Welcoming a new baby is a joyous time for the entire family. The diapers are stacked, the nursery is decorated and new parents are as ready as they can be. The ride to the hospital is filled with adrenaline as mom anticipates holding the baby she has carried so preciously for all these months. But for some families, this joyous event will turn tragic.
What is Maternal Mortality and Maternal Morbidity?
Severe maternal morbidity can be thought of as unintended outcomes of the process of labor and delivery that result in significant short-term or long-term consequences to a woman’s health.2
When tennis superstar Serena Williams shared her terrifying birth story, women began taking a greater interest in the health and well-being of new moms. Many wondered how women with no celebrity status might be treated if similar conditions were present.
Williams suffered from blood clots (embolism) prior to pregnancy and the condition had previously sidelined her career. She recovered and often wears special compression suits to prevent a recurrence.
After delivering her daughter in 2017, she felt ill and her lungs were heavy. She shared her birth story with Vogue Magazine and recalled having to flag down her nurses to convince them that something was wrong. She knew her body, and she knew this condition, she was aware of how it felt and she was suddenly fighting for her life just a short time after giving birth.
She insisted on an MRI in which the presence of clots in her lungs was discovered. Her global celebrity status helped shine a new light on maternal health problems that have affected women since the beginning of time.
Despite modern medicine and technology and a previous drop in maternal mortality, the U.S. maternal mortality ratio has doubled to 14.5 per 100,000 live births, with rates among African Americans reaching 37.7, which is three to four times higher than rates among white women.1
What are the most common conditions that impact maternal mortality?
Providers continue to look for better ways to educate patients and train doctors to bridge communication gaps that lead to care gaps, but sometimes you have to be your biggest advocate. Being aware of the conditions impacting maternal mortality can be the first step towards noticing when something may be wrong.
Hemorrhage can be caused by unexplained, irregular bleeding during pregnancy. It is vital to report any signs of this condition to your doctor immediately. During labor and delivery, your providers will monitor you carefully, but if you notice bleeding after being sent home, do not wait to call your doctor. Seek treatment at your nearest emergency room for immediate answers if you experience heavy or unexpected bleeding postpartum. This is one of the leading causes of death in mothers after childbirth.
High blood pressure
Untreated high blood pressure in pregnancy and in the postpartum period is one of the greatest causes of morbidity and mortality for moms and babies. A condition called preeclampsia is associated with new-onset high blood pressure, most often after 20 weeks gestation. Some other associated signs and symptoms include protein in the urine, abdominal pain, headache, and laboratory abnormalities. Conditions such as preeclampsia can cause very dangerous conditions for mom and baby.
Venous thromboembolism (VTE) or blood clots
According to the American Heart Association, venous thromboembolism (VTE) refers to a blood clot that starts in a vein. VTE can start in the leg and travel through the body. Since pregnancy can often change the flow of blood in a woman’s body, there is an increased risk if you are overweight or taking estrogen or oral contraceptives.
Amniotic fluid embolism
Amniotic fluid embolism is a rare but devastating condition that occurs when amniotic fluid enters the maternal circulation with the onset of a cascade of cardiac, pulmonary, and hematologic compromise. It most commonly occurs during labor and delivery or immediately postpartum.
Cardiac disease in pregnancy and the postpartum period is a large contributor to maternal mortality rates. Specifically, cardiomyopathy, which is a form of heart failure associated with pregnancy and the postpartum period. It is more common in those with advanced maternal age, smokers, diabetics, high blood pressure, multiple gestations (i.e. twins), obesity. Symptoms include shortness of breath, fatigue, chest pain, cough and swelling. Early detection is key in managing this condition.
How to advocate for yourself and for your health
African American women have a higher rate of morbidity and mortality related to pregnancy and childbirth. Although the reasons for this are not well-defined, it is suspected to be multi-factorial and related to access to insurance coverage due to greater financial barriers and discrimination, access to healthcare and prenatal care, and higher rates of comorbid conditions that can alter pregnancy outcomes.
Here are some tips to help you feel confident and get the answers you need when talking to your doctor:
- Know your body, pay attention to subtle changes.
- Get regular check-ups.
- Keep a journal and note irregularities in your health or body. Bring the journal to your appointments.
- Don’t be afraid to call your OB-GYN (even if it’s after hours) – that’s what they are there for.
- Create a list of questions for your doctor before each visit.
- Don’t feel rushed at an appointment (yes, they may be running behind, but your provider owes you their undivided attention).
- If you don’t understand something (a medical term or your diagnosis) ask:
- What does this mean for me? What are the risks?
- What will this mean for the baby? What are the risks?
- Are there any alternatives?
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) maternity benefits will vary depending on individual and group plans. Visit Blue Connect for details on your benefits. Download the My Pregnancy App for information on important pregnancy milestones. Take a pregnancy risk survey or find resources to help you track your pregnancy and access to our 24/7 OB nurse line.
1 American College of Obstetricians and Gynecologists, 2013 (Berg CJ, Callaghan WM, Syverson C, Henderson Z. Pregnancy-related mortality in the United States, 1998 to 2005. Obstet-Gynecol 2010; 116:1302-9.)
2 Obstetric Care Consensus, NO. 5, September 2016