Moms Are Dying

Can Doulas Help Curb America’s Soaring Maternal Mortality Rate?

U.S. Moms die in childbirth

Five Figures to Consider

26% increase in U.S. maternal mortality rate between 2000 and 2014
60% of maternal childbirth deaths are preventable
3 to 4X greater probability of a black woman dying from a pregnancy-related complication than a non-Hispanic white women
22% less likely to have a premature birth if mother regularly sees a doula
56% less likely to have a C-section when a doula attends a mother prior to birth

Olivia or Jack, pink or yellow, co-sleep or bassinet, breastfeed or bottle? When anticipating the arrival of a new baby everything’s considered. What’s not usually thought of? The possibility of dying in childbirth. But, it should be. Alarmingly, America’s maternal mortality rate (MMR) is on a rapid rise, increasing 26% from 2000 to 2014. (1,063 moms-to-be died in 2015.) Meanwhile the international MMR trend is in the opposite direction, decreasing 44% during the same time period. In the United States more women die of pregnancy-related complications every year than in any other developed country. According to the Centers for Disease Control and Prevention (CDC), about 700 women die in childbirth annually and over 50,000 more come close to dying. As defined by the CDC, a pregnancy-related death is the death of a woman from the start of pregnancy to one year after delivery or termination. What’s going on? Why is it so dangerous to have a baby in the U.S.?

Experts in maternal health point to a variety of factors. New mothers are older than they used to be. Cesarean births (C-sections), which can lead to complications like hemorrhages and blood clots, are more common. The closure of family planning clinics and hospitals, particularly in rural areas, has made it harder for some women to access health care including prenatal and emergency care (see 5F, Just Say No, To Sex). This lack of access also leaves chronic conditions such as obesity, STDs, high blood pressure and diabetes untreated, all which can complicate childbirth. Additionally, a lack of standard hospital protocols for dealing with potentially fatal complications makes it easy for treatable complications to turn deadly.  Furthermore, we are a baby, not mom-focused, nation. Consider that Title V, the nation’s largest federal-state block grant program supporting maternal and child health, devoted just 4.6% of its 2017 budget to programs for mothers. Often when a mom leaves the hospital a nurse has shown her how to breastfeed, talked to her about what to do if her newborn becomes sick and sent her on her way with samples of diapers and baby-wipes without ever having had a conversation about how to recognize potentially dangerous symptoms in herself. In fact, the new mother may have had little contact with a maternity nurse at all. Many mothers imagine an assigned maternity nurse will spend at least half of her time offering support during labor. However, modern hospitals have reduced the availability of an attending nurse to continuously remain with a mother during labor. The result is maternity nurses now spend just 6–10% of their time on labor support activities.

Better and sustained support for women during and after labor could help. Enter the doula. A doula’s focus is on the mother, not the baby. Her role is to serve as a mother’s advocate providing physical and emotional support plus an informed ear to women during pregnancy, labor and postpartum. One study found that when mothers received pre-birth assistance from a certified doula they and their infants were two times less likely to experience birth complications, 22% less likely to have a premature birth and 56% less likely to have a C-section than those who did not work with a doula. Doulas also support new moms when they return home providing knowledgeable and quick action when something is not right.

The catch is doulas are expensive, up to $1,500 per birth. Not everyone can afford one. As with the rate of STD infection (read Needed: 20 Million Condoms), African American women suffer maternal mortality disproportionately (they are 3-4 times more likely to die of complications during pregnancy or birth than non-hispanic white women.) One survey found that black and low-income women are the most likely to want but not have access to doula services. In response, some states including New York, Minnesota and Oregon are piloting programs to expand Medicaid coverage for doulas. Another handout you say? Consider that Medicaid pays for about half of all births in the United States and that in 2016 9.85% of births were preterm and 31.9% of births were by cesarean delivery. Given the average cost of cesarean ($9,023,) preterm ($18,788 not including associated ongoing care) and vaginal ($6,468) births, offering women the support of a doula saves money and lives. At least two non-profits, The Doula Project and the Joy In Birthing Foundation, are bringing doulas to some of the communities that need them.

The CDC Foundation reports that about 60% to 70% of maternal childbirth deaths are preventable. Consider the death of Laura Bloomstein, a neonatal nurse, who died in the hospital where she worked. Laura’s chosen ob-gyn was a doctor she had worked with and seen in action. She had a healthy pregnancy and was scheduled for an induction at 39 weeks. After a 23-hour labor she delivered a healthy baby girl. Twenty hours later she was dead. What happened? Lauren’s ob-gyn and nurses had repeatedly ignored spikes in Lauren’s blood pressure that resulted in a textbook case of one of the most common complications of pregnancy, preeclampsia. That is not uncommon. An in-depth investigation conducted by ProPublica and NPR, found that a common perception among mothers who almost died in childbirth is that no one took their physical concerns seriously until they were in crisis.  A doula would do just that.

 

Sources

American College of Obstetrics and Gynecologists, American Journal of Managed Care, Centers for Disease Control and Prevention, CDC Foundation, Federation of American Scientists, Health Resources and Services Administration, Henry J. Kaiser Family Foundation, National Institutes of Health, University of Minnesota, Maternal Health Task Force, The Lancet