Banner by Shirin Kaye
Don’t Forget to Hug Your Mother
By Riya Sharma
Does the name Serena Williams ring a bell?
Of course it does—Williams is a famed and accomplished tennis player, having won 39 major tennis titles. Do you know what else she has achieved? Making it out of childbirth alive. We often talk about how hard it is to raise kids, but it’s time we bring more attention to the strenuous process of childbirth itself. In 2017, Williams had to have an emergency cesarean section and then faced distressing complications in the days that followed, as she had to re-enter the operating room to get rid of a pulmonary embolism. Fortunately, she had access to amazing care and doctors able to save her life. Unfortunately, that is not the case for every expecting mother.
Maternal mortality is defined as “a mother dying from a pregnancy-related health issue or an existing condition exacerbated by pregnancy.” The time frame during which death can be defined as maternal mortality is the entire duration of the pregnancy and approximately the six weeks that follow. Maternal mortality rate (MMR) is the number of maternal deaths per 100,000 live births. The average MMR in low-income countries is 430, whereas in high-income countries, it is about 13. The MMR of the United States in 2021 was 33, which puts into perspective how large of a problem maternal mortality is in our country, especially since it is a developed nation. There are a plethora of causes, often intertwined, that contribute to maternal mortality. These include, but are not limited to, social determinants of health and public policy.
Social determinants of health are nonmedical factors that play a role in someone’s health. Examples include race, access to education, socioeconomic status, and someone’s environment. In terms of maternal mortality, some may not realize how large of a role these social determinants of health play. According to the CDC, the rate at which Black women die from maternal mortality is 2.6 times the rate at which white women die. Those of low socioeconomic status are also more likely to have hypertension and diabetes, and the presence of these chronic diseases prior to pregnancy increases the risk of maternal mortality. These chronic diseases aren’t limited to physical ailments, as 23% of deaths are caused by mental health conditions—which are also more prevalent in those with low socioeconomic statuses. To add fuel to the fire, studies have shown that women with no education have 2.7 times the risk of maternal mortality compared to those with 12 years of education, which is equivalent to a high school diploma. When it comes to the living environment of the mother, exposures to toxins and endocrine disruptors increase the risk of adverse pregnancy outcomes. Why don’t you guess who is more likely to be exposed to these chemicals? Racial minorities. Furthermore, access to different hospitals can impact the level of care received. Depending on the location and funding, quality of care varies and understaffing can lead to inadequate care or attention for expecting mothers. As a result, health care professionals miss warning signs or are unable to deliver treatment in a timely manner.
The amalgamation of these factors increases the risk of maternal mortality for certain populations—but it doesn’t stop there. When comparing health care systems and policies with those of other developed countries, the U.S. differs on many levels. The first is the type of health care provider. In the U.S., maternal care is provided primarily by obstetrician-gynecologists, but in other countries, OB-GYNS are outnumbered by midwives. Midwives are able to provide prenatal care, deliver babies, and then provide individualized postpartum care to mothers. These home visits are correlated with better mental health outcomes for the mothers, which could be part of the reason for lower maternal mortality rates, as 60% of maternal deaths due to mental health issues occur postpartum. These mental health issues can be further aggravated by the average paid maternity leave being only four weeks in the United States. Durations of paid maternity leave of fewer than 12 weeks are associated with an increase in the chances of maternal depression and anxiety. Countries such as France, with an average paid leave of 16 weeks, and Germany, with an average paid leave of 14 weeks, have seen a 50% decline in maternal mortality. Given the data showcasing the success of other countries in reducing their maternal mortality rates, it begs the question—why hasn't the U.S. made a significant push for similar changes? Instead, it seems the U.S. has decided to take an entirely different direction.
June 24, 2022. Unless it’s your birthday, the day might not hold much importance to you, so let’s jog your memory. On June 24th of 2022, the Supreme Court overturned Roe v. Wade, a constitutional right regarding abortion that had been protecting a woman's right to choose for the past fifty years. Following the vote, 14 states modified their policies to near total abortion bans, making exceptions if the mother’s life was on the line. Despite these “exceptions,” the impact of these bans are detrimental. If no abortions are allowed in subsequent years, there is a projected 24% increase in maternal deaths and a 39% increase for Black women.
If those statistics don’t sound alarming, let’s take a look at what happens when a mother gets to the hospital in these abortion ban states. In some states, doctors must confer with risk management committees to gain approval before performing an abortion. Even for those who don’t have to receive approval, policies using indeterminate language allow for the fear of being prosecuted to weigh heavily on their shoulders—two situations in which life-saving care is delayed. Take a look at what happened in Texas; in 2023, Amanda Eid’s water broke earlier than expected due to premature dilation and left her at risk for life-threatening infection at 22 weeks pregnant. Since the baby still had a heartbeat, although it was determined the baby would not survive, the doctors refused to perform an abortion because Texas laws hadn’t definitively stated what a “life-threatening condition aggravated or caused by pregnancy” was. They told her they had to wait to provide care until she was in a worse condition. Three days later, when she became very sick very fast, she was rushed back to the hospital, and this time around the doctors felt that she was sick enough to terminate the pregnancy. For those of you thinking that this couldn’t possibly be the only solution—you are absolutely correct.
Amanda Eid did have another option: driving eight hours to a sanctuary state. Unfortunately, this is the terrifying reality for the six million women who are now an additional 200 or more miles away from a legal abortion clinic. Indubitably, banning abortions was not a policy conducive to reducing maternal mortality. Waiting until you are “sick enough” or traveling up to 600 miles to receive treatment is not the ideal scenario, so with all these socioeconomic factors and policies, what can expecting mothers do?
There are several precautions that doctors and pregnant women can implement to decrease the chances of maternal mortality, as 84% of these deaths are preventable. The first is creating thorough treatment plans for chronic diseases. Ideally, this should be done before women are planning to have children so they can work on reducing their symptoms before their pregnancy. However, something is always better than nothing, and it can also be done during the pregnancy, as the physician and mother can work together to create a plan that would decrease the severity of the chronic disease while maintaining the health of the fetus as it develops. These plans can include screening to catch chronic diseases as early as possible, proper medications, as well as identifying possible lifestyle changes. Additionally, genetic screening can help mothers see if they are predisposed to certain diseases or complications that can arise during pregnancy. Having prior knowledge makes it easier to predict challenges that may arise, and effectively handle them if they do arise. Finally, health care providers should be raising awareness of mental issues that are common in pregnant women. They should carve out time to discuss topics that may have a stigma surrounding them so expecting mothers are not only aware that they can seek help, but also know how to do so.
Overall, maternal mortality may be the most harrowing outcome of pregnancy, but it does not have to be this way. These are—for the most part—preventable deaths, and there are solutions both on governmental and individual levels. The theme of autonomy is interlaced in a plethora of these solutions, whether attempting to maintain a healthier diet to lower your blood pressure or raising awareness for women’s health. There are many ways to enact change, but an easy way to start is recognizing the resilience and strength of these women who are putting their life on the line to give you one. So, with all this in mind, don’t forget to hug your mother.