Decreasing Maternal Deaths
The birth of a baby is a momentous occasion baked with excitement, sprinkled with pain, and topped with the unknown. However, most females experience anxiety and fear surrounding the birthing process. Rightfully so! Circulating around social media platforms and various news outlets are concerning information highlighting American maternal deaths. Basically, mothers are dying due to complications after the delivery of a baby at alarming rates. Why isn’t decreasing maternal deaths a priority? Consequently, we are not able to turn a blind eye to this matter any longer. Let’s educate ourselves and take the health of our loved ones into our own hands.
**Alarming Statistic Alert **
- The US has the highest maternal death rate among the world’s developed nations
- 700 women die per year, in America, from childbirth
- 50,000 women experience severe birthing complications
- ½ of the deaths could have been prevented
Listed above are only a few of the many alarming statistics printed in the USA today an article by Laura Ungar and Allison Young addressing how to save new mothers’ lives. Not to mention, the state of Georgia, where I currently reside, is ranked #2 for the highest maternal deaths. As a matter of fact, this is scary! In addition, women of color are 3 to 4 times more likely than white women to die due to pregnancy-related complications according to an article by NBC News Today.
Traditionally, the mothers’ education, socio-economic status, weight gain during pregnancy, lack of prenatal care, and other lifestyle plus societal ills are blamed. In fact, these factors play only a minor role in maternal deaths. Through research and observing other countries, we are learning that there are TWO leading preventable causes of maternal mortality:
- HYPERTENSION – dangerously high blood pressure
- HEMORRHAGE – extreme blood loss
What Do We Know about Decreasing Maternal Deaths?
Before we explore potential solutions, we need to better understand what information is currently known. Let’s look at how the state of California was able to decrease maternal deaths and complications during delivery. In 1999, California experienced 8 deaths per 100,000 live births. However, in 2006, it increased to 16.9 deaths per 100,000 live births. The death rate basically doubled from 1999 to 2006 despite advances in medicine. In the hope that California would be able to understand the increase in maternal deaths, healthcare providers, advocacy groups, and health departments started searching for a cause and a solution. Based on their research, they developed a toolkit with clear intervention and prevention guidelines to save mothers lives.
The main focus was on early detection and management of high blood pressure and excessive bleeding. Since 2008, California has experienced an impressive decline in maternal mortality to a low of 7.3 deaths per 100,000. At the present time, the rest of the nation’s mortality rate is 3 times as high as California and continues to increase.
The main question is, WHY ARE MORE STATES NOT ADOPTING THIS TOOLKIT? Shouldn’t every clinician and facility involved in childbirth receive training regarding these updates to decrease maternal mortality rates???
What Can I Do?
The USA Today article developed a simple and practical document to safeguard mothers from preventable complications: Lifesaving Tips for a Safer Birth:
- Ensure your birthing facility is measuring, not estimating, blood loss during and after childbirth
What Happens to My Blood Volume During & After Pregnancy
The Body is AMAZING! Did you know that during pregnancy, your body increases its blood volume by 50%? Sure you did. As an illustration, you may have experienced intense action in the bedroom, feeling hot or flushed, swelling in the legs and feet, exhaustion, increased sweating… these are all common signs of increased blood volume coursing throughout your body. This is a good thing because more blood in mommy means nourishment for the growing baby.
As you can imagine, when it comes to delivering a baby, we expect some blood loss. The average amount of blood loss after the vaginal birth of a single baby is about 500 milliliters or 2 cups of blood. For a cesarean birth of a single baby, the average blood loss is 1,000 milliliters or 4 cups of blood. Blood loss is higher if the mother is pregnant with multiple babies.
The most fascinating part is the built-in system our bodies use to stop excessive bleeding. Many call them after-pains or cramping that occurs after birth, but they are technically life-saving uterine contractions. The after-pains help us to clear out the placenta for vaginal deliveries, but it also compresses the bleeding blood vessels where the placenta was once attached. Regardless if the mother had a cesarean section or a vaginal delivery, the same uterus that carries our babies for 9 months also helps to control blood loss after delivery of our babies. BUT if the mother’s uterus does not contract strong enough or there were other complications, the mother will continue to bleed excessively, potentially leading to hemorrhage.
What Can I Do About Pregnancy Related Hemorrhaging?
1 – Understand why pregnancy related hemorrhaging is a health concern
Hemorrhaging or excessive blood loss is a health concern because it can lead to a drop in the mother’s blood pressure, shock, surgical removal of the uterus, and even death, if not identified and quickly treated. To identify blood loss, nurses commonly look for a blood-saturated sanitary napkin or pad in a short period of time? If the mother has a catheter in her bladder, the urine output is also checked for blood. The tricky thing is that not all bleeding is visible like in a cesarean section. This is why you and your support network need to be aware of the symptoms of excessive blood loss.
2 – Recognize common symptoms of pregnancy related hemorrhaging or excessive blood loss
- Uncontrolled bleeding
- Swelling and pain in the vagina or surrounding areas
- Feeling out-of-sorts
- Loss of consciousness
3 – Ensure your birthing facility is measuring your blood loss during and after child birth.
Do you remember the game where we guessed how many marbles are in the jar? It was nearly impossible to guess the number of marbles in the jar correctly. We play this same guessing game when we rely on visual assessment of sanitary napkins for quantifying blood loss. It is nearly impossible to guess blood loss correctly. It has been shown time and time again that the estimate is generally lower than the actual amount.
For this reason, IDEALLY, the hospital is quantifying blood loss through weighing the bloody sanitary napkin or collecting blood in a graduated container to identify excessive blood loss. This decreases the guesswork of knowing blood loss because your health is at risk.
3 – Grin and bear the uterine checks and/or abdominal massages
After delivery, nurses will frequently push on your lower abdomen to encourage and ensure the uterus is contracting. Remember, this is your body’s natural system to constrict the blood vessels of the uterus so you will not bleed too much. My recommendation is to BREATHE! It can be very uncomfortable and allows the nursing staff to either massage the uterus or alert the doctor.
4 – Monitor your blood pressure
Not all postpartum bleeding is visible. Some pregnancy-related hemorrhaging can occur internally, especially after cesarean delivery. One of the first signs may be a dramatic decrease in your blood pressure. If you are either having symptoms or notice a drop in your blood pressure, make sure you bring it to the attention of the nurses and doctors.
5- Monitor blood loss 12 weeks after you deliver your baby for delayed postpartum hemorrhage
Alert your doctors if you notice consistent bright red blood, soak a sanitary napkin within an hour, or if you have golf-ball-sized clots. In the event that you experience light-headedness, weakness, fast heartbeats, fast and shallow breathing, or confusion along with blood loss, get to the hospital. These are potential symptoms of shock due to blood loss.
Let’s PAY ATTENTION and educate your support network. If you notice something weird, feel different, or are unsure, SPEAK UP and ADVOCATE FOR YOURSELF!