BellyBelly understands this content might trigger strong emotions. We’re passionate about people’s personal birth experiences and research because we can learn from them.
In this article, you will find important information about how to reduce your risks of pregnancy and birth related complications.
Knowledge really is power, and we want the best possible outcomes for everyone.
There’s a common misconception giving birth in America comes with little or no risk.
After all, the US is a high income, developed country that has top medical care and research. How could any healthy woman die in childbirth?
It might come as a surprise to many, but the US actually ranks pretty low among developed countries in terms of good outcomes for mother and baby.
And one of the most frustrating, and surprising facts: more than 30% of maternal deaths in the US are potentially preventable.
What’s Killing America’s New Mothers? 4 Things You Need To Know
It’s important to note, although the US has poorer outcomes than many other countries, the risk of women dying during childbirth isn’t extremely high. Neither is it something new parents should be stressed about.
When we are aware of risks, however, it helps us to make informed decisions about our care. Awareness lets us know when to insist on the medical care we need.
For example, after giving birth recently, tennis star Serena Williams suffered from a potentially fatal pulmonary embolism. However, her knowledge of the symptoms and her persistence saved her life.
So, what exactly do pregnant parents need to know?
#1: Being Pregnant And Giving Birth In The US Carries Risks
If you’re pregnant, the last thing you want to hear is giving birth is risky. After all, how can added stress at such a time possibly be helpful?
Statistics aren’t meant to scare new parents or to increase stress, but rather to help them make informed decisions.
Understanding the higher rate of maternal deaths in the US helps people understand why choosing their healthcare providers and birthing facilities are important, major decisions.
In 2015, the US had the highest maternal mortality rate of all industrialised countries. For every 100,000 live births, the mortality rate in the US was 26.4, compared with:
- 3 in Canada
- 2 in Western Europe, with some countries such as Italy, Norway, Austria and Sweden having a rate of 4
- 8 in Iran
- 7 in China
- 1-15.8 in Lebanon, Turkey and Puerto Rico.
The rate equates to about 700-1200 US women losing their lives during pregnancy, childbirth or the immediate postpartum period. In addition, 50,000 women narrowly escape death, and 100,000 fall gravely ill during pregnancy or following pregnancy.
While these numbers sound scary, the overall risk is still fairly low. Pregnant couples shouldn’t be overly fearful. The information is meant to help them in healthy decision-making, and to shed light on possible improvements to maternity care.
Any level of poor outcomes is tragic, but there’s an extra level of tragedy when deaths are preventable.
The good news is, there are things we can do to lower our own risks.
#2: What’s Killing New Mothers? The Answer Is Complex
Perhaps the most frustrating part of the crisis in American maternity care is the fact there are many possible culprits for the poor outcomes.
There are several potential causes of pregnancy-related death. In many cases, proper prenatal care, evidence-based care from practitioners, maternal education and healthy lifestyle choices can work together to reduce risks drastically.
In 2011-2013 the Center For Disease Control (CDC) found the following causes of pregnancy related death:
- Cardiovascular diseases – 15.5%
- Non-cardiovascular diseases – 14.5%
- Infection or sepsis – 12.7%
- Hemorrhage – 11.4%
- Cardiomyopathy – 11.0%
- Thrombotic pulmonary embolism – 9.2%
- Hypertensive disorders of pregnancy – 7.4% (preeclampsia is one type of hypertensive disorder)
- Cerebrovascular accidents – 6.6%
- Amniotic fluid embolism – 5.5%
- Anesthesia-related complications – 0.2%
- Unknown causes – 1%
What do these statistics mean for pregnant mothers?
First, it’s important to remember overall risk is low. These statistics, however, can help you understand the importance of choosing a midwife or doctor who practises up-to-date evidence-based care, making healthy lifestyle choices, and educating yourself on symptoms that you need to share with your care provider.
Why are so many US mothers experiencing cardiovascular, hypertension and other scary complications?
It’s a very complex question, and one which many researchers have attempted to answer.
Some theories are:
- More women have pre-existing conditions prior to pregnancy
The chief of maternal and infant health at the CDC, Dr. William Callaghan, said: “We’ve seen a big bump in cardiovascular disease and chronic disease contributing to maternal deaths. Underlying heart disease is common, diabetes is common. We now have a group of women bringing them into pregnancy”.
In the early 1980s and 90s cardiovascular conditions accounted for just 3% of maternal deaths. Today, they account for 14.6% (the slight difference in numbers depends on which year’s statistics are being cited).
- Simply being in a hospital poses a risk of acquired infections
Infection prevention is a huge part of hospital policy and something which continues to be a focus of hospital care in general. For low risk women, giving birth in a freestanding birth centre, or having a home birth with a skilled provider carries a lower risk of infection when compared with low risk births in a hospital.
- Side effects of birth interventions
Interventions are not without potential risks. It’s important for parents to evaluate the benefits and risks, before deciding on interventions, especially considering the potential cascade of interventions (when one minor intervention then requires more interventions due to side effects).
- Racial disparities
There isn’t a clear cut ‘why’, or an easy solution, but statistics show a very clear disparity between maternal death rates among white American mothers and black American mothers.
In 2011-2013 the rate of pregnancy related deaths for white mothers was 12.7 per 100,000, while the rate for black mothers was 43.5 per 100,000. In 2014, the rate per 100,000 was 52.5 for black mothers and 46.5 for Native American mothers.
- Poor lifestyle choices and a lack of preconception care
The US healthcare model tends to be reactive rather than proactive. It is a complex socio-economic issue, but many Americans rely on emergency medical care rather than established preventative care with a primary healthcare provider. This increases the rate of pre-existing conditions at the start of pregnancy.
Preventative healthcare could help to reduce poor nutrition, substance abuse, and a late start to prenatal care.
You can read more in BellyBelly’s article: Why Are Women Still Dying During Childbirth? Find Out What A Study Discovered.
BellyBelly is certainly not in the business of scaring women. We are simply passionate about making sure parents have access to the vital information they need to make informed choices in childbirth.
#3: Your Provider Choice Can Greatly Reduce Your Risks In Childbirth
Unlike those in many other developed countries, the majority of American mothers see obstetricians for pregnancy care, regardless of their risk level.
Study after study, however, shows low and even moderate risk pregnancies have improved outcomes with midwifery care.
Why? Again, a complex answer but, in short, midwifery care generally approaches pregnancy in a holistic way. Not only is there a focus on the outcome for baby, but the mother’s health and experience during and after pregnancy are also prioritised.
Midwifery tends to view birth as a normal physiological process which often unfolds well; midwives step in only when there are actual, or potential complications.
Obstetrical care is more high risk, and approaches care with the idea that intervention is needed to prevent any possible complications. In theory, that sounds good, except each intervention comes with its own risk of complications.
#4: Knowledge Of Risks And Symptoms, And Self-Advocacy Are Important
Again, BellyBelly has no interest in increasing your stress during pregnancy. Knowing about risks can be scary but, in reality, knowledge is power.
As mentioned above, knowing the signs and symptoms of a pulmonary embolism and insisting on proper care saved Serena Williams.
When I had my youngest child, I was on bedrest in the hospital. Being sedentary during pregnancy greatly increases the risk of developing clots, which can lead to serious complications, including a pulmonary embolism.
Having had only low risk pregnancies in the past, I wasn’t aware of how serious developing clots could be. I was given compression pumps to improve blood circulation, and when I had sudden chest pain I was rushed to a CT scan in minutes. Fortunately, my chest pain was due to severe anemia and/or a side effect of a medication, but it really showed how seriously complications during and after pregnancy should be taken.
What was the difference between my sudden symptom onset and the Serena Williams scenario? I was still pregnant.
In reality, much of US maternity care is hyper focused on the wellbeing of the baby, and not always on the mother.
During my bedrest, I was quite shocked at how frequently I was checked. Yet, after the birth of my daughter, it sometimes took hours to reach someone for medication, even though I was still in the hospital. I was even discharged by phone, rather than by a practitioner.
My point is this: it’s important to know what symptoms need to be addressed as the maternity care system isn’t really trained or designed to provide good pre and post-natal follow up for mothers.
During pregnancy you should call your midwife or doctor if you experience:
- Vaginal bleeding
- Changes in urination – especially pain during elimination, as this could be a sign of infection
- Leaking fluid – especially prior to 37 weeks gestation
- Swelling – especially sudden swelling in the face
- Persistent pain without a known cause
- Severe headache – especially accompanied by vision changes
- High fever
- Persistent leg cramp or pain – especially if the spot is hot to the touch
- Difficulty in breathing and chest pain
- Changes in fetal movement
- Any uncertainty or concern about your wellbeing, or that of your baby.
After the birth of your baby, you should call your midwife or doctor if you experience:
- Any fever over 100.4F (38C)
- Bleeding heavier than your typical menstrual period, or a sudden increase in bleeding
- Severe pain in your lower abdomen, accompanied by nausea and vomiting
- Pain, tenderness and swelling in your legs – especially your calves
- Discharge, pain or redness which has become worse, or which doesn’t clear, from your c-section incision, episiotomy, or perineal tear
- Foul smelling vaginal discharge
- Pain and burning with urination
- Difficulty in breathing
- Chest pain
- Symptoms of shock, such as clammy skin, chills, dizziness, fainting or tachycardia (racing heart)
- Any uncertainty or concern about your wellbeing.
In most situations, birth unfolds well and, with proper support, women recover just fine. Having proper prenatal care, being an active participant in your pregnancy and birth, making good lifestyle choices and having adequate follow up can all reduce your risk of experiencing severe complications.
Should a complication arise, knowledge and a good healthcare provider can make a world of difference.