When we hear about maternal death, we immediately think of a third world country but in reality, 2 to 3 women die every day in the U.S. from pregnancy and childbirth. Unfortunately, African American women are affected disproportionately and are four times more likely to die than anyone else. The tragedy is that at least half of these deaths are preventable.
In her article, Special Report: Black Women Die Nearly Four Times the Rate of White Women From Pregnancy Complications, Rita Henley Jensen, describes the dilemma of the acting chief of the maternal and infant unit of CDC, Dr. William Callaghan. Callaghan can’t sleep at night because he wants to know why pregnancy is more dangerous for U.S. African American women.
During my residency training, I witnessed a maternal death. It involved an African American woman who was having normal labor until her baby’s heart rate dropped precipitously. As we rushed her to the delivery room, she stopped breathing and by the time we were draped and gowned for the emergency c. section, she was dead. The cause of death was an amniotic fluid embolism that is both unpredictable and unpreventable. Amniotic fluid from the uterus had somehow traveled into the patient’s lungs and she stopped breathing. Unlike the patient described, most maternal deaths are quite preventable if someone is paying attention at the wheel. So here is a “To Do List” for my colleagues who take care of pregnant African American women:
- Do pay attention to complaints of vaginal discharge and don’t assume it’s a yeast infection if the Chlamydia and Gonorrhea cultures are normal. Do the speculum exam because she could have a Trichomonas infection that needs treatment. Untreated Trichomonas can cause preterm labor with its inherent complications.
- Do not ignore blood pressures if they are elevated, thinking she’s “just having a bad day or is stressed.” Send her to the hospital to rule out Pre-eclampsia. Remember, pre-eclampsia is three abnormal blood pressures taken one hour apart. If you haven’t checked for three blood pressures, you’re not following the standard of care.
- Do not send a pre-eclamptic patient home without blood pressure medication if her blood pressure remains high post partum. She could potentially have a stroke and die.
- Do pay close attention to her if she is obese and assume there will be complications and be pleasantly surprised if there are none.
- Do not ignore complaints of asthma, shortness of breath or chest pain, especially in women over 35.
- Do take the time to obtain a patient history and listen to her complaints. It’s what you DON’T know that could come back to haunt you.
I pray for the day when the term “maternal death” is obsolete. However until then, remember– a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.