Postpartum is the most dangerous moment of motherhood – 06/15/2023 – Health

Sherri Willis-Prater’s baby was two months old and she was about to go back to work in a Chicago school cafeteria. But one night, as she climbed the short flight of stairs to the kitchen, she almost fainted, panting.

At the hospital, Willis-Prater, who was 42 at the time, was hooked up to a ventilator that pumped air into her lungs. Her heart, the doctors said, was working at less than 20% capacity. She developed a rare form of heart failure that comes after pregnancy.

That diagnosis was the last thing she expected to hear. After giving birth, Willis-Prater thought she had “made it across the finish line”, she recalled in an interview. “I didn’t have to worry about anything anymore.”

Most people think of labor and delivery as the most dangerous part of pregnancy. But new scientific research is disproving this idea, finding that substantial risks persist for a full year after childbirth itself. The deadliest time for mothers is actually after the baby is born.

For every woman who dies, an estimated 50 to 100 suffer serious complications that can leave them with permanent health problems. The numbers are growing as more American women gain weight, and high blood pressure and diabetes become more common.

An increasing number of women are also delaying pregnancy later in life, so they are more likely to start it with chronic medical conditions that can lead to complications.

The new numbers come amid a worrying rise in deaths of pregnant women and new mothers in the United States, which has the highest maternal mortality rate in the industrialized world.

Numbers skyrocketed during the pandemic, to 32.9 deaths per 100,000 live births in 2021, up from 20.1 per 100,000 in 2019. Rates for black and Native American women are two to three times higher than for women white.

But these numbers reflect a traditional definition of maternal mortality – deaths that occur during pregnancy or up to six weeks after birth.

A broader scope of the problem came to light in September 2022, when the Centers for Disease Control and Prevention (CDC) looked at deaths of mothers over an entire year after giving birth, including deaths resulting from mental health issues.

Based on data provided by 36 states on 1,018 pregnancy-related deaths from 2017 to 2019, the CDC concluded that about a third of them occurred during pregnancy or on the day of delivery, and approximately another third before the baby is six weeks old. A full 30% occurred from that point until the baby’s first birthday, a period that had not been entered into research on maternal mortality.

The data led to calls for closer monitoring and more support for new mothers during what has been called the “fourth trimester”, with special attention paid to vulnerable women.

“Our approach to birth has been that the baby is the candy and the mother is the package, and after the baby is out of the package we put the baby away,” said Dr. Alison Stuebe, professor of obstetrics and gynecology at the School of Medicine. from the University of North Carolina. “We need to recognize that the package is a person – mothers are getting very sick and dying.”

The leading causes of maternal mortality among white and Hispanic women are mental health conditions that lead to suicide or fatal overdoses. Among Asian women, the main cause is hemorrhage.

Among black women like Willis-Prater, heart problems were the leading cause of death. High blood pressure, a predisposing factor, is more common among black women, and they have greater difficulty accessing health care, a legacy of both poverty and racism.

The risk of late maternal death –from six weeks to one year after giving birth– is 3.5 times higher among black women than among white women.

Medical practice is often slow to change. But the numbers are accelerating revisions to Medicaid, the health insurance that covers low-income Americans, including more than 40% of pregnant women in the United States.

Thirty-three states and the capital, Washington, have expanded Medicaid coverage for new mothers for up to a year after giving birth, so they are insured while they recover from pregnancy, and eight other states plan to do so, according to the Kaiser Family Foundation. .

Three states, including Texas, are extending only limited coverage, and six – including Arkansas, which has one of the highest maternal death rates in the country – have no plans to expand Medicaid coverage, according to the foundation.

Doctors are now advised to screen new mothers within three weeks of giving birth, rather than waiting for the once standard six-week checkup.

“Now it’s ‘See you in two weeks, right? And yes, you’re coming for sure,'” said Tamika Auguste, author, with Stuebe, of new guidelines on postpartum care from the American College of Obstetricians and Gynecologists.

New mothers with medical conditions like high blood pressure should be seen even earlier, Auguste said.

Even more important, however, is that physicians and other health professionals listen when women voice concerns and pay special attention when Black and Native American women say something is wrong.

“It’s not like, ‘Oh, honey, you’re okay,'” Auguste said. “Now it’s, ‘Let’s see if we can see her today or tomorrow.’

Although most women survive pregnancy-related complications after giving birth, prompt medical attention is critical.

Deidre Winzy, a 28-year-old medical assistant from New Orleans, already had high blood pressure when she became pregnant with her third child. Doctors gave her a blood pressure monitor to use at home, along with Babyscripts, a remote monitoring system that sends readings to her midwife.

She was induced two and a half weeks before she was diagnosed with pre-eclampsia, a dangerous hypertensive condition. But three weeks after giving birth Winzy woke up in the middle of the night feeling disoriented and dizzy. She called a friend for help, her speech slurred.

The paramedics thought she was having a panic attack and at first didn’t want to take her to the hospital. In fact, she was having a stroke. “I got there just in time,” Winzy recalled. “If not, I could have been paralyzed for life.”

Winzy now struggles with short term memory loss and weakness but is able to work. Still, as a single mother of three, she worries.

“My biggest fear is not being here for my kids,” said Winzy. “What if I have another stroke and it permanently paralyzes or kills me? It’s scary.”

Complications can surprise even women who have had a smooth pregnancy. After a C-section, Aryana Jacobs, 34, a health technology analyst in Washington, DC, was told her blood pressure was fluctuating. At home, Jacobs checked with a blood pressure cuff that she had because of a family history of hypertension. Within days, the reading reached 11/17.

She went to the hospital and was treated for pre-eclampsia, which usually develops during pregnancy, not afterwards.

“I wish every new mom was sent home with a box of chocolates and a blood pressure cuff to emphasize that she’s still a patient,” said Jacobs. “Her body is recovering from something huge.”