typically don't offer pain management. I have friends who passed out and have PTSD from IUD insertions or removals gone wrong. We would never expect someone to get a tooth pulled without pain killers, why we expect women to put up with pain for reproductive procedures can really only be explained by sexism.
17
@Amy Tuteur, MD That isn't what California has done at all, Amy. Stop misleading people. You've been doing it for over a decade. You lie, cherry pick & twist facts to suit your agenda.
California set standards for things like monitoring post-birth bleeding and actually listening to patients (still lots of work to do on that front, sadly), not by increasing unnecessary and dangerous interventions.
The science shows that interventions increase hemorrhage, infection & cesareans, without improving outcomes.
7
@Amy Tuteur, MD Can you cite studies that prove that high tech intervention is better than Certified Nurse Midwives? I chose CNMs because I wanted less intervention. No internal fetal monitor, no IV, nothing. In a hospital setting.
3
This brings some traumatic memories for me. My placenta wouldn’t come out and I hemorrhaged. Lost almost 3L of blood. The hospital saved my life but then discharged me 2 days later after a very small amount of blood transfused. I came back within 12 hrs and was diagnosed with postpartum preeclampsia. Had a great pregnancy, ate super healthy, exercised. But am over 40. This occurred in Denmark and they saved my life. Hearing stories of the US makes me wonder what would have happened. Seems like the care is very dependent on hospital and doctor.
13
It seems to me that Male OBGYNS do not have a dog in the fight when a woman gives birth. No man ever died in childbirth although millions of women have over all of time. Perhaps the solution is Women only OBGYN's https://www.npr.org/sections/health-shots/2018/04/12/596396698/male-ob-gyns-are-rare-but-is-that-a-problem
254
@Joel Friedlander But more women are attended by women (OBs and midwives) today than any time in the past 60-70 years, yet maternal mortality rates have risen.
23
@Joel Friedlander I know this kind of dialogue is accepted in society today, but one day it will be appreciated for the sexist nonsense it is. If a male medical student is fascinated by the science of reproduction you would deny them the right to practice as an Ob-gyn? If you truly believe that, then should all urologists also be male because only males have experienced the horror of prostate cancer?
There are some rotten eggs in medicine. Perhaps slightly more than 50% of those are male. As a medical student who has seen some bad behavior firsthand, I would guess that the very slightly higher mortality rate among male physicians is probably due to the increased societal pressure for male physicians to be financially successful and the reduction in care quality that occurs as a result. Still, the vast majority of male physicians practice ethically. Holding all individuals of a demographic group responsible for the bad actions of a few is literally the definition of discrimination.
31
Empathy and patient care are not driven by gender. Nor does does a physician need to have a “dog in the fight” in order to take good care of patients. If one follows your logic a cancer doctor that has cancer is better than one who does not ....
Also the NPR story you reference states that the vast majority of OBGYNs now going through training, and have been for the last 2 decades, female. Maternal mortality has increased and many factors are responsible but gender of the physician is not one.
33
When I was pregnant with my now 10 year old daughter I was having problems with the pregnancy. Every time I went to the doctor he dismissed my concerns. He told me pregnancy isn't comfortable, deal with it, grow up, etc.
I went numerous times with complaints. I was swelling tremendously. I couldn't wear shoes or even socks. My shoulder was hurting, I was having headaches, I couldn't eat. Still he dismissed me.
When my blood pressure hit 210/100 I went to the hospital. I was certain I had HELLP syndrome and told them so. They all laughed.
They took all day trying to decide what to do with me. Finally, eight hours later when I had kidney, liver and heart failure they brought me in for an emergency c-section.
My daughter and I both survived, but we each spent a considerable amount of time in ICU.
Why does this happen in this day and age? Why is it that no one listens to women? We were so lucky but so many women and babies are not.
43
@MaryEllen it sounds like the problem may have been that your doctor was a "he." Male doctors tend to be more dismissive toward female patients' complaints. In 2017 female enrollment in medical school was greater than 50% for the first time. We, the next generation of female physicians, hope to be able to change this. We will listen.
16
@Future Female Surgeon
I think the problem was the doctor was an idiot who didn't listen.
15
@Future Female Surgeon
Thank you for being a part of that change! Sadly, many women have subconscious misogyny too. It seems the whole gynecological profession assumes that being in pain all the time is the natural state of affairs for women, whether it's painful periods, painful pregnancy and childbirth, or painful IUD insertion without pain killers.
7
I had my first child in Massachusetts in 1999, and I almost died after--more than once. I attribute some of the problem to the reluctance to keep me in the hospital after my first episode of prolonged bleeding (followed by a D& C and transfusions). On my third trip back--in an ambulance--and after emergency surgery I insisted on being kept in the hospital until there was absolutely no risk of hemorrhaging. With my second child (Michigan), a planned C-section, I was yelled at by the hematologist for requiring so much blood during the surgery. Seriously. This article is spot on: insurance factors + blame the victim. What of the women with no one to advocate for them? I shudder to imagine.
782
@Danielle Price Yelled at for requiring too much blood? What the hell - that's horrible!
80
@Danielle Price
I am astounded that the doctors didn't insist you stay after three episodes!
17
@Danielle Price
Wow. I can believe that the Hematologist chastised and rebuked you for needing so much blood during surgery.
The things patients have to endure to stay alive are amazing.
19
Once a woman is pregnant, she ceases to exist as a whole person. She is simply a vessel. This is how society and Republicans treat women. Women and their fetus need to be treated with dignity and respect during the birthing process.
Thank god I never had kids. I don't want people blaming me for not exercising enough, not eat healthy enough, or whatever. It's always the woman's fault.
We are a nanny state here. My friends in Europe, do not have these issues.
582
@LiberalAdvocate: One Republican politician actually referred to pregnant women as "climate-controlled environments." Seriously.
83
@LiberalAdvocate "Friends in Europe do not have these issues." I beg to differ. Obstetricians in Italy tried to pressure my daughter into a scheduled Cesarean. She almost succumbed because the first birth (Europe is big into inducing labor unnecessarily) was so unpleasant, with one doctor calling her a "stupid American" when she was in hard labor. Do you want more? Same problems over there as here. Listen to the patient.
38
@Carson Drew
Time for a little climate change.
21
It is not only during obstetrical care that women receive substandard care due to bias; I am aware of a study in the field of Orthopedics. In the culture of the United States today, women are dismissed as "over-reacting" when seeking medical care. It will take an enormous amount of focus and perseverance for physicians (female as well as male) to recognize their own innate biases, and then to refuse to act on the basis of bias, but on their medical knowledge and judgment.
That said, there are many facilities today that bind physicians to "algorithms" for the care of human beings; when the algorithm is not followed, it counts against the physician. And those very algorithms could have bias written into them; we humans are not good at recognizing our own biases.
12
@DJN
And how many of those algorithms are based on the male model of the human body with women as odd outliers?
4
“Women know what they want when it comes to labor and delivery, and it turns out the things they want (midwives, doulas, fewer unnecessary interventions and cesarean sections) are less expensive and produce better outcomes.”
It's not complicated. A for-profit healthcare system means more of what the providers want (profit!) and less of what the patients want.
9
The situations in this article perfectly illustrate the “Pro Birth” mentality of the right. All babies must be born regardless of whether the baby is wanted, whether or not it is healthy, and whether or not the Mother is able to bring it to term. Once the baby is born, the Right to Lifers, most of whom are on the political right, don’t want to invest In healthcare, welfare, food stamps, education or affordable housing for this child. Abortion and birth control are frowned upon or actively fought against. The Mother is of no importance in and has no say about what she can do with her body. Until American women stand up at the voting booth and get these anti-women legislators out of office at both the state and federal level, change is not going to happen.
1292
@Carol Clark
In labor & delivery suites, one can safely assume assume we are all "pro-birth." You don't get to 40 weeks of pregnancy and worry about "pro-choice." That choice is extremely limited after the third trimester, for good reason. This isn't an abortion debate, it's about how to improve health maternal outcomes.
25
@Factumpactum I think she was pointing out that once a woman's in labor, many self-described pro-life advocates have zero concern what happens to her (pain, bleeding, even survival). Their sole focus is on the baby.
When a close friend of mine was having problems during labor, a doctor took her husband aside and assured him, "If things go badly wrong, don't worry. We'll let your wife go and save the baby." That was the last time she dared to use a Catholic hospital for childbirth!
204
@MLChadwick
God.
37
"As a result of this initiative, between 2006 and 2013, California saw a 55 percent decrease in the maternal mortality rate, from 16.9 to 7.3 deaths for every 100,000 live births. During that same period, according to The Washington Post, the national rate increased — from an estimated 13.3 to 22 deaths in 100,000."
So, basically, we know exactly what to do to reduce deaths... and refuse to do it.
Shameful.
36
This is disgusting! Bloomberg recently ranked us 54th out of 56 countries for healthcare efficiency. I lost my wife in two months and ten days to our screwed up, inefficient, slow, for-profit system. I'm convinced she would have lived much longer in any country in the top ten on Bloomberg's list. I'm a new grandfather and am deeply concerned about anyone having a baby in this country. We have some of the best doctors and equipment in the world and a dysfunctional system and our Lobbyocracy is loath to change it.
416
@Frank Walker
My condolences on your wife's death.
20
@Frank Walker
The term "lobbyocracy" is on point!
21
@Frank Walker I am not surprised. Very sorry for your extreme loss. This is why I am politically active. Hearing stories like yours and all of the others. Due to the despicable US for-profit patchwork inhumane healthcare system. This is not sustainable and will destroy the USA socially and economically ultimately. We are well on our way to global oblivion.
14
Having raised a child from maternal death has been a real challenge. Mom was not taken care of, she had stated high risk but they would not listen. Internal hemorrhage, placenta previa and a massive heart attack killed my sister-in-law. Doctors have a long way to go especially in low income neighborhoods, she attended her appointments, different doctors or midwives every single time does not help! Maternity advocates might be another way to help.
33
Wow a stunning article. Thank you. Just having gone through a pregnancy with my wife and knowing the difficulties this article scares me. To think that insurance companies or the medical community are more concerned with their well being than the mother. Good medicine, good science, good business management should require assessment of failures or problems to avoid repeating mistakes. The military requires after action reports for combat. Message to the right get your hands off women reproductive rights. Treat women as equals to men and their offspring. After all a woman gave birth to us all. Be humble and respectful to all mothers and mothers who may be.
19
I’m a Californian and I was lucky enough to deliver my children in Germany and Switzerland. The woman’s wishes are respected and all options are presented with all of the information possible in both countries. But what I find the most striking is the lack of postpartum care in the US. In most European countries you stay for 3-7 days after a healthy birth in a family room with your spouse and baby. You and your child are looked after. After you go home, a doula will come to your home for the first month and check in on you and your baby. I can’t even imagine being kicked out less than a day after giving birth. It’s inhumane.
92
@SMS To be fair, everyone's experience is different. When I had my son (now age 23), insurance in California only paid for a 24 hour stay. As it turned out, that was perfect for me. Notwithstanding my "advanced" maternal age (I was 40), I had had an easy delivery and was itching to get out of the hospital almost as soon as the epidural wore off. Two and a half years later, when my daughter was born, insurance paid for 48 hours. I stayed in for the two days - but only because my son was at home and I thought it would be nice to have an extra day with his sister without the obvious distraction of simultaneously taking care of a toddler. Again, I had two easy deliveries, was healthy, had healthy babies, and the babies (and I) took to nursing with no problems or complications. Lucky.
6
What a ridiculous statement. It is not inhumane, its the way it was done in the 80s and 90s if not farther back. Women didn't opt for drugs either back then. It is different now, it will be different 10 years from now, and so on. I had all 3 of mine in hospital stays lasting totals of 19, 16 and 19 hours, respectively. If there is nothing wrong w/you except that you are tired and sore, that is not an illness or life threatening condition requiring hospitalization. Why take up a hospital bed for no reason?
3
SMS, I was in the hospital a week after my C section in a teaching EU hospital. Women who gave birth vaginally were there for three or four days. They didn't let you go home until you had shown the nurses that you and/or your partner could handle changing diapers, breast- or bottle-feeding, and bathing the baby (they gave us mini 'classes'). May sound elementary but I thought it was a great idea.
6
Swapping delivery horror stories is pretty common among women I know. I have one. My friends have them. We all did our best to get the best care, and we're middle-class with good insurance. We went to different hospitals in our region. A recurring theme is that the doctors and nurses refused to listen to us. They believed a broken monitor instead of me. And it doesn't do any good to carefully choose your OB-GYN or midwife. All of the midwives and my regular OB-GYN happened to be off the night I delivered. In the end, my son and I were just plain lucky, and we're both fine. I agree with Kim Brooks that nothing is going to change until we start valuing and respecting mothers and children.
38
Republicans deny access to birth control, deny access to abortions, deny access to healthcare - but they provide easy access to the criminal justice system (that they want run by the private sector).
There's a lot that's infuriating about today's GOP - but immoral, profit-driven inconsistency tops the list for me.
51
Obviously this article brings to light a horrible ongoing crisis.
Indeed the cause of this is because medicine and politics have been male-dominated. Therefore this crisis should reverse course now.
But it's not OK to use this crisis, as some commenters are, to make it seem as if only women suffer in society.
Life is hard on all humans.
If men control everything, then explain why far more men are disaffected in life, commit suicide, are homeless, are innocent victims of violent crime, are rotting in prison and die in war? It's true that the majority of humans in positions of power are men, but those men are a tiny subset of all men (we're all familiar with the term 1 percenters, that applies here).
99% of men are happy more women are coming into power.
The world will be a better place.
6
@Full Name
It is also true that all male doctors are not good doctors or don't take good care for the mothers.
@Full Name Ah, the well-worn "what about men" rejoinder. Heaven forfend it be absent from any discussion, even one about pregnancy and childbirth.
3
@Full Name
Not only women suffer, but only women suffer this. Why must all articles pay equal attention to men and women's pain?
5
I don't know if I would have had more interest in having children if I had not observed so much shaming of mothers.
21
Not all women want "midwives and doulas."
Choice over our bodies also includes the right to a "medicalized" birth if that is our preference. I have had three babies with two different OB practices and two hospitals. I had excellent birth experiences overall. I got epidurals, full range of tests, and my request for an elective induction with my 3rd was honored and respected.
There are many sides to making sure women are heard. Not all women want the same thing. Medical interventions save lives and many women - including myself - prefer that their doctors err on the side of their baby's life.
On the other hand, go on any pregnancy message board, and you will find that there are tons of expectant mothers who put "The Birth Experience" before the health of their baby, who consider medical actions taken to save their child's life as some kind of affront to "Their Experience". While women have a right to this, imagine how frustrating this is for many doctors. Doctors act on evidence and often have to act on the limited facts they have.
Personally, I would have NEVER forgiven a doctor who ignored a sign like dropping fluid levels if the result was a stillbirth. And most women don't suffer life threatening complications during inductions. Doctors do the best they can with FACTS, not feelings.
Also, American mothers are some of the most unhealthy in the world. Acknowledging that this contributes to high maternal mortality isn't "blaming the victim."
26
@A F - where is your citation backing up the statement that American mothers are some of the most unhealthy in the world? We don't know the reason for why our mortality rate for childbirth is so high because we don't have data. Just putting out a statement like the one mentioned does no good in helping to understand what is going on. The rate didn't go down when only lifestyle was examined. That leads one to believe that something else is going on here and unless we get data we will never find out what and we will never be able to bring down the rate.
16
@A F - Actually, that's exactly what it is -- blaming the victim. That's what you're doing, as well as making excuses for the medical system. Doctors are NOT doing "the best they can," as shown by the big drop in maternal mortality rates once California finally decided to figure out was wrong. Does anyone seriously think California mothers are that much less "unhealthy" than the general population? And do you realize how outrageous it is to suggest that American mothers, unlike mothers everywhere else, value their own "Birth Experience" over the health of their babies?
14
@Not all doctors act on facts, and, in fact, some doctors ignore facts. My wife a degree RN with over 40 years experience, some of it in OB, can also attest to it.
3
In 2000, I was proscribed terbutaline for preterm labor. It made me violently ill, and I knew if it made me that sick it could not be good for the baby. The CNM and a OBGYN insisted that I go back on it. (I had researched that it was off label and only shown effective for a maximum of 48 hours.) They insisted I sign a refusal of treatment form to try to intimidate me into going back on it. If my husband had not left work and come to this appointment to support me I don't know what I would have done. This drug now has an FDA black box warning. I was right, they should have listened to me. The truth is there was never any real evidence this drug was effective let alone safe, yet they insisted they were right, and I was selfish and irrational.
23
I am a physician, although not an obstetrician; I do know a bit about public health. I have no doubt that the problems with obstetrical care described by Ms. Brooks are real, and in need of correction. Readers should realize, however, that conditions for an optimal outcome for mother and baby start much earlier in pregnancy, if not before. Many women, particularly those who are poor or minority, do not have access to good prenatal care, and have other adverse factors like poor nutrition, teen pregnancy and substance abuse, to name a few. Pointing this out is not "blaming the victim," but rather shows the need for a vigorous public health response and universal access to family planning and prenatal care.
51
@Hoarbear This article doesn't deny or ignore the importance of prenatal care. It is pointing out that, while factors like poor nutrition and substance abuse are widely studied and examined, hospital procedures and COD are NOT being studied, and that that needs to change. It also points out there is evidence that there is widespread mismanagement of OB/GYN care, which needs to be studied and addressed. Bringing attention to under-studied areas isn't saying that other policies aren't good or necessary - it's pointing out that there are things beyond prenatal care that need to be addressed to reduce the US' abysmal rate in maternal health.
9
I don’t think that was the case in any of the examples cited.
1
@Hoarbear
A number of states have forced Planned Parenthood clinics to close. These clinics provide prenatal and postnatal care in addition to complete obstetrical care and of course contraceptives. Plus testing for stds for both women and men....all of it paid on a sliding scale based on income.
These clinics also took care of Medicaid patients in so many areas where doctors wont accept Medicaid patients.
The Planned Parenthood clinics forced to close have not been replaced with some other provider..
One of the main cause of miscarriage ---and no doubt of maternal and infant deaths (yes we have more of these too than other wealthy countries) is the lack of prenatal care which Planned Parenthood clinics have a sterling record of providing.....
etc.
14
Our country’s rate of maternal and fetal morbidity/mortality is shocking and shameful, and the medical community needs to improve, but it is important to look at both sides of this issue.
1. Obesity and diabetes rates are sky high, and there are high poverty levels and the opioid epidemic, all of which increase the risk of bad outcomes. People are also having children much later in life, as are people with other chronic diseases who would likely not have borne children in the past. Many people have complications who are otherwise healthy and just have bad luck, but people have to realize that unhealthy lifestyles have consequences. It’s not blaming the victim if a smoker gets emphysema...the same applies here.
2. OB/gyn doctors are terrified of getting sued. Their malpractice insurance costs are off the charts compared to other medical specialties. This is a major factor leading to more procedures because it’s “better to be safe than sorry”
3. The article makes a false claim that “midwives are safer.” In most cases they are just as good and emotionally preferable but they cannot manage the complicated cases like those mentioned in this article.
4. Doctors are people. We do our best but we make mistakes. The high expectations placed on us above any other profession are a constant source of stress and burnout, especially when things go wrong.
26
@Zack MD I would argue that the expectations on MD are not above that of any other professions. Many professions involved in healthcare fear the consequences of mistakes and are exposed to the resultant stress. If medicine could evolve into a collaborative profession valuing the contributions of all disciplines I feel we would have a healthcare environment that was safer and with better quality.
5
I would beg to differ, but that is a matter of experience and opinion. No other profession that I know of goes through nearly decade of training, deals with life and death issues on a daily basis with all the related emotional and family issues (this is actually the most stressful and challenging part of the job), is expected to work “whatever hours necessary to get the job done,” and is held personally and financially liable for any mistake made.
Someone threatens to sue me about once a week, almost always for something I had no control over. Imagine if you were trying to help someone and that was their response and it occurred regularly.We take the brunt of the blame for all of the issues with the medical system that we have no control over. The vast majority of people treat us with respect, but until I became a doctor I had never been treated his rudely by people as I have while working in a hospital.
12
@Zack MD I agree with #3 on your comment. I've read many horror stories of using a midwife, just as many as I have been reading about doctors. Things can go wrong so quickly and I know for me it just wouldn't have been worth it. Having my oldest was just awful and she ended up getting stuck. My BP was dropping and her heart rate was racing. If it wasn't for an episiotomy and the doctor literally yanking her out I have no idea what would have happened.
3
This teeters very close to accusing the medical profession of murder. I'd be cautious to claim OB/GYN as a class intend in any way to harm a woman during pregnancy and childbirth. Whether a woman is full knowledgeable to choose the manner of giving birth raises the question of maternal mortality before modern medicine (very high). Modern medicine is doing something right. That being said, maternal mortality is too high in the US and is likely connected in many cases to poor lifestyles and access to good medical care. Is that blaming the victim? I'm not sure. Pregnancy is a completely unique situation where two future lives are deeply and indivisibly intertwined (a future mother and a future child). Parsing morality in this situation is fraught. That woman are unique in "suffering" this situation is a fact of biology, not of male patriarchy. Blame God or evolution, not America.
12
@OneView "Access to good medical care" - If a pregnant woman doesn't have that, how is it her fault?
1
@OneView
You write "blame God or evolution". I please help me understand how that can explain the disparities in maternal mortality between the United States and other developed countries.
4
@Concerned Citizen My point is that no man ever died in childbirth, the fact that only women die in childbirth is irrelevant to the discussion. That is what God or evolution has established. Now what do we do about it rather than blame doctors whom I expect are doing the best they can.
1) improve access to good medical care and 2) improve US public health.
1
Kim Brooks, you have to untangle your thinking a bit on this. Is it really the rise of C-sections that's causing maternal death rates to rise? The C-sections create their own set of risks, and they're used too often, because hospitals want to save money--time and labor costs--but overall they're not causing babies or mothers to die. In fact, the natural labor movement is causing too many to trust the mother's instincts and not take proper medical precautions. I came a hair's width away from dying from HELLP syndrome. It's a rare condition, often lumped in with pre-eclampsia, but much worse. The maternal death rate from HELLP is 25 percent. It was what killed many mothers in childbirth back in the old days. It could have been diagnosed early, but I had a midwife (in Brooklyn) and no one ever took my blood sample--the entire time I was pregnant. When they did, at 38 weeks, they rushed me to a hospital, did an emergency c-section, and saved both my life and my son's life. Another few days--even hours--and my liver would have exploded. So I'm just saying: the natural childbirth movement is dangerously flippant about childbirth. Especially for first-time mothers. The combination of midwife-assisted childbirth in birthing centers that are located INSIDE HOSPITALS is the only way to deliver babies safely and with a mother's dignity and wishes intact. When you come close to dying, though, you don't care about the "beauty" of the birth. You just want both you and baby to be alive.
25
As with many things, the truth is in the 'gray zone'.
Many gestational problems are the result of nutrition, obesity, metabolic diseases like diabetes and high blood pressure, lack of exercise, lack of sleep, drug, tobacco and alcohol use, age, timely prenatal care etc.
It is the choice of the mother, both before pregnancy and during, what she eats, how overweight she is, what substances she uses, how much exercise she gets, whether she gets enough sleep. This isn't a matter of 'blaming the victim', it simply is true.
In general, a pregnant woman who maintains a healthy weight, eats a healthy diet high in vegetables and fiber and low in fat and processed foods, gets enough sleep, abstains from substances, and gets treatment for other medical issues will have fewer medical issues than one who doesn't.
Of course, quality prenatal and delivery medical care is important and should be available to all women, but much of the responsibility does rest on the woman's choices.
Not always of course, but there are many things a woman can choose to do to make the pregnancy more or less safe.
7
@organic farmer You are not paying attention to the availability of the nutritious diet you blame pregnant women for not eating. Have you heard of "food deserts"? Are you aware that poor people often live in environments that are toxic, both physically and emotionally?
And here's a little tip: Pregnant women are overrepresented among the poverty population for some very obvious reasons, one being that pregnancy is far more common among younger women, and younger women are far more likely to be poor--they're at the beginning of their work lives. In addition, due to various reasons, poor women are far more likely to not have access to contraceptive services and prenatal care. Finally, poor women tend to have poor spouses (it's called homogamy).
If we really want to do something about high rates of maternal and infant mortality, we have to do something about inequality in general and poverty in particular. And stop blaming women for conditions they didn't create.
16
@organic farmer
You make good points about nutrition. However, our USDA has conflicting missions to both find markets for US agriculture and to support sound nutrition. Guess what wins out?
Congress supports grain growers and sugar producers but not vegetable and fruit producers.
We cannot hold pregnant women accountable for a political system that doesn't support human health.
2
For those of you looking for facts and data, I was surprised to find a comparison table of national maternal mortality rates on, of all places, the CIA's website: https://www.cia.gov/library/publications/the-world-factbook/fields/2223.html
It seems the US is on par with some of the poorer countries in the EU. The data suggest that we should not infer that the maternal mortality rate is correlated with social policies on women's rights. Saudi Arabia has a lower rate than the US!
Furthermore, the article points out that, although the doctor may protect a woman's life, the decisions made may be contrary to her mental and physical well-being and traumatise her for many years after a difficult birth. I don't know if anyone is measuring these health outcomes for women at all.
18
I have been working with maternal mortality, infant mortality and under 5 mortality rates since 1980s. USA compares very poorly versus other developed nations and many developing nations like Malaysia, Middle East etc. since decades.
8
@gf Why does the CIA care about health of the population? Because it is really a national security issue. I don't see any reason that the US could not reach the same, lower rates of maternal/infant mortality as Western European countries. The big difference is that they have national health systems making family planning and obstetric/pediatric care accessible to all, and we don't. It is highly likely that current efforts in the US to further restrict abortion access will lead to an increase in maternal deaths, as desperate women seek alternate means of ending pregnancies.
5
My father came from a very Roman Catholic family. When I was a girl back in the 1950s, the norm for Roman Catholics was that the baby was more important than the mother. I heard that if I were pregnant and there were problems requiring a choice between saving me or saving the baby, the baby would be saved and I would be allowed to die. Scared the living daylights out me and I never became pregnant.
43
The attitudes described in this article are entirely consistent with the devaluation of women's bodily sovereignty underlying the antipathy to reproductive rights. When the state asserts a legal, as opposed to compassionate, interest in the unborn, it is really proposing to colonize a pregnant woman's body, to seize it for the benefit of the embryo/fetus. Ethical questions about pregnancy and abortion (there are many) take second place to this fundamental principle: A woman is sovereign over the internal affairs of her own body, even when it contains another. If there is any "natural law" at all, it is that the unborn child is wholly and solely dependent upon the choices made by its mother. The nightmare of "A Handmaid's Tale" is coming true before our eyes when a woman's authority over her own body is ignored or flouted and her body appropriated through the agency of the medical profession.
63
@R.D. Eno
The growing preponderance of Catholic hospitals is a cause and illustration of this trend. Why should ideology take precedence over personal liberty?
6
This article has stirred up sad memories for me. While we were young, a former co-worker and I were pregnant together, due to deliver our babies in the same month. I gave birth to a boy and I am still alive. She also gave birth to a boy...and then died.
15
That’s terribly sad. Also brings memories to me - I almost died but not in the US
Ironically, the writer makes the same mistake as the doctors she criticizes: assuming what's best instead of considering women as self-aware, informed individuals with agency.
Many women DO want, as she writes, midwives and doulas and minimal intervention and no C-sections.
Many other women, myself included, want doctors, C-sections, and all the intervention necessary to come through childbirth in good shape.
The bottom line here is that women need to be listened to and taken seriously, as the primary patients and as individuals with particular needs. We are not a collective public health agenda.
15
@Jaclyn I agree with you, except that the research shows, wanting what is "necessary to come through childbirth in good shape" and "minimal intervention" are not mutually exclusive, and in fact, are often overlapping. Surgical intervention can be life-saving, and it also is much, much riskier for women than many women are informed about. Indeed, many women being advised about interventions like epidurals, c-sections, and episiotomies are only briefly explained the very serious risks of those, and not told at all about the other, far less risky options (that coincidentally, do not pay doctors or hospitals well). That is not informed consent.
15
@Jaclyn Everyone does need help in weighing risks vs benefits. Pregnancy emergencies are uncommon, but when they happen, can turn very dangerous very quickly. The idea of "natural" birthing centers within hospitals seems to be a useful compromise.
3
@Bonnie So true! New York City has one in-hospital birthing center, the Birthing Center at Mount Sinai West (formerly Roosevelt Hospital). Its 2 or 3 small rooms are at constant risk of closure, because it it isn't massively profitable like everything else there. This year, we fought against the hospital turning them into privately rentable rooms at $1k per night. Getting private, high profit hospitals to include birthing centers within them is unlikely. We need to find another way. (At least in the mean time, before the massive overhaul of our for-profit health care system which seems like it will never come. . .)
2
We're the richest country in the world, and among the advanced countries we're the poorest in govt responsiblity to its citizens--- in health care, economic equality and protections.
The center of our politics is that business profit comes in 1st, and citizen well being comes in last.
That's why we're so far behind other modern countries in health care for all---generations after it became accepted policy abroad.
And the party that has dominated our 3 branches of govt is still fighting it.
40
@Meredith
We are not the richest country in the world. We are the country that may have some of the richest people in the world.
And therein lies the problem. We have monetized everything in America. If someone cannot make money on our joy or sorrow, we don't deserve it.
13
My daughter would have died from a Pitocin induced labor if she hadn't push the call nurse button before she fell to the floor and was bleeding out in the hospital bathroom. When I gave birth to her 34 years prior I knew I didn't want Pitocin. It was fine that I refused it when it was offered. "Not listening" is a practice which is not recommended if one wants to have a healthy relationship with others. Let's be healthy and learn how and why it is essential to listen with genuine curiosity and care for the person in front of you. I've heard that doctors no longer take the oath to "do no harm". We need them to commit to doing no harm and to accept that they are accountable to the people they serve.
8
In the same article you deride too many c-sections and insist that a Thea's doctor should not of waited to perform one.
I don't believe there are many doctors who chose sleepless nights of OB/GYN specialty in order to dominate women. In fact, there's a shortage of OB/GYN as older ones retire and burnout and too few new graduates ready to step in.
Articles like this demonize doctors, use 20-20 hindsight to prove them wrong and contribute to OB/GYN shortage.
If you use anecdotes in place of statistics - here's one:
I have 2 teenagers, but I was born in Moscow, Russia.
I can confidently say that I would not survive my first childbirth back there.
I wish I didn't have to go through long labor before getting emergency c-section, but there were no warning signs at all. I don't remember giving a consent for a surgery - I was not lucid enough for that, probably my husband did, but mostly we trusted our doctor.
My case could be turned out to the honor story: long labor! c-section! no consent! Except it was nature conspiring against me, and doctors keeping me and my baby alive.
I'm forever grateful.
18
"America" is not blaming anyone for anything. Can we please stop with the "I have a gripe, so I declare that you are ALL responsible" angle all the time? In this case, it's very lazy not to name the actual perpetrators in order to try to force-guilt public buy in. I'm already involved in this issue, and passionately so, but this constant blanket public smearing is getting to the point where it is a harm, in and of itself.
9
@MLit how many children have you given birth to? What are your experiences?
As a woman who has birthed two, this article is dead on: women are considered to be collateral damage by our medical system when it comes to giving birth. Asking questions is forbidden, even insulted and attacked, as in HOW DARE YOU EXPECT TO BE TREATED AS IF YOUR LIFE MATTERS. Or, simply put to me "complications to the mother are not important". You don't know this so I'm guessing you are either male or have not chosen to have biological children.
11
The soulless nature of much of the country, often calling themselves "religious", "christian", constantly referring to "faith", none of it has gone unnoticed. They bring shame down upon us at every turn within their politics and no more so than the way they treat the poor and the sick.
They and the politicians who con them out of their votes hate the poor. They hate the sick. They hate anyone in need.
They are mad. This psychosis is a worship of wealth and it's proxy power. This is their true golden rule. It is the 21st century manifestation of an old evil of the puritans - the doctrine of John Calvin ( dictator in Geneva as a theocracy which banned all fun, down to card playing and even dancing! But founded a tradition of banking which would accept any funds from anywhere no matter how blood stained.)
Calvin said that we see that god loved a man by the wealth god had bestowed upon him. Technically this economy was a sort of communism with god alone judging and dispensing rewards. Predetermination is a little more complicated but thats the gist.
The sick. the poor. the abandoned, even the vulnerable all find themselves in the bad graces of god. They are sinners and should be hated. This was not, until TV evangelists, the core philosophy of Baptists, Methodists, Pentacostals and other protestant sects. But electronic indoctrination required a single doctrine, no nuances, and so Calvinism is Republican Politics. Even Republican catholics and jews have converted to it.
19
@Arthur The arrogance of people who presume to speak for god in telling others how to live is quite astonishing. That such people work to make the secular state enforce their views over all others is very wrong, and it suggests their religious/spiritual argument is not in itself a persuasive one.
4
"Richest country in the world"?!? What a pathetic joke. When it comes to "healthcare" we have the MOST EXPENSIVE in the world. No other country comes close. BUT, when it comes to the quality of healthcare delivery, we're an unbelievably horrible 37th! Why? Profit over health. Money over health. Commercials over health. In almost all other western countries, healthcare is a RIGHT. Not here. We're still living in the Gilded Age. "Ask your doctor".
36
Women have died in labor throughout history. There is nothing new at that. Republicans believe in leaving things as god set them. Furthermore, maternal deaths may mean that more young babies are available for adoption.
1
@Inveterate
Yes, and men have died since time immemorial of lock-jaw from minor cuts or stepping on a rusty nail. So don't get your tetanus shot since you believe in "leaving things as God set them". Disgusting.
3
@Inveterate
I am a physician. I find your comment to be appalling! People have also died of smallpox, bubonic plague and tetanus. By your reasoning, we should have done nothing to stop this, since these diseases were ordained by God. This is not only inhumane, I don't think it's particularly Christian. It's not even Republican.
5
I can barely believe that people still think like this.
2
Many hospitals are now refusing to deliver babies. That's how you make American great again. Unreal.
15
You're comment made me smile.
We really do reap what we sow.
Maybe the doctors should all retire so that everyone can give birth in bathtubs with midwives.
I would never want to be an obstetrician. Ever.
1
I am not a new-age, aging hippie. I believe in the benefits western medicine can provide.
But when it comes to childbirth, as the appalling statistics cited in the article attest to, western medicine has got it all wrong.
Both of our children were born at home. There were no IV's, chirping monitors, fluorescent lights, or stressed out nurses. Nor was there the godlike presence of an MD to tell us how the labor was proceeding.
The atmosphere was quiet, intense, exciting.
Our son was born in our bed after a five hour labor, mid-wife present. Our daughter, 4 years later, just plopped out onto to our decidedly non-antiseptic bedroom floor after virtually no labor and no pushing. The only people there for that one were mom, dad, and our 4 year old son. It all happened too quickly for the mid-wife to make it.
Oh the calamity and horror that would have followed THAT event were it to take place in a hospital. Our daughter had the umbilical cord wrapped lightly around her neck. I removed it. We cleaned her up and all was well. We did wait for the mid-wife to cut the cord.
The point is, giving birth is not an emergency. We should not hand over our fates to omnipotent deities called doctors and their magic potions: pitocin, epidurals, and c-sections. All of those things have their uses if a woman is in an actual emergency during childbirth. But they all have the potential to kill the mother.
Hospitals are often dangerous places for
mothers. Beware.
9
@Nicholas Kirgo
Glad to know it went well for you, but this is not the method to solve this problem.
4
@Nicholas Kirgo
You should not wait for an emergency during childbirth to intervene. It may otherwise be too late.
My first daughter was pulled out (vacuum) because I (34) was so exhausted and my contractions disappeared.
My second daughter's birth was induced (7 hrs from start to finish, no episiotomy or tearing) because at 40 weeks I still hadn't had any contractions. She weighed 4.5 kilos and part of the protective vernix caseosa was gone (washer-woman hands). Before inducing, the doctor did caution it could come to a c-section.
I had suffered no health problems before or after.
BTW, I live in northern Germany and did not pay a single mark for the prenatal, hospital and postnatal care we received.
Editor’s note: This comment has been anonymized in accordance with applicable law(s).
1
This is a very naive comment. To each his own. Great that you had safe and joyful home delivery experiences. Lucky for you that no complications arose. There is no judgment from my side. But they wouldn’t be my choice - you should not judge those who choose the security of a hospital setting nor warn people from choosing to deliver in a facility. And I don’t believe for a second that being pregnant or giving birth is not a medical risk. I have known several women all who gave birth around the same year I did and almost all of them had an issue requiring doctor intervention (we use midwives otherwise here in Denmark). I almost died and thank god i never had any desire for a home delivery. I have spent part of my career promoting facility deliveries in developing countries due to the risks many women face in delivery
9
My son turned 13 yesterday and every single one of his birthdays is a reminder of how I too faced death when he was born. I was admitted to the hospital w/ severe abdominal pain @ about 6pm & by 10am the next morning I was being rushed into an emergency c-section under gen. anesthesia. Turns out I had HELLP Syndrome and not only were my liver and kidneys failing but my platelets sunk and my bp was dangerously high. I was dying and the only way to save me was to deliver him—9 wks early. He was 2lbs 11oz and was rushed to the nicu where he spent the next 7 weeks. I spent 9 days in the hospital getting magnesium, morphine, steroids and blood transfusions. It took 2 days for me to be stable enough to see him & I didn't get to hold him until he was a wk old. The thing I remember most about that experience were looks of utter concern & at times bewilderment from the doctors and nurses about our situation, and it always seemed like they wanted to tell me more, or say they were sorry—but I think out of fear of being sued—they chose to tell me it was a case of bad luck. When the postpartum depression sank in I was told it was just the baby blues. I wasn't offered any sort of counseling or therapy. I was discharged and sent off to manage my physical/mental trauma and a dangerously fragile preemie (my 1st child) w/ limited guidance. It was the darkest time of my life but we got through it (thanks to my amazing husband) and we're both healthy. I look back and I still don't understand.
40
@TH I just made a comment about HELLP. I had it, too. Why do doctors not know about HELLP!? It's absolutely insane.
3
@TH I had HELLP as well. It is not as rare as people think. My case was completely mismanaged and I am lucky my daughter and I made it.
My daughter's birthdays are happy occasions but each year I am forced to go back to that dark time.
1
@MaryEllen I am so so sorry that you were treated this way.
Here is an interesting article on the difference between England's pregnancy care through the NHS and the US. Care begins much earlier and is personalized. Very early on women are divided into categories by known risk factors. Prenatal is started almost immediately and midwives attended 100% of births. It seems to me that the UK considers the mother's care and support and input as vital. The US? Not so much.
https://www.propublica.org/article/why-giving-birth-is-safer-in-britain-than-in-the-u-s
27
I was in the exact same position as Thea except at 42 weeks - easy pregnancy, good vital signs, but no amniotic fluid. Luckily, I was transferred to an excellent practice at a hospital. My OB went through my options and literally held my hand as I made the decision to move forward with an emergency C-section. I had originally hoped for a birth at a midwife-led practice, but I'm forever grateful for having a medical team that was well versed in the emergency situations that can arise during childbirth. I had a frank conversation with the doctor after delivery about all the "what-if" scenarios that could've played out. It's CRITICAL for doctors and medical staff to have the training needed to handle these situations. I'm thankful I found a doctor who not only had the training but continued to listen to me as I dealt with a significant change in what I had hoped for my daughter's birth.
21
The title of the article is misleading as well as the point Kim Brooks is trying to convey. America is 300+ million people and not everyone thinks the way that doctor did in the case of Thea. There are 50 states in the union and not all of them have those extremist fetal personhood laws. You choose the state you live in and have to deal with the laws that are not in your best interest.
I am completely against curtailing any motherhood rights. However, not all of America is to blame as implied in this article. The parents should make all final decisions and not the government unless there is blatant abuse such as mother doing drugs, excessive drinking, etc.. The doctor is there to guide the parents in the medical decision making process.
When we planned and had our baby, I made sure we went with highly recommended doctors from family and friends. I even interviewed our pediatrician before our son was born.
Yes, there are some crappy, neanderthal type laws and doctors out there but do your homework before you trust a doctor with your life or that of your infant.
Keeping voting for Republicans and the Trump mentality and women will continue to be treated as second class citizens.
12
@mrpisces You're right, the parents should make final decisions with the guidance of doctors. But the point of the article is that the DOCTOR made the decision for Thea, not the government. The DOCTORS told Claire that she couldn't feel her surgery, completely ignoring both her and their own equipment. Claire and Thea probably went with highly recommended doctors, too. You are also guilty of blaming the victims here -- which proves the author's point perfectly.
7
I think you may have missed the point. These outcomes should not be happening at the rate they are happening. They are not happening elsewhere at these rates. This is not “blaming” America. It is merely saying that we have a system place now that is not working for women and we have the tools to correct the system. “Trust your doctor” is a simplistic reaction that does little in the face of the real trauma that women are facing. But you are right about Trump!
2
@H All of America is not at fault for these particular instances. Many of us voted for better health care choices and empowering all genders and races.
Here is the flaw in your argument and it is the word "probably". "Claire and Thea probably went with highly recommended doctors, too."
Your other flaw is the decision. The doctor had to follow the demeaning law legislated and passed by the state. If you chose to continue to live that kind of backwards state, then, oh well.
I appreciate the dialogue created by this article and the ensuing discussion. Many great points have emerged, including the need to more carefully analyze the mortality cases, to promote the use of midwives and doulas, and take a deep look at our societal priorities and governance.
However, one must also consider the insidious influence of the malpractice industry in any legitimate review of American health care. With regards to obstetrical care and the occasionally competing interests of mother and fetus, the following statement is a cruel indictment of our current state: Obstetricians are rarely sued for performing C-sections; instead they are sued for NOT performing them.
18
@Erik D Largely because so long as the mother and baby are eventually "healthy" (aka not dead or permanently physically disabled) it's impossible to find a lawyer to take a case against a doctor, even if the doctor blatantly violated consent laws and caused unnecessary pain & suffering.
1
And why, pray tell, did the great US of A not take part in the UN study? With all the resources, intellectual and what have you, our contribution would have been invaluable.
15
I'm not shocked, postpartum care in the hospital is horrendous. After 16 hours of labor(in hospital), I chose to have my doctor perform a c-section, otherwise I'd be with a doctor I'd never met if the baby came later.
After surgery, I experienced an IV in my hand that swelled to twice the normal size with fluid(and was painful for 3+ months), my catheter was left in for 6-8 hours and it overflowed onto the floor twice. I wish I would have sued the hospital, instead I felt fortunate to leave ALIVE.
Additionally my son disappeared to the nursery for nearly 8 hours, had my husband not been with me to go insist he be returned to me, I'm sure nursing wouldn't have been very successful.
Keep in mind, it was also a Friday night, so I'm sure the staff was lacking motivation.
7
@Katie You're sure right about Friday night. My brother died of cancer a few years ago, and he had the poor luck to take his final turn for the worse just before a weekend. He really should have been sent to hospice as soon as the situation became apparent, but nobody working the weekend and wanted to make that call. So instead my brother spent two uncomfortable days in the hospital with a bare bones staff who hardly noticed him. He still died once the weekday crew came back and sent him to hospice, but his final days were worse for it. And we'll never get those days back. Of course I am fine with doctors and nurses having time off (as they should!), but I wish the hospital was equally well-staffed on all days. I guess it's hard to find people who want to work weekends, and I get that, but it's still infuriating that innocent people suffer because of it.
2
@Katie - Um, if you'd ever worked in a field which requires 24 hour coverage, which apparently you have not, you would know that motivation is the same whether it's Friday at midnight or Monday at mid day.
Having said that, I hope you and your child are doing well now.
4
@PM I've worked several types of jobs from factories with 12 hour shifts, overnights and weekends at a resource home for children with disabilities, hotel overnights, retail stores, and 16 years of teaching. In all fields, no workers wanted to work night shifts and were focusing on when they could get home to their own families.
The biggest problem is lack of healthcare insurance & male doctors. Women in the US are not treated as first class citizens when they consider pregnancy or become pregnant. Health problems are not seriously discussed with women & many times it is all about the delivery of a "baby" (healthy or not) & the money. If a pregnant woman has no money, support, or insurance she has a greater risk of dying during pregnancy or after delivery.
I remember trying to get a tubal when I was 21 & knew I never wanted kids. I was told I had to be married & had to have at least one kid before any doctor would consider doing it. What is it about male doctors that they can't accept what a woman says in matters of her own health? I eventually got the tubal at 40 when the use of birth control had affected my health & my husband's family had mental & physical problems I did not want passed on. My woman physician did not even ask my husband, thank god. I divorced him a year later after I caught him with another woman who had had his baby (his mother wanted a grandchild out of him).
Men should have NO say over a woman's health decisions.
42
During my unplanned c-section, my doctor didn't believe that I could still feel his touch and cut anyway. I'm told a friend in the waiting room halfway across the (Hoboken) hospital heard my screams.
I guess that was why doctor finally general anesthesia, which he denied earlier because "the baby had restarted breathing so it wasn't enough of an emergency."
8
The US has one of the lowest perinatal mortality rates in the world; this is the best measure of maternity care on infants. Infant mortality is due to other issues. Congenital anomalies are the biggest cause in both cases. Other countries don't always include stillbirths or deaths due to very early prematurity, which improves their rates.
https://www.healthsystemtracker.org/chart-collection/infant-mortality-u-s-compare-countries/#item-perinatal-mortality-u-s-slightly-lower-comparable-countries
6
@Susan Lemagie In citing infant mortality statistics rather than maternal mortality, you have both missed the point of the article and confirmed the author’s point.
39
Completely agree.
Countries like Sweden do not report still birth rates below a certain gestational age (I believe 26) while the US it is 22 weeks which is nonsurvivable — apples and oranges
@Susan LemagieThis article is about maternal mortality rates.
6
Awful experiency, and an insult to sanity, by belittling pregnant women as just a vehicle of a soon- to- be- born child. Much arrogance must yet be conquered...and someone really listening to the patient. 'First, do not harm', is a mantra for us physicians and nurses and 'healers' in general, even if we fall short at times. But a hefty dose of humility and compassion ought to remain our 'calling', once our professional expertise is proven. And 'bedside manners', as old as it seems, remains indispensable even in this day and age of revolutionary technology.
13
While I never would have imagined this type of crisis here, I am not surprised because I believe, as a culture, we simply do not value or even like women very much.
66
So glad I had a midwife and homebirths for my three babies!
7
And yet, the women who know this is happening and don't want to have children (partly because of this), are still characterized as somehow "less than woman" by other women.
10
@Jen
Please, you must mean "by some other women."
Editor’s note: This comment has been anonymized in accordance with applicable law(s).
4
Trump and the Conservatives believe that there is an emergency occurring across America. Not the emergency of high mortality rates during pregnancy, but the alarming rate in which the Caucasian birth rate is slacking recently.
Even though high mortality rates, lack of medical access and the ability for women to take control of their own pregnancies affect or benefits all women, Conservative's main fear is that Caucasian babies will not be born fast or more frequently enough to match the birth rate of others.
So, sorry ladies. The current American policies are bending towards turning women into simple vessels to increase the Caucasian population.
18
@Uptown Guy
Please don't use term "Caucasian". It's part of the nineteenth century taxonomy of races that has been totally debunked by geneticists and physical anthropologists finding out that we are all mixed.
Use the term "European -American " instead with the understanding that Europeans skin tones ranges a gamut . For instance by the US old 'one drop rule' which was at basis of Jim Crow segregation laws opining who was "white" and who was "black", such major figures in Western culture as Beethoven and Pushkin were black (and of course Empress Josephine, Alexandre Dumas, etc.)
1
Appalling. Rather than being respected and cared for, these women are being treated as nothing more than living incubators.
Around where I live, "Choose Life" license plates appear on many cars. They bear a picture of a chubby, beaming white child that appears to be a few weeks old. I've often wondered what the reaction would be if the plates were randomly issued — no choice — and included pictures of unattractive babies, screaming babies, painfully premature babies, and babies that do not match the driver's skin tone, plus a few of the horrors that may make a parent opt for abortion. Hydrocephalic fetuses, anencephalic fetuses …… Tragedies that happen in real life.
127
@KJ I've seen those license plates also. I like your idea of random issue images.
12
@KJ And do the "Choose Life" people care what happens once the fetus has become a toddler? Do they want to pay for things like universal childhood preventive health care?
19
@KJ Because it's not about babies at all, it's about controlling women's sexuality - punishing them for having too much sex resulting in an unwanted pregnancy.... Some (presumably male) pro-lifers are candid enough to directly tell women they shouldn't open their legs if they don't want to have a baby. In a way I appreciate their honesty.
5
ALWAYS blame the Woman. Obviously, she’s did something, anything wrong. Or, She omitted to do something, anything she should have done. It’s like she’s in a no-situation, no matter what. Imagine THAT. Welcome to OUR World, Men.
Seriously.
22
When Women as considered as breeding stock, why should anyone be surprised when their treatment is that comparable to farm animals. A Woman’s body apparently belongs to everyone, except to Her. Seriously.
80
@Phyliss Dalmatian
Except that a valuable cow or broodmare would be treated way better!
I've seen a lot of interventions in which a struggling cow was rescued - there was no question of killing her in order to save her calf.
A woman, however, can be sacrificed "for the sake of the baby." It can and does happen and it's the default position in certain hospitals especially those associated with the Catholic Church.
1
"The richest country in the world" for whom? The general population? An outdated description of the U.S. for most of its citizens these days.
37
By GDP per capita you're number 19:
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2004rank.html
And WHO ranks your health-system at number 38 on the list:
http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/
The 1950s are over, and the world has left you behind.
Has anyone looked into the correlation between maternal mortality and the rise in church owned hospitals? Florida Health Care has 25 distinct hospital campuses and is owned by the Seventh-day Adventists. Then there's Baptist Health in South Florida. The Catholic Church owns Sacred Heart medical and Ascension Health Care, and the Lutherans own Good Samaritan Health Care.
I'm certain that poverty has an impact on maternal health, as it does on infant health. And African American women are not only more likely to die during pregnancy, but they're also more 20 to 40 percent likely to die from breast cancer. This is completely unacceptable.
19
For us foreigners, stories like this are part of the image of sheer total derangement America projects on an almost hourly basis. America's total disregard of its own basic practical needs, let alone basic rights, is appalling.
The only way to stop things like this is by class actions, targeting each part of these insane pseudo-legalistic ALEC-like protocols and other obstructions to best practice. There may also be grounds to attack the Constitutional rights of women who are at least in these cases deprived of due process rights. Since when does a doctor threaten a patient with prosecution, for example.
America may be the richest country in the world, but only a percentage are actually rich. Everyone else isn't. As for mental and ethical poverty, does anything need to be said? I suggest a #MomsToo campaign. You've obviously got enough information to start one.
44
There is a pervasive attitude in American work culture that sees pregnancy and motherhood as expensive hobbies some women choose to engage in. We create a family at our own risk and like any other expensive hobby, we should be responsible for all of it and practice our hobby in some kind of social vacuum that insulates unmarried and childless people and our employers and our health insurers from any risk or responsibility associated with our self indulgent choice to be mothers. Although femininity may be less so, a functioning uterus is still very much a social liability.
We have created a work culture where work and success and career is the primary goal of our lives and any deviation from work is what we do privately on our own time. Men are the default status of American professional life and childless women will be celebrated as workers only until their status changes. Medicine and political policy are reflective of this pervasive American cultural phenomenon. No anti-discrimination law can protect us from how people think. Women who find themselves unemployed and struggling to feed children will be scorned and shamed for their "irresponsible choices" no matter the circumstances. We will be embattled when we ask for nursing space or some time off to attend to our children or a paycheck during our confinement. Children and pregnancy are a deviation from serious work.
This is why mothers are dying in America. because it's just not America's problem.
125
@Geraldine
Pragmatically speaking, Americans do not view having children as a hobby.
Instead, they view having children as a responsibility.
Choosing to have children is a choice that confers the responsibility for raising them on the person who made the choice to have them, in the first place.
People in our society are expected to take responsibility for their own actions -- to include the progeny that may result from those actions.
It's a matter of accountability.
It's the same way we treat people who break the law.
If you choose to break the law; then you choose to accept the consequences.
It's the same with having children. If you choose to have children, then you need to accept the consequences of raising them.
I did not have children because I knew I could not afford to raise them.
I did not expect anyone else and most certainly not American taxpayers to have to foot the bill to shoulder the fiscal responsibility for providing for any children that I knew I could never afford to support with food, clothing, shelter, medical care, and education (college).
Simple mathematics.
And really, that is the basis of the point of view of the Americans whom you decry as being those who regard having children as equivalent to a "hobby."
Having children is not a right: it's a responsibility; and if you do not have the means to support children, then you should not have any.
It's that simple.
America's point of view, take it or leave it.
7
@DrH
If American women went on strike and refused to have children, you'd change your tune. Children convey a benefit to the society--and every society, everywhere, throughout time, has understood this: except the US.
14
@Dr. H
You fully just proved her point.
Having horses is also a responsibility. No one would disagree that being an equestrian is a hobby. Do you see now how something can be a hobby that involves tremendous responsibility?
(PS you do have the right to have children in this country. There are literally dozens of SCOTUS cases affirming that "having children is a right.")
15
My doc was on vacation when my daughter was born, so I had to go with the on call doctor, who advertised in the Yellow Pages as "a pro-life physician." He walked into the room and imperiously announced that he would be inducing me to clear a bed for the weekend. I said no, as I'd planned to do natural. He was infuriated, immediately gave orders to the nursing staff that I was not to be allowed to walk the unit during labor but kept in my room, and then when I was delivering her, he gave me an entirely unnecessary and unprepped episiotomy, apparently to teach me a lesson about how to appropriately cower before male authority. That is my anecdote on how Republican-style thinking has impacted maternal care. It's not that they just LOOOOVE babies so much. It's that they hate women that much.
441
@MLit That is a traumatizing experience! I'm so sorry you went through that.
23
@MLit
You should have sued him for the episiotomy and report him to the medical association and state health dept.
Editor’s note: This comment has been anonymized in accordance with applicable law(s).
22
@MLit
I think you should sue. That's terrible.
10
I understand the fact that physicians, OB-GYNs, nurses, or any health professional for that matter have studied and mastered the science of medicine. However, articles like this with the data to back up it show how little some physicians seem to care for the patients. People are dying because of implicit bias, lack of healthcare and simply not listening to the people they took an oath to protect.
25
I was told by an OB when I test came back that my PapA marker showed I would develop Preeclampsia later in my pregnancy, he said “I wouldn’t worry about it. If it was my own wife, I wouldn’t even tell her.”
I moved a month or so later because of my husband’s job and at the next OB office, not one but TWO PAs missed that the Preeclampsia had started. I ended up hospitalized at 34 weeks and had an emergency c-section when my test came back with protein numbers the doctor said they had never seen that high in real life, they had only read about numbers that high in textbooks.
With both pregnancies, I had Cholestasis. By the time the test results came back—for tests I had to request—atthe end of my first pregnancy, the preeclampsia was so bad that the Cholestasis was a non-issue. During my second pregnancy when the Cholestasis symptoms started, my OB has new info on it, but hadn’t read it yet. After delivering my second child, I had post-partum Preeclampsia and went to the ER with BPs over 180/100 and was never officially diagnosed with post-partum Preeclampsia or put on BP meds.
Thank you for writing this piece. It should serve as a wake-up call to medical professionals as well as a reminder to pregnant women. If something doesn’t feel right, keep pushing for answers, keep pushing for more tests, and don’t be afraid to change doctors in the middle of your pregnancy.
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For those who like to look at international statistics, there is a book chapter (from ~2006) that has a few from page 1053. In the 1920s in Germany, MMR was 400-500, went down to about 3 in Germany, Austria, Switzerland in the 00s. More recent data from Netherlands and UK show a slight increase, which is blamed on more high risk pregnancies (older age, fertility treatment, etc). There is also a comparison of different world regions.
4
This column is long on anecdote and short on data. Women should not be blamed for their deaths or poor outcomes - but where is the issue? Is it with the lack of health insurance for all women so that women enter pregnancy without pre-existing conditions such as morbid obesity, diabetes, and hypertension? Reading this article you learn nothing of the true causes and it's just one more article about how bad our system is. The Thea anecdote makes it look like C Sections are preferable to inductions; the Claire anecdote happened 13 years ago and shows what - a problem with the epidural?
Really the author could do better than this in making the true case of what needs to be done to help women give birth safely and have the healthiest possible outcomes for themselves and their babies.
26
@Pediatrician X My take on the article is that our current society has decided that a mother's survival is secondary to the survival of babies. It is an artificial construct--the survival of the mother and child should be on equal footing. And, the goal should be to reduce the mortality rate of both. However, the current political environment has lead to the focus being solely on fetuses with little regard for the mothers and for children once they are born. The statistics are there to back up the thesis that the US has a maternal death rate problem it is ignoring. However, statistics are dry and do not lead to action when presented on their own. The stories cited here bring the numbers to life and can lead to the attention this pressing issue deserves. Our daughter became critically ill with post partum pre-eclampsia in 2014. Fortunately, she was delivering her baby in California and the protocols mentioned in this article probably saved her life.
24
@Pediatrician X
The column addresses this. We have data on maternal death rates but have done a very poor job investigating why they are what they are. The author clearly has her own perspective on what’s wrong but the hard data isn’t around because no one has bothered to collect it.
15
@Eric
There is data on this maybe not enough but much better than this article:
https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm
A lot of issues here. In the United States, maternal mortality is Increasing, but in California, maternal mortality has been decreasing. And maternal mortality in the other developed countries has been decreasing. The argument that other countries have physicians that are more in tune with women’s needs I think could be somewhat convincing. In the last 20 years American obstetricians have become increasingly female, the argument that only California physicians are more in tune with females needs compared to the rest of the country is absurd. What has happened in the last 20 years has been the evisceration a federal public health infrastructure. The California state health department has stepped in. The other states have not done so far variety of reasons. This is the best explanation. Public health departments are critical for issues like infant mortality, maternal mortality, sexually transmitted diseases etc. which does not garner a lot of press but is one of the critical elements of the health of a society.
20
I gave birth 4 years ago. Early on in my pregnancy, I asked my regular doctor for recommendations on hospitals to give birth at and for recommendations for Ob/Gyn practice groups.
I went with a hospital that was a level 5 trauma unit that also had a PICU but also put my life ahead of the baby's life. I'm glad I did, I had an emergency situation which required me to deliver early. But, during the process I was listened to, i was able to get a second opinion and my health was just as important as the baby's health.
33
When is comes to medicine, you always have to follow the money:
"Women know what they want when it comes to labor and delivery, and it turns out the things they want (midwives, doulas, fewer unnecessary interventions and cesarean sections) are less expensive and produce better outcomes.”
There's no money in midwives and plenty in hospital stays and cesareans.
31
Pathetic, and so, so true.
A lot of this has to do with with the medical profession turning pregnancy and childbirth into a medical "condition" to be managed rather than the natural process that it is. Pregnancy isn't an illness, but then these days it seems like everyone requires a "diagnosis". It seems like it's impossible to just simply be healthy any more.
11
@WesternMass
Illnesses are most often natural processes, too.
6
Just for the record, I had two children born in 1982 and 1986. Both girls were delivered by C-section due to feet-first position and bottom-first position. I am completely happy that I had two healthy girls who may not even have been born ten years prior. My doctor was wonderful, compassionate and efficient, and friendly. I could not have asked for more. There were no complications, except a low fever with the first child that kept me in the hospital for an extra day. The first child had a high bilirubin count and had to be readmitted to the hospital for the lights. All in all, even small hiccups were handled well. I understand that not all women have access to such good physicians as I did, and that things can go wrong, through no one’s “fault.” Just want to point out that there are and were great doctors who listened and wanted patients’ births to go well for moms and babies.
11
@Denise McCarthy but why point it out? There are women in Saudi Arabia who have rich, full,satisfying lives and happy marriages. It doesn't change the factual state of women's rights for the whole country. A few good doctors doesn't fix a fatal and broken system.
8
@Liz I do think it's worth recognizing good medical care because 1) we can learn from it about how to reform a broken system and 2) it doesn't do any good to demonize doctors (or any group) as a whole--it just makes people defensive and deflects attention from the systemic issues that prevent them from providing quality care.
8
another fantastic graphic at the top of this story!
read a lot of other newspapers but in the words of Carly Simon "nobody does it better"
1
Please forward this article to every girl/woman and socially conscious man you know.
This can only continue if WE THE PEOPLE allow it. The time to take action to stop it is NOW.
5
It's not just in childbirth, but in most aspects of healthcare that doctors don't seem to be interested in listening to the patient.
However, I had a similar experience as the woman in the story, where I walked in for a normal pre-natal visit and ended up being sent immediately to the hospital to be induced, without being allowed to go home to get my prepared supplies. My story had a happier ending, fortunately, but my son did suffer complications from my prolonged labor and spent 3 days in NICU before he could come home.
I feel that our childbirth mortality rates in this country are so bad simply because women are seen as second class citizens.
64
If the issue here is women are second class citizens, why is mortality going up when women’s relative income to men is rising,educational levels are rising and the providers (OB/GYN) are increasingly female. Second class citizenship does not explain RISING maternal mortality
3
This problem in the US has been known for a while. I don't understand why OB-GYNs, in their professional organization, do not try to make the improvement of maternal care during pregnancy and delivery for all socio-economic classes better. They need to call for better standards and improve the protocols. It can be done, but a concerted will and money needs to be put toward it. In my mind, I think this problem is a perfect example of treating and regarding women as second class to men. Their lives are not as important.
25
@Happy2B, It's all about money.
Oligohydramnios is an indication for delivery, and induction is generally preferable to surgery (this newspaper has reported on how C-sections are over-done). Unfortunately in this case Thea ended up needing surgery, and had a not uncommon complication (hemorrhage). I'm not sure what could have been done to avoid this particular situation medically speaking. Yes the maternal mortality rate is unacceptable, but not because of cases like this.
14
@DR Low fluid in the absence of any other indications that the baby is having a problem (as in Thea's case) is called isolated oligohydramnios. There is actually little evidence that isolated oligohydramnios warrants induction. Studies have shown that simply having women drink two liters of water before an ultrasound dramatically increases fluid levels. Maybe things would have turned out radically different for Thea if she'd happened to chug a bottle of water before her appointment. Since you don't know what exactly happened in Thea's case you should avoid making omniscient pronouncements regarding whether her experience was acceptable or unacceptable. And you seem to have missed the larger point, which is that Thea was threatened with ARREST if she left the hospital, a rather dramatic illustration of the larger phenomenon of pregnant women being routinely devalued and denied dignity and autonomy.
21
This story says nothing about one of the most obvious reasons why maternal mortality continues to rise in the USA but not in other developed countries: health insurance. The availability, or non-availability, of high-quality prenatal, obstetric, and postpartum care correlates directly with the mother's financial resources. Even when doctors look at the data regarding what care mothers who died received, their recommendations will concern evidence-based best practices but say nothing about the most glaring discrepancy in the system. Until all women can access high-quality medical care before getting pregnant, during pregnancy, and continuing afterwards, nothing will change.
57
@Nikki
Agree totally. Additionally, women also need access to birth control to control when and if they want to be pregnant. And it should be free for uninsured women. Many pregnancies are unplanned in the US due to lack of birth control and lack of sex education.
3
On the other hand, if the doctor had allowed Thea to go home to get her overnight bag and something had happened to the baby, the doctor could have been sued for malpractice. The flip side of having a baby in the richest country in the world is the expectation that the baby will not die and a reluctance to accept that sometimes nature, and not negligence, is the reason.
25
@Anonymous The problem here is not that they wouldn't let her go home. It's that she asked for a C-Section (a safe and common procedure which generally has fewer risks than emergency inductions), was denied and given drugs to induce her instead, needed a C-section in the end anyways, and as a result of labouring and the medication had a massive hemorrhage. She wouldn't have hemorrhaged if they had listened to her request and just done a C-Section to start with.
50
Csection is safer than induction? - especially for a nonemergent cause?
As an Obstetrician please find me the data on this.
The problem with this article is that like most other perspectives on maternal mortality, it is too reliant on individual anecdotes - you can cherry pick an individual patient out of the millions that deliver each year and find one that supports any cause. I can tell you dozens of doula horror stories but that doesn’t make every doula an unqualified side.
What NYT and most commentators are missing is that this first a societal problem. I routinely deliver patients with BMI of 50-60 and above. Patients with uncontrolled hypertension and diabetes, patients with IV drug abuse and heart valve disorders from untreated infections.
Patients that are demanding and that will sue if they don’t get the perfect outcome regardless of their noncompliance. I have not personally delivered babies in Sweden but I find it hard to believe they have many 300 lb patients as we do.
Yes we are encouraging patients to become healthier prior to pregnancy. That is not a bad thing
24
@ anonymous
The problem with your thinking is that it is completely reliant on hindsight is 20/20
- this is a no win proposition for the obstetrician. Provide the csection on maternal request and if there is a hemorrhage get sued for not allowing an induction. Do the induction and if it doesn’t work, and there is a newborn injury during birth get sued for not doing a csection.
We rely on strict criteria for estimated fetal weight and cesarean planning. We try to adhere to patients wishes but our job is to make appropriate recommendations based on evidence and clinical experience - I am sure there are bad players out there that abuse patients trust but the majority of doctors I work with try their darndest to have a healthy mom and a healthy baby on the other end of this process. We have many happy patients and some not so happy ones also. Welcome to life
8
I think the story should have reported how many babies die, or incur lifelong injuries, at birth, compared to mothers. My impression is that babies are simply more vulnerable during the birthing process and that is why they get more attention. I could be wrong, but it would be nice to know the statistics on this.
My husband and I had a hard time getting pregnant and had to use Artificial Insemination for our first child, and IVF for our second. In addition, I am quite small and both babies were large, meaning two c-sections were required. So I don't think my husband and I would have had any children without medical help for both conception and delivery. I am extremely grateful for this help.
The fertility treatments and the births were painful, but I also have almost no recollection of them today. My clearest memories in my whole life, however, are the two moments when I first saw my children and heard they were healthy. While consideration of women could be improved, I myself would not have changed anything in my treatment that might have changed the final result, now 20 and 25.
8
@DWS
America's infant mortality rate is a disgrace, like most of it's right-wing public policy.
America has world class poverty and the greatest healthcare rip-off system in the world thanks to 'free-market' derangement syndrome.
You and your husband had resources and things worked out for you; that's great.
But many people do not ... and those people have a radical Republican government to rely on that would prefer to see them drop dead.
http://time.com/5090112/infant-mortality-rate-usa/
Babies born in America are less likely to reach their first birthday than babies born in other wealthy countries in the Organisation for Economic Co-operation and Development (OECD), a new study found. While infant mortality rates have declined across the OECD since 1960, including in America, the U.S. has failed to keep pace with its high-income peers, according to a report published in the journal Health Affairs.
Compared to 19 similar OECD countries, U.S. babies were three times more likely to die from extreme immaturity and 2.3 times more likely to experience sudden infant death syndrome between 2001 and 2010, the most recent years for which comparable data is available across all the countries. If the U.S. had kept pace with the OECD’s overall decline in infant mortality since 1960, that would have resulted in about 300,000 fewer infant deaths in America over the course of 50 years, the report found.
Drop dead, America !
GOP 2018
27
Hi Socrates:
I agree with you - mostly. If the article had been about the inequality of fertility treatment insurance coverage, then I would have said that I was lucky enough to live in one of the states, Massachusetts, where insurance has to cover fertility treatments, by law, and that other states should also do this. If the article had been about unequal access to hospitals, especially in rural areas, then I would have said that the Federal Government should make sure that everyone has access to a hospital delivery.
But the article seemed to be about doctors putting the life of the child over the life of the mother, and also devaluing women, and that was what I was commenting on.
5
@Socrates Didn't Paul Ryan blame women, I assume he meant white women with white partners, for not doing their part in having enough children and smugly claim he had done his part?
I agree with you about the GOP wanting most of us dead. I guess Paul meant only wealthy white women having children, since only they can afford the best health care or any health care. I would be interested to know what the mortality rate is for them.
3
We welcomed our first child this spring. Natural birth, though induced with Pitocin after a week late.
I must say the process left much to be desired. I feel if I hadn't been there to speak up for my wife, it could have gone awfully different.
I have no doubt that American birth/delivery is in dramatic need of improvement and education, I don't have a whole lot of faith in the new generation of doctors. Our encounters seemed entitled and even forceful, taking steps without checking with the mother and pressing unneeded procedures. I dreaded the fate of C section, especially after reading studies of the amazingly high, yet unnecessary c-sections done in America and UK. (BBC news had excellent stories this year).
I had to assert myself into the situation more than once to have my wife's concerns heard.
There were 2 very good nurses, but most everything else could have been done much better. We're lucky things turned out well for us, because of my wife's strength and determination, but I know there are many out there who didn't have a good experience or didn't live through it.
I recall a parent couple telling us "if things get rough, you may have to decide between the mother or the child" I was shocked. We went into it, no questions asked, Mother's life. As tragic as a child's loss is, without the Mother, the child doesn't happen. Ideally another child could be conceived. Get profits out of the hospitals and things will go much smoother.
108
The Republican Party, over the course of the last forty years, has demanded that America have the greatest healthcare rip-off in the world...AND that 'small government' keep its empty head out of decent public policy.
And that's exactly where we are.
The Republican Party banned the CDC, NIH and ATF from studying gun violence and murder; the same goes for just about everything else, including public health policy and women's health.
As far as the rabid Randian right-wing is concerned, a total lack of transparency and facts is the ideal atmosphere to maximize private profit and maximize social losses...and that's what 2018 America largely is....a backward sewer of unregulated greed that defers to doctor, hospital corporation and pharmaceutical lobbies that resist disclosure, resist transparency and resist progress.
Combine that horror with the rabid religious right-wing that refuses to talk about sex education, contraception and modernity, and the Republican anti-Christs do a nice job of drowning American progress.
Aside from treating women like birthing vessels, look at how Republican-governed states treat the babies they're bearing.
Southern states generally have higher rates of infant mortality. The only states with infant mortality rates above 8 were Alabama, Arkansas and Mississippi.
https://www.cdc.gov/mmwr/volumes/67/wr/mm6733a7.htm?s_cid=mm6733a7_w
The Party of Death - whether by guns, poverty, healthcare abandonment, misogyny - never disappoints.
Nice GOPeople
266
@Socrates
You should talk to Ms. Pelosi, she can’t bring herself to even mention single payer or Medicare for all, it’s not on her radar. She sounds exactly like a Republican wanting, “affordable," healthcare with no plan of how to get there. She gets a ton of money from big Pharma and health insurance companies to keep the status quo. Americans are given a choice between Republicans who are against abortion, and “Republicans” who are pro-choice. Instead, we got Trump who promised “a great healthcare plan.” A complete and total lie. Hey, at least Pelosi hasn’t lied to us!
7
One can always find examples of callous or incompetent health care where the patient is not listened to and the patient's concerns are not addressed and the result is injury or death.
But is this really the reason for high maternal (and infant) mortality in the USA?
Just as someone experiencing severe chest pain should not be afraid to call 911 because the care would cost too much, no mother should fear obtaining adequate prenatal and obstetric care for financial reasons.
Someone enlighten me. What percentage of excess maternal (and infant) morbidity and mortality in this country is in fact caused by an uninsured mother not getting adequate (or any) prenatal care?
If this number is as high as I imagine, the solution is obvious: universal health insurance.
95
@PETER EBENSTEIN MD
I think a real issue is that Moms become pregnant in an unhealthy state. Since many low income adults have no health insurance, moms become pregnant with diabetes, morbid obesity, smoking, drinking, and with high blood pressure. They can be depressed during and after pregnancy. They are eligible for Medicaid for pregnancy and up to 6 weeks after the birth of the child. That's no system for optimal outcomes!
12
@PETER EBENSTEIN MD
It's not.
Most of these women are on Medicaid.
The problem comes about because of teen pregnancies and women who are addicted to drugs.
3
@lucky and @Pediatrician X Maternal and infant mortality is a statistic for which doctors and the "healthcare system" is blamed, but is often due not to poor healthcare but to poor health and to other social problems which in this country are out of control. To compare our maternal and infant mortality to that of Sweden, for example, is like comparing apples and oranges.
4
The primacy placed on the health and well-being of the baby--to the exclusion of the person giving birth--creates the potential for postpartum complications to be overlooked. This is, of course, compounded by other variables, but a crucial underlying issue here is that women are routinely not listened to and not believed about their own experience. (Especially, painfully, black women, whose maternal mortality rates are 3.5x higher than white women, as the author points out.)
This is coupled, dangerously, with the narrow and infantilizing (no pun intended) narrative that exists in the US about what early motherhood looks like, and what feelings and concerns are allowed within that framework. Case in point: postpartum anxiety and depression, tramautic birth injuries requiring "repair" and physical therapy (if the woman has access), the grim reality that is our abysmal lack of paid parental leave, judgment from "well-meaning" family members...all of this is isolating, as well as physically and mentally debilitating.
54
It infuriates me that women in this country are:
1) reduced to the black and white slut vs good girl categories when it comes to premarital sex in this country despite engaging in similar behavior as their male counterparts;
2) denied birth control and autonomy over their own bodies by law when it comes to taking steps to prevent or terminate a pregnancy that took joint efforts with a man to create in the first place;
3) seen as mere incubators and a secondary concern to a fetus once she is pregnant; and
4) dismissed as mere statistics when they die in childbirth when they do actually carry a pregnancy to full term.
All of the above are in addition to being subjected to unwanted advances, sexual harassment and living in perpetual fear of being assaulted whenever they're alone.
So spare me the "it's a scary time for young men in America" nonsense that's being parroted by the obtuse and ignorant misogynists in this country like Trump. If it's scary to be a man right now, then it's downright dangerous and even fatal to be a woman right now despite whatever strides and progress we've made in the past several decades.
703
@EM
Actually, it has ALWAYS been downright dangerous--and frighteningly often fatal--to be a woman. In this country, and everywhere else in the world.
So, like you, I'm not feeling all that sympathetic to the men, young, old or in-between, for whom it is supposedly "a scary time in America."
Walk in OUR shoes, guys. See what it feels like.
66
@EM Thank you and amen, sister.
35
@EM It's going to get worse. Roe vs. Wade will be gone soon.
4
I'm hoping my daughter puts-off pregnancy until we can relocate to another country. Canada and Belgium are in the running. I'd like to live to see a grandchild, but the risks are simply too great here in the US. And we have one of those 'gold standard' HMO plans.
Respectfully, we're not the richest country. We have some very rich people, but the majority of the women having babies are not rich, and frequently don't have access to any medical care, much less competent or adequate medical care. Our political
and economic systems made the choice of guns over butter. We can get very sharp satellite photos of all those gravestones.
We do not have the best healthcare system in the world. Ours is the most expensive, which doesn't make it the best.
Where does the money go? Bricks and mortar and Mercedes. Bricks and mortar for the HMOs who will deny your coverage, Mercedes for the Hospital CEOs and CFOs who are complicit.
I'm hoping things will change for the better. I'm also hoping to view the changes from another country.
222
@ErinsDad
You're making a critical point that should be repeated, loudly, as often as it takes. We have a layer of extremely rich people whose wealth skews the statistics. Our GNP is, if not the highest, among the highest around. But the lower 75% or so of Americans are most definitely not among the richest people on earth. combine that with the purely obscene price of health care and we are what one would have once called a Third World country.
162
@ErinsDad
By all means find a country that offers universal healthcare if you think that’s a politically palatable solution to birth risk but the Globe & Mail a few years back had several articles about how many of western Canada’s high-risk deliveries were sent to US hospitals for the birth itself. In other words, the grass isn’t necessarily greener on the other side of the (border).
5
@EGD Realize, though, in America those high risk deliveries might never have been identified beforehand and those women would have died in America because of a lack of prenatal care! Likewise cancer patients- we have the best cancer treatments in the world- but how many pass the window of opportunity for trx before they are even discovered because no one can afford to go to a doctor? You can't say we have "the best" if most people can't access the care. That's still poor care.
44
My first daughter was more than a week overdue. I'm petite, and the OB was concerned if we waited too long, a C-section would be required, so he induced labor at 41 weeks. Not sure if the harder contractions you have when labor is induced are what caused me to hemorhage, but I lost so much blood they had do put me under a general anesthetic and do an emergency D&C, after which I spent an extremely uncomfortable night with my uterus stuffed with gauze. My older daughter was born during the AIDS epidemic, and the last thing I did before I was put under was beg the nurse not to let them give me blood unless it was essential to save my life. They didn't, but I had anemia for more than 6 months, which means you're exhausted all of the time.
The second daughter, born 5 years later, was also overdue; I went into labor the night before the induction was scheduled. Normal birth. I had my husband bring champagne to the hospital so I could celebrate that I would never, in this lifetime, be pregnant again.
I love my daughters. I didn't love the nausea, the physical discomfort, the loss of individuality (you become a generic pregnant woman), the labors or the recoveries. Pregnancy is a hard process, and religions--like Mormonism and Catholicism that make it a woman's highest and preferably only calling and push women to avoid contraception--do women a great disservice. I hope this article calls attention to the need for doctors to listen to women.
190
This is nothing new. Back around 1960, when I was born, my dad told me that they had originally gone to a hospital recommended to them. There, he discovered, to his horror, that in the case of an emergency, the child's life was considered more important than that of the mother's. They switched hospitals immediately, to one that said they would focus their efforts on saving the mother, if a choice had to be made. My dad said he couldn't imagine living without my mother, but I was an abstract concept to them, not a real factor in their lives. That made total sense to me. If I had died as a baby, sure, it would've been sad, but nowhere near as tragic as if my mother had died - she had a husband, two parents, three siblings, and a multitude of friends and students who knew and loved her, and would have mourned her, whereas if I'd died, everyone would have managed to get along without me. Not to mention that it would have been much easier to have another child than it would have been to replace my mother. We only obsess about babies because we are used to modern medicine. In the old days, babies died all of the time. Infants, toddlers, you name it. Kids were lucky if they lived to be five. Anti-choice people live in a fantasy world.
814
@Allison Two points here: First, in my opinion, there is an interesting dynamic at play between women as part of the (recognized) labor force, the number of children people have, and the attention to babies vs mom's. For many women now, unlike what you mention from many decades ago, pregnancy is a carefully choreographed life event, that has a fairly short window for success. As such, with many fewer babies per woman and the woman having to carefully schedule her life events, the value of each pregnancy goes up astronomically. You're right, years ago people had many more children -- upwards of 10 to 13 wasn't extremely uncommon. But now they have 2 at exactly the right time, making those 2 extremely important.
Second, many decades ago when women were having so many kids, not only were many children dying, but many mother's were dying in childbirth too. In about 10% of pregnancies with females that are child bearing age, the baby is too large to deliver. In many of those cases historically the female would die. Also, after 5 pregnancies the risk of uterine rupture increases.
Given that babies are more important now, it's no doubt that society tries hard to save them.
As for the fact that some states' investigations pointed to lifestyle choices, there could have been more analysis on this point. Obesity has been increasing in the US for decades and it's not hard to imagine that this could impact on maternal death rates.
Anecdote heavy, fact light.
11
@Allison Thank you for mentioning that this has been going on ... well, forever. And it really isn't just women of color who experience this. I had my son in 1972 after 16 hours of labor. Last minute I found out that my doctor had just broken his leg and couldn't be there. My husband and I were among the first couples to complete a Lamaze class, and I was heartbroken that my very accepting (and near to retirement, I might add, so an older man) wouldn't be there.
The rest of my experience was a blur of emergency doctors and nurses treating me as though they thought I was crazy to even consider natural childbirth. I finally kicked out one of several nurses and threatened to walk out and have my child at home (and this was in Brooklyn, NY at Lefferts General Hospital). All they were concerned with was making sure I gave birth; my own health, wishes, preparations be damned!
38
@Allison they may live in a fantasy world, but their actions cause pain and suffering in the real one
37
Just in case there is anyone left who doubts that American women are under theocratic control now, read this article. Every single aspect of our reproductive lives will soon be controlled by others, and women are becoming increasingly devalued, day by day. The concerted effort by the misogynistic Catholic Church and the evangelical churches are carrying over to the hospitals. Women are expendable, women must be controlled, and their decisions about their own bodies and lives can be completely disregarded.
268
@Madeline Conant Yet another is the fact that Catholic hospitals are buying up secular institutions. For women outside of populated urban areas, this is real concern. My sister gave birth in a catholic hospital that refused to perform a tubal ligation at the time of her C-section, making another admission and another procedure necessary.
50
@Madeline Conant
Exactly. And yet white women voted in large numbers for Mr. Trump and the right reverend Pence. The mind boggles.
37
@Spencer Quick note: in NYC and suburbs the opposite is happening, Catholic hospitals (all hospitals in fact) are being bought and we are losing all competition. Why do non-profit hospitals need such astonishing growth rates?
4
C-sections are used by doctors as insurance against liability. The c-section rate is still way to high. Doctors dont want you to labor for long as they have a schedule to keep. And if you go beyond 40weeks, watch out. They want to schedule your c-section. My doctor wanted me to get a c-section so badly she was trying to convince we to get the date 12-12-12 for my son, like that mattered to me. ( eye roll). I had a horrible experience trying to have a Vbac ( vaginal birth after c-section). In my Vbac contract it said, if I dont go into labor at 40 weeks its an automatic c-section. I was treated like a vessel and my life did not matter. I fought hard and was able to get that contract changed in Orlando so that mothers that came after me had more time to go into labor. They changed it to 41 weeks. Did not benefit me, but it was a win in this community.
49
@Hillary
Part of the reason for your win is that Florida is a state with tort reform and a malpractice cap of $500,000 in most cases. Doctors there have more leeway to use their judgement and practice "real" medicine instead of defensive medicine.
Practice patterns and decision-making change when doing the "right" thing may not "sound" right to a jury of non-medical laypeople who have the power to levy a $500 million judgement against you.
More states should follow.
6
1. People need to stop thinking that America is the greatest nation on earth, it is not, and many of its people are terrible human beings, as is evidence in this article. Witness the violence against women even in childbirth!
2. Among developed nations, America has the worst healthcare.
In Israel if a mother’s life is in danger during pregnancy, it is the child that must be aborted which is seen as the cause of the problem, not the mother. The mother can always have more babies, is the thought. America’s obsession with sex is psychologically unhealthy. This spills over to views on pregnancy, childbirth, and abortion. Too many people who have strong opinions about these matters know nothing about them, because they are men, who are also, by and large, the ones making the rules. That has to change.
434
@Jude Parker Smith I don't really agree with how Israel does it. Why not let the mother decide if she would rather abort the child, or rather let the child live and the mother die? I really would not like the government to decide what is to be done regarding my medical treatment. It's my body, after all.
2
@Jude Parker Smith Clearly, America has ignored th 1st Amendment: “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof“ instead imposing the religious beliefs of some on all. If an American does not want an abortion or to use birth control they are not compelled. Conservative politicians exploit religious beliefs and employ those beliefs to oppose insurance coverage for abortion and birth control by also subordinating the rights of all women. (Why does government and insurers have the right to break HIPAA guarantees of medical privacy? If there is an arcane loophole, close it.) Why? Because fetuses are persons, a euphemism for fetuses have souls, a religious belief.
Conservatives will never pass legislation giving “personhood” to fetuses because it would destroy their inheritance-property privileges; but they will use that narrative.
Law schools have neglected the issue. What law school considers fetuses persons? Which Law school considers the incorporation of religious dogma in law and policy Constitutional? Sophistry can destroy democracy.
3
Without health insurance how do poor mothers and families
pay for prenatal, birth and post natal medical care?
41
@jahnay Cold hard cash. When my daughter who was a high risk pregnancy had a miscarriage the hospital wanted cash before they would even see her. Her employer provided such high deductible insurance that the thousands of dollars for care had to be paid the day before her surgery. Welcome to American health care and insurance.
55
@jahnay Before ACA I had a friend whose baby was born with a heart defect. The insurer considered the fetal abnormality to be a pre-existing condition and this family is still paying the $250,000 medical bill for their neonate's care. He turns 12 this year.
18
@jahnay They have Medicaid to cover the costs if they're lucky.
1
The majority of women in the US experience more trauma than necessary during childbirth. It is the new birthing 'industry', where women are treated no better than livestock.
Profits over people.
48
There is a real founded fear on the physician insisting on admission immediately because of the decreased amniotic fluid volume. What if the patient was allowed to go home to pick up her bags, came back for admission only to find a dead fetus?
5
Thea’s physician could have used language to encourage Thea to go directly to the hospital. The physician could have said “I would feel you and the baby are at risk the longer we wait.” Or perhaps, “I have seen a lot happen very quickly during labor, and it would be best for you to head directly to the hospital. Perhaps, your husband or a friend could collect your things from your home.” Threatening legal action and arrest to a woman so close to her delivery... who does that? A physician who is more interested in holding power over patients.
13
@K.
That would be the doctor's fault. "You should have known better that to let her go." Go straight to jail and do not pass GO.
1
Honestly, I'm not trying to be cute but this idea that you cease being an independent, thinking human being when you become pregnant occurred to me when I was still quite young. It is a big reason why I have never wanted children. The whole thing is totally unfair and being a woman is already laden with unfairness. Why help society pile on more scrutiny and disdain? The simple solution is to stop having kids until men (and some women) realize that women are human beings deserving of respect and compassion, the same as or even more than is due to a zygote, embryo or fetus. If all (born) humans are created equal, why does this huge inequity persist? Why do women willingly create their own prisons? Use birth control and make informed decisions! You deserve to live your life!
72
the attitude expressed in this comment is also indictive of victim blaming. should we stop reproducing so society learns it's lesson? that is a poorly considered solution.
2
Four boys, four natural childbirths all in the hands of women who in my limited experience seem to have a better sense of what is actually going on in childbirth than their male counterparts.
16
The fact that republicans do not care about women’s health surprises people? Really? This from the same guys who wanted to cancel all healthcare and still do. What a poor country to get sick in or need any form of health care! It’s easier for this same group to get money from their donors than a woman to deliver a healthy child. This is how Trump and his GOP. Take care of all of us. Yes you too who stand with him. Shame on all they stand for. This is great?
57
What happened to Thea is unconscionable. The doctor who threatened her with arrest should be in jail, not practicing medicine.
177
@Brad Blumenstock
Disagree completely.
There was nothing in her apartment that she would need.
The doctor was in the right.
I am shocked how you can see it any other way.
5
@lucky Threatening a patient with legal actions for not following orders is coercion and should be punished by immediate loss of licence. I am shocked but not shocked you see it your way.
Doctors make mistakes too, they are not gods.
10
@lucky The doctor was lying. Telling a woman she has low amniotic fluid is a common ruse to induce and get her off their books. The odds are greater that you will win the lotto than that there was a problem with the pregnancy-- but if there was, there was no reason to threaten her. Sadly, I'm not shocked this reality of this article went right over your head. People do not want to admit they have been lied to.
9
Obstetrical training is the least "academic" of specialties; it tends to attract physicians who are more interested in "doing" than in "evaluating". The good records of midwives relate to doing less.
What is needed are data-driven evaluations of best practices.
4
@OF Are you involved in the medical community? As a medical student who has considered specializing in this field I've found this to be incredibly false. There are great academic obstetrics and gynecology programs that produce quality research. OB/GYN as a specialty attracts those who both have an interest in performing surgery and procedures, yet also care about medical management of cases and providing longitudinal care to patients. It is as much a primary care specialty as a surgical one (if not more so).
14
@OF
OB/Gyn has the highest malpractice burden of all specialties. Many docs are retiring early or retraining in other fields. Medical students would not go into this field unless they felt a particular calling for it. There are safer and less stressful fields in medicine that pay a lot better and don't leave you with the daily fear of losing your house and life savings.
I wonder if there's a particular personality type who chooses this field while disregarding the above.
5
I had some mild difficulties during my labors with all 3 of my children but I found it wasn’t the doctor who didn’t listen but the labor and delivery room nurses. I am a physician and know what to look for when something isn’t going well so when the nurses would placate me I would persist until the doctor was notified. The doctor always took action. Luckily for me neither I nor my children suffered undue complications but do you need a background in medicine to have a safe delivery? I would hope not. As an aside, my first delivery was the most risky and it occurred at one of the premier medical centers in the country.
41
With my first pregnancy, there were issues with the baby’s position and epidural. Forceps were used and I had bilateral 3 degree tears. A day or two later, I was found on the floor Two units of blood were ordered but it was in the era of unsafe blood and the transfusions didn’t help as much as they told me they would. My crit was 18. After coming home after a week, I still was having bleeding and the doc gave me Ergot- after breast feeding one time, my daughter seemed off so I stopped. Later on, I read that Ergot was considered to be a possible reason for the behavior of the females involved in the Salem Witch trails.
Not only did I have to deal with all of this but superimposed for those of us needing transfusions was the fear of AIDS. Elizabeth Glaser ran into similar problems and did acquire AIDS. This is so very important and for any medical doctor or social worker one has to take a very close look at any past history with these issues. Trauma memories never go away without getting really excellent stand out help with processing them. Otherwise the rise and fall like waves in our lives. And btw not one so called counselor or MH professional ever took the time to ask about my childbirth history.
Thank you for bring this narrative out and SHAME to any professional who ignored this problem and failed to help and reach out.
19
As a woman patient I have been ignored, lied to, questions ignored or evaded.
I have learned, keep saying no, ask the question directly and multiple times. Say oh you aren't going to answer my question are you? Many just focus on what they are intending to accomplish, not the impact on the patient.
In hind sight, when the medical professional refused to stop a procedure due to pain, as she said she would, I learned I should of just let out my screams of pain, rather then enduring it.
I will say, not all medical professionals act in this manner.
20
This is no surprise. Our country's (the USA) laws, culture, institutions, etc., marginalize women in every way possible. I am a 70-year-old woman and mother, and I cannot even begin to relate how many times the medical establishment (with sadly way too few exceptions) has treated me in a patronizing manner. This must change. I hope that Ms. Williams and every other woman who has been belittled will join forces to make serious and much-needed changes.
81
And worldwide over 800 women die as a complication of pregnancy or childbirth every day resulting in close to 300,000 deaths per year. If truth be told, pregnant women everywhere are devalued. Assuring safe childbirth is the top priority of the United Nations Population Fund which Republicans have defunded since Ronald Reagan. When George W. Bush defunded UNFPA of $34 million 2002, I started 34 Million Friends of UNFPA and Donald J. Trump and I were on the same honorary committee in support of UNFPA. In 2017 now President Trump lied through his teeth saying UNFPA was complicit in the coercive practices of China and withdrew all funding. Trump devalues women, especially pregnant women, here and all around the world.
44
With my 4th pregnancy at age 41 after an emergency c-section duirng my previous delivery, my labor was induced to "protect the baby". I was left to labor by myself without any staff or pain relief but with the risk of uterine rupture, rushed to the delivery room as my daughter was crowning, and after a thankfully safe birth, left by myself in the delivery room without a call button for two hours until I screamed for help. I somehow did not die alone from hemorrhage. My insurance was billed thousands of dollars. So much for American exceptionalism!
284
There are clearly problems here, but I'm not sure the proffered solution halfway through the article (fewer interventions, more midwives) is the answer. Midwives, too, can be guilty of failing to listen to patients; in the UK, there has been a substantial increase in maternal and fetal injuries that has been partly blamed on midwives pushing high risk pregnancies into the "normal" category and denying intervention. With the first example in the article, it's not clear that leaving the women with low amiotic fluid for 5 more weeks (non-intervention) would have been better. The right answer might have been a more substantial intervention--C section--or admission with monitoring, or other options. The right answer, of course, is that pregnant women are taken seriously by all their providers, that their symptoms are taken seriously, and that interventions are appropriate -- given when necessary, but not forced when not. Getting the data is the first step. Then it should be analyzed to figure out WHY these women are dying. If it is happening more to certain racial and ethnic groups, again, they need to look at WHY. And that includes, of course, looking at the quality of the care.
25
@Jessica
Do you have any evidence to support what you've written there about substantial rising maternal and fetal injuries in the UK, because I live here and it does not sound true at all.
Th latest statistics for material death here are 9 per 100,000 as opposed to 8 per 100,000 ten years ago (around 30th in world rankings) - not great and sadly not improving, but far better than the 14 per 100,000 in the US (47th in world rankings)
5
Jessica, Of course most midwives cannot by themselves deal with a serious emergency during birth. That is why ideally every midwife would have fast access to emergency services when necessary for the mother.
Unfortunately many women using a midwife live far from the nearest well-equipped and well-staffed medical facility. In this case, when an emergency arises they should be med-evacked to a facility that can help them. Certainly funds must be allocated for this by any government that cares.
2
@Jessica not to mention the fact that having your first baby at home with a midwife has been proven to be more dangerous than having your first baby in a hospital.
If---God forbid---my doctors had to choose between saving my baby and saving me, I wouldn't want them flipping a coin. Yet many decision protocols are developed under the assumption that maternal and fetal death are equivalent outcomes. Outrageous.
57
@Tamar R. Follow the money : which case is more likely to get the doctor sued : Only the baby dying or only the mother dying ? Sadly parents are partly to blame in USA when they are more likely to sue the doctor for saving the mother but letting the baby die.
2
@Thomas Anantharaman What is your information source for this assertion?
5
Pregnancy is a major source of maternal death world-wide. This is one of many reasons women should not be forced into it against their will.
349
@Audaz Exactly right it was the justification for Roe v. Wade you cannot force someone to donate a kidney at their risk so why is carrying a pregnancy to term any different. i.e. risk the mother's life to have a child.
27
@Audaz
The Republicans have an answer for that, never have sex. And, if you have sex, never use birth control. And, if you get pregnant, prayer.
11
"Lawmakers claimed that it wasn’t the job of the state to meddle with doctors’ decisions"....where's the punchline to this joke? Who is passing all those anti-choice laws? Who says insurance companies know better than doctors about medical procedures?
367
"At least 30 states have avoided scrutinizing medical care provided to mothers who died, or they haven’t been studying deaths at all,” the newspaper said. “Instead, many state committees emphasized lifestyle choices and societal ills in their reports on maternal deaths."
This gives the lie to the title of the piece, "America is Blaming Pregnant Women for Their Own Deaths."
No question these states can and absolutely should investigate such deaths. But — no surprise — smoking, nutrition and other aspects of a woman's health have a significant impact on survival when she gives birth.
The *most important* thing is to provide top-notch healthcare to all citizens. Currently it is very difficult for pregnant women to obtain decent prenatal care, *especially* if they don''t have much money. There is no reason they should have to put their own lives and those of their babies at risk because the U.S. does not bother to take good care of them.
15
@polymath How does the fact they fail to look at the actual causes of maternal mortality "give lie to the title of the piece"? Have you ever read medical professionals comments in the media when discussing the abysmal maternal morbidity & mortality in the US? They *always* blame the individual women, never the system. It's the same with the rise in cesareans, they blame women instead of looking that the real causes (hint, it's the doctors as a recent study finally showed). Whatever doctors say in the media repeatedly tends to become "truth" even when it's not actually. So yes, Americans in general & doctors in particular are blaming women for their own deaths.
3
You do know that once women become pregnant, they become public property, don't you? If you think that I'm wrong or exaggerating, just ask any women who is or was pregnant. Pregnant women become less than adult, less than human. They are images/icons or they are incubators.
122
I was almost killed at MGH, a hospital I worked in as an RN. After the attending reassured me she was an expert in forceps delivery, she allowed a first year resident to attempt the forceps delivery. My son was ripped from my body and was silent and limp. I hemorrhaged from a deep sulcus tear (tear of the vaginal muscle) while they furiously and incorrectly gave me pitocin (for a uterine hemorrhage). I went into shock and did not even have a blood pressure cuff on...I was resuscitated by anesthesia and given a series of blood transfusions. My son was also resuscitated by an awaiting neonatal team. MGH almost killed me and my son, and I will never forgive them. I am currently studying at a top university to become a midwife and prevent this from happening to other women and babies.
263
@Jennifer
I am so glad that you and your son survived such an ordeal and admire your determination to contribute to solving this problem. Good luck in your studies. Future women will thank you.
31
@Jennifer Forceps deliveries are extremely tricky. When I was born in the 1970s, I was an active baby and tangled up in the umbilical cord. So I was delivered by forceps but it was by one of the best doctors in Asia, an old-timer who was trained in Paris and had extensive experience. Forceps deliveries can help avoid Cesareans and tearing but it really has to be done by an expert as you state.
5
A pregnant woman is responsible for the baby she is carrying. Drinking, smoking, skipping pre-natal appointments... all of these actions have an impact on the baby, an impact that ALL of us pay for down the road.
8
@Sharon
Why do you avoid addressing the actual issues raised in the article?
11
@Sharon yes but in NONE of the examples provided in the op-ed was maternal behavior offered as a reason why their pregnancies and deliveries were so complicated and their health so compromised.
And...if you're over 50, it's likely that YOUR mother smoked, drank and took medication or even recreational drugs during her pregnancy. Medical care evolves and women have managed to have healthy babies since we've been doing this. We need to meet women and future mothers where they are and do our best to help them have a healthy pregnancy because women have a tendency to get pregnant when they have sex with men.
8
@Sharon ...None of these nightmare near-death stories involved drinking or smoking. They involved bad medical care.
9
I know someone who is expecting and does not want a flu shot because she has inflammatory reactions afterward. She isn't opposed to all vaccines; just the flu shot. She will vaccinate her children. She told her OB she didn't want the flu shot and was argued with for 20 minutes during the visit. The conversation ended with, "We'll talk about this again on your next visit."
How about no means no?
48
@Wrytermom
Your friend should find another OB. If the doctor is this dismissive of her well-articulated decisions now, imagine how much more dismissive he/she will be in the delivery room.
6
@Wrytermom. Perhaps you and your friend should read what the CDC says:
"Vaccination has been shown to reduce the risk of flu-associated acute respiratory infection in pregnant women by up to one-half. A 2018 study showed that getting a flu shot reduced a pregnant woman’s risk of being hospitalized with flu by an average of 40 percent. Pregnant women who get a flu vaccine are also helping to protect their babies from flu illness for the first several months after their birth, when they are too young to get vaccinated."
https://www.cdc.gov/flu/protect/vaccine/pregnant.htm
How serious, exactly, is her inflammatory reaction?
4
@Darth Vader Get a grip. Your reaction is exactly the point of this article: a pregnant woman is still a person, and should have the same rights and freedoms of choice as a non-pregnant person. And yet, people like you (yes, you) deny pregnant women just that. If a woman says no to a flu shot while pregnant -- or not pregnant -- she has the right to do so. It is her body. Not yours, not the State's, not the fetus's. Hers. She knows her body better than anyone else, and there is zero legitimate excuse for the doctor to spend 20 minutes arguing with her over it. And while we're at it, data is useful for driving public policy but should not be taken as gospel when making personalized medical choices. Not everyone fits into the majority, and only you know if you are the exception to the rule.
5
If you think it's bad now, just wait until SCOTUS rolls back reproductive and privacy rights.
The first time America sees a woman criminally prosecuted for having a miscarriage will be wake-up call for many
233
@Steve El Salvador does not allow abortion under ANY circumstance. They are currently imprisoning a woman for 20 years because a physician who "suspected" she tried to abort called the authorities. Her pregnancy was the result of rape by her stepfather who had been abusing her for 8 years. This is what the "pro-life" people want. Don't let it happen here.
74
@Steve
I seem to recall that in some states women have been prosecuted to having a miscarriage.... look it up....
15
@Steve
It's already happened.
In 2015, Indiana sentenced Purvi Patel to 20 years for feticide. She claimed it was a miscarriage. They said she murdered the fetus illegally.
No one really knows. A LOT of people don't think it was well proven and that she's a political prisoner to the Pro-Birth Right.
30
My sister's birth despite it being in a wealthy suburb resulted in near death experience and unnecessarily so. The physician was not only poor he was barely present and didn't have good judgement. His expertise was great but only in very narrow way. There was no team, no others making suggestions, all was dependent on this docs calls.
15
The culture shock of becoming pregnant was absolutely devastating to me with my first daughter, and expected now that I'm pregnant with my second. I frequently told my husband that I didn't feel like a person anymore, nothing mattered except the baby! I'm 38.5 weeks pregnant and still terrified of going into labor in a country where everything is supposedly "routine" until it isn't. I had many issues - some mentioned in the article - and the doctors continually blew my concerns off. It is so frustrating when they tell you to let them know about any issues, and when you do you're treated like a whining baby.
I was asked at my last appointment if I'd been drinking while pregnant. I laughed and said no - except that I had a sip of wine at a wedding the previous weekend. I was berated by the nurse to not believe everything on the internet and that any alcohol is detrimental to the baby. I immediately began wishing I had just not said anything - which is exactly what's going to happen when people are honest and then treated like that over a sip of wine. Meanwhile, the incredible pains I've been having while pregnant I am continually told are normal, even though it makes walking debilitating.
125
@Steph Mueller Honest question: Why are you on your second pregnancy?
3
@atb lol. Good Question. My husband felt there was a "tooth missing from the grin" and we wanted a family of 4. I am perfectly happy with adoption - he is not. Societal pressure, family pressure. I love my daughter very much, and will love this daughter just as much - but being pregnant again is not something I really wanted to do. The amount of women that have opened up and said the same to me is incredible - as a woman there is a lot of pressure to "have a family". This will absolutely be the last.
26
@atb
Are you kidding? Women choose to get pregnant, despite the very real dangers and pain, because they want a baby. If we let fear of these real dangers and pain prevent us from having kids, there would BE no human race. I wouldn't count on men to be this brave.
28
I had hydrocephalus at birth, and for most of my life, medications haven't affected me like they "should." When I developed pre-eclampsia and they went to induce me in 1999, none of the induction meds worked, so they decided to do a C-section. I told the attending anesthesiologist, who had tickets to the SEC championship that night, that I had read that an epidural would not work on me because of my hydrocephalus. He asked me where a copy of the study was, then dismissed my concerns when I said it was in my car. When they began the C-section, I told them that I could feel everything and was about to start kicking. They ended up using lidocaine to numb me, and my clearest memory of that day was a nurse saying, "I feel like I just attended a Civil War birth." To this day, I don't recall much more of my daughter's birth than that.
44
I wonder if the malpractice insurance industry has weighed in. They have to be.
7
@C The insurance industry is the cause of most, if not all, these problems. Don't expect it to weigh in unless, of course, there's more money to be made.
9
@shar persen The insurance industry had nothing to do with my doctor failing to diagnose postpartum preeclampsia. The insurance industry has nothing to do with doctors refusing to properly diagnose and treat pregnancy complications, and simply LISTENING when we tell them what is wrong.
2
The obesity epidemic in the United States is probably one of the major causes for the increase in maternal mortality and morbidity. Obesity is associated with hypertension, diabetes, increased risk of deep venous thrombosis and pulmonary emboli. Maternal diabetes carries the risk of increased fetal size which poses additional stresses on the process of giving birth. All these factors contribute to increased risk to both mother and child during the birthing process. This article seems to blame the healthcare system but other factors are at play here.
9
@Robert Gendler
Greece has one of the highest obesity rates in the world, at least on a par with the US. Their maternal mortality rate is 3 deaths per 100,000 live births, a fraction of the US rate. Darned right I blame the healthcare system.
384
@Robert Gendler
Just to add......1) increase in number of c-sections because of malpractice concerns has exposed mothers to risks of surgery and anesthesia. 2)Increasing maternal age raises the risk of pregnancy. So we have three factors operating in our society which has elevated the risks of pregnancy...obesity, threat of malpractice, and advancing maternal age.
11
@Robert Gendler
Obesity rates among Germans and other Europeans are high and similar to the US but maternal mortality is 3 to 4 x as high in the US. While high BMI and smoking and diabetes are risk factors I would look at differences in how the health of pregnant women is managed here and there for the causes - particularly the lack thereof in the US. Amongst all nations, high maternal mortality is driven primarily by poverty, poor nutrition and lack of healthcare.
61
"Alabama voters have just approved a constitutional amendment recognizing “fetal personhood,” a measure that could be used to further curtail the rights of pregnant women in favor of the safety of fetuses."
Rachel Maddow (MSNBC 9 pm ET weeknights) reported this week on the incredible corruption in Alabama politics. Jeffrey Sessions is just the tip of the iceberg. He and his supposed "christian" brethren are intent on taking America back to the dark ages.
Both of my daughters and my granddaughter were endangered by the cavalier approach to child delivery. My oldest daughter endured 36 hours of hard labor in 1992 before the doctor would do a c-section because "medicaid says too many of them are unnecessary".
Six years ago my very health conscious other daughter used a mid-wife. She went into labor but they sent her home with morphine after the first 24 hours. I was leaving her alone but finally went to her home the 3rd morning and saw that she was in hard labor. I insisted she get to the hospital and, although she had planned a natural childbirth, they gave her an epidural. Six hours later they finally figured out that she is physically unable to deliver a child through the birth canal and they ordered a c-section.
Two months ago my granddaughter had some trouble with her pregnancy at 8 1/2 months and her midwife seemed unconcerned. I told her what to watch for and said this is how women died (and still to) during childbirth. Fortunately she and the baby are fine.
25
@njglea It is extremely rare for a woman to be genuinely unable to deliver a baby and usually involves them having had a severe pelvic injury. Sometimes (somewhere between 5-10%) a particular woman is unable to birth a particular baby, but that rarely means she can't give birth at all.
I was told after my eldest was delivered by cesarean that I was "too small to ever give birth to a baby of any size". I went on to give birth naturally to 3 babies, one of whom was nearly 1 1/2 lbs bigger than my "too big" eldest child.
2
I don't understand your comment, Blue. I'm glad you can deliver babies normally but my daughter can't. Yes, it is unusual but a simple x-ray or some other screening could have shown medical providers that it's impossible for her.
In my opinion she would be stupid to try to deliver normally again - as the article says women are still dying in childbirth.
5
In USA the government is bound by commerce in a way that is incredible to believe when viewed from European countries. There is so much talk here about how government is corrupt and the free market are efficient. Yet medicare is more efficient than private plans. Private hospitals and doctors are governed by fear of malpractice lawsuits which leads to an intrinsic desire to not disclose facts at all times. Ironic when you think that America is supposed to be the land of the consumer. Yet big business fights back against the consumer through disinformation and management campaigns. And Americans roll over and accept it.
86
@Stella,
I knew 60 years ago from listening to the stories of my friends that what they endured while being treated by obstetricians for their pregnancy and delivered that any questions and comments by their patients were completely ignored . The routine practice was for 4-6 doctors incorporated and one never knew which specialist would show up for delivery...sometimes someone who had never seen you before. When I chose a doctor to deliver my baby, he was a medical practicianer, who in those days were till able to deliver babies with the minimum interferance, being in a hospital there were other specialists who could be called upon in an emergency. I was grateful that the MD who saw me through multiple pregnancies was at the hospital Shen I arrived, stayed with me throughout, and we both enjoyed our success. What happened to those caring general practicianers? If they saw a problem they recommend ed seeing a specialist..
Since when has childbirth become an illness? But now I don't think there is a doctor in a metropolitan area who can be allowed the privilege of seeing through a normal delivery
8
@Stella
"And Americans roll over and accept it." Gee, that's helpful.
I'd have been happy in another country, but it meant leaving my elderly parents who were my first priority. A lifetime of quiet resistance hasn't moved the needle at all: this is reality.
Nice to know that in your own world, you control all levers of power. Share the secret, and I'll be happy to change America.
3
@Stella: But, but, CAPITALISM! Must defend it at all costs, including the lives of women, children, and anyone else who needs healthcare.
9
A couple of years ago I believe the WHO rated the United States in general, pinpointing in particular, certain states in the south and Texas, mortality rates on par with many "third world countries".
It seems little has changed.
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Ten years ago, in 2008, I developed severe preeclampsia and HELLP syndrome during my first pregnancy. The initial symptoms, high blood pressure, rapid weight gain, upper right-quadrant pain, were blamed on me. The fact that I was very healthy and fit before that pregnancy didn't seem to count for much.
Once my platelet count, an objective measure, started dropping, they paid attention - but it was all about the baby. Once my daughter was born, the focus was entirely on her. I was largely on my own for recovery with my sky-high blood pressure, rock-bottom platelet counts, and a damaged liver. The graphic of this article illustrates my experience perfectly.
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@Regina S.
What?! What!? Rapid weight gain, high blood pressure, and the liver pain are all objective symptoms; classic ones for pre-eclampsia and they should have recognized it immediately.
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@Regina S.- sorry that this has happened to everyone writing their experiences. In 2002, i too developed severe preeclampsia and HELLP syndrome at 28 weeks. I was rushed to the hospital, given an emergency c-section. My son was whisked to the NICU while i was taken to the ICU to treat my blood pressure that was not falling after delivery, fearing a stroke. I was devastated that i was not able to see my son immediately after his birth, but my fear of dying and leaving him and my husband alone was worse.
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Happy to be in California where science and best known methods have been implemented to make sure *everyone* is safe during pregnancy and delivery.
The attitude of women being less important than the baby she carries is just a reflection of a culture where women are in general not valued as people.
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My niece was saved and her baby by the exceptional care for high risk pregnancies at Alta Bates in Berkeley. The entire process was amazing and I just wish more states would give this medical care to their pregnant women.
The USA is a travesty for mothers and I blame the male religious hard liners. When I was pregnant my doctor told me that as a practising Catholic my baby's life was more important than mine. I found a midwife. need I say more?
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@mcgerry Alta Bates is a great hospital. The ethos is v patient-driven, and of course, it has top notch doctors from UCSF, UC Davis and Stanford.
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@mcgerry
It's really scary to me how many hospitals have been taken over by the Catholics. Given their aversion to basic health care standards, I think they ought to be forbidden from providing medical care.
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I had a "routine" pregnancy and such, except that I was 36 at the time. However, it became obvious to me that my doctor's practice was not interested in caring for me, but only my unborn child. As the pregnancy went on, I developed such a severe case of symphysis pubis dysfunction that I could at times not walk. A doctor of mine told me that "if I walked sometimes" I would minimize my risk of gestational diabetes, not a minute after I had explained that, at the time, I was feeling compelled to secure wheelchairs any time that I might have to take a flight in order to transport myself through the airport! I asked explicitly for help with the dysfunction and was told that I had to wait until delivery. It turns out there are myriad ways to address this issue, but only if you actually care that it's affecting your patients.
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If Trumpers and The President really want to Make American Great Again, they could start by taking a clear-eyed look at this issue - we don't need a larger military, a wall, tax cuts for the 1%--we need decent healthcare and social services for all.
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