Brookings register | Saving Lives: Will America Protect Our Mothers?

In medicine, we regularly ask people about their family history. Knowing that your mother was diabetic or that your grandfather struggled with alcoholism helps us to be aware of any health problems to which you may be predisposed. Sometimes, however, what is revealed by these stories is not a medical issue, but a family tragedy.

Earlier in my career, my older patients often told me that their grandmother, or even their mother, died in childbirth. Today, it’s too easy to forget how perilous it can be to be pregnant. In the early 1900s, nearly one mother died for every 100 live births.

Even today, around 800 women around the world die every day from pregnancy-related causes, and a woman’s risk of dying from pregnancy hovers around one in 200. In some countries, this risk is about one in 20. In others, it is less than one in 10,000. Infants and their older siblings face a grim future without these mothers.

Many infants do not survive until their first birthday. Older siblings have an increased risk of dying before the age of 5.

Although most maternal deaths occur in developing countries, where access to skilled birth attendants or hygienic childbirth conditions is limited, the United States ranks worryingly among the developed countries. In fact, our rates were higher in 2017 than in 2000. A woman’s risk of dying varies depending on her age, education, socio-economic status and, more significantly, her race.

Black women have a risk of pregnancy-related death more than three times that of white women, and Indigenous women are about double the risk. Wealth, health and education are not enough to close these gaps. Serena Williams and Beyonce have both spoken publicly about their own potentially life-threatening pregnancy complications. More research is needed to understand and address these disparities and maternal mortality rates in general.

Sometimes death is caused directly by pregnancy: bleeding, eclampsia, embolism of amniotic fluid in the mother’s lungs, infections. Sometimes death results from the added stress of pregnancy combined with another illness. Weak hearts, for example, may not meet the additional demands of pregnancy and childbirth. Historically, the flu has killed a disproportionate number of pregnant women. My own great-grandmother was one of them.

Likewise, a pregnant woman who contracts COVID is 20 times more likely to die than another. Women struggling with depression or drug addiction may experience overdoses or suicides triggered by the stress of pregnancy and caring for a newborn baby. Domestic violence can start or escalate during pregnancy, and too many women die at the hands of their current or former partners.

The good news is that almost two-thirds of maternal deaths are preventable. We just need the will of society to make change and save lives.

Debra Johnston, MD, is part of The Prairie Doc’s team of physicians and currently practices family medicine at Brookings. Follow The Prairie Doc on and on Facebook with On Call with the Prairie Doc, a medical question-and-answer show celebrating its 20th season of truthful, tested and timely medical news, aired on SDPB and streamed live on Facebook most Thursdays at 7 am. afternoon

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