Episode 56 (Epilogue): Maternal Mortality

On tonight’s episode we discussed the current situation surrounding maternal mortality in the United States. We discussed the fact that maternal mortality rates have doubled in the past twenty years, and that according to Amnesty International, it's more dangerous to give birth in the United States than in 49 other nations, including Kuwait, Bulgaria, and South Korea.

We first talked to Ina May Gaskin, founder and director of the Farm Midwifery Center, located near Summertown, Tennessee. Founded in 1971, by 2011, the Farm had handled approximately 3000 births, with remarkably good outcomes. Ina May discussed with us how maternal mortality in the United States came to be a topic of interest and passionate activism for her. Ina May discussed the issues with the system which counts maternal mortality, lack of knowledge about the current situation in the US, and lack of standardization across states for death certificates. She argued the need for expanding time frames in which an individual has a death related to pregnancy, extending to a year, so that we, as a nation, have a more accurate picture of the current situation in the United States, as well as changes like post-partum visits after hospital births and adequate knowledge given to patients about the risk of complications related to medical interventions.  We talked about methods that other countries use, such as the Saving Mothers Lives report issued by the United Kingdom every three years to examine the causes of death for mothers lost and strategies to reduce their rates, which have proven effective. She also discussed the Safe Motherhood Quilt Project, and how this project to help focus people’s attention on the issues surrounding maternal mortality. Gaskin called listeners to educate themselves about maternal mortality and identifying problems within the current framework. Ina May Gaskin ended with asking us to “Spread the word!”

We next talked to Lauren Young, who lost her sister, Pam, passed away after given birth.  Lauren talked to us how a Cytotec induced birth ultimately led to medical complication which resulted in the loss of Pam’s life. Lauren talked to us about how despite the controversy surrounding Cytotec, neither Pam nor her husband were informed of the risks involved with the drug. Lauren talks to us about the ways in which this experience has led her to call for greater awareness among individuals about potential birthing risk, as well as for a call to medical professionals to adequately discuss the hazards associated with certain medicines and interventions.

Finally, supermodel Christy Turlington Burns joined us to discuss her advocacy in maternal health. Christy founded the organization Every Mother Counts, participating in their second ING NYC Marathon November 4th to raise awareness about and proceeds for the cause. We discussed her documentary film, No Woman, No Cry. She discussed with us how her own experience with a birthing complication led her on a journey to learn more about the subject, and ultimately lead her on her journey towards maternal mortality activism.  In particular, Christy pointed out the need for access to adequate maternal health care, both international, where access may be entirely unavailable, and here in the United States, where issues like lack of insurance may hinder access to quality care.

We closed with a story that relates to last week’s discussion of infant loss. In our previous week’s show we talked to Arielle Carrillo about the loss of her full-term stillborn daughter Tanwen. This week we shared with you a healing act of beauty that occurred between Arielle and the family of midwife Jennifer Wollheim, who passed away in childbirth days after Arielle’s loss. Arielle donated her breast milk to this family.

Maddy Oden is a friend of Maternally Yours and a staunch advocate for maternal health, following the loss of her daughter Tatia in 2001. When asked about her beliefs on why this crisis exists in America, Maddy offered these sobering statistics:

• The US is 50th in the world in maternal deaths.
• African American women are four times as likely to die as white women in childbirth in the US.
• Latina/Spanish-speaking women are three times as likely to die as white women in childbirth in the US. 

Continues Maddy: "These statistics are totally unacceptable. Inherent racism in the US medical industry is the foundation of cultural incompetence on the part of the provider and general mistrust of the medical institution on the part of women of color (based on history). These factors lead to lack of access to prenatal care, which leads to poor birth outcomes including preterm births, low birth weight, poor nutrition, high blood pressure, preclampsia, gestational diabetes, high C-Section rate, and death of the mother and/or death of the child.

The Tatia Oden French Memorial Foundation was created after the death of my daughter and granddaughter, to educate and empower women around the issues of childbirth and pregnancy. Our focus  is on maternal mortality in US, off label use of drugs and informed consent. We feel that by addressing and attacking these issues directly through our dealings with the FDA and presentations to a wide variety of audiences including midwives, doulas, high schools, churches , Amnesty International events, and other gatherings we are able to educate women and encourage them to trust their instincts regarding what is best for themselves and their babies during pregnancy, childbirth and through their lives in general."

Additional resources:

• Trailer for No Woman, No Cry
• Ina May Gaskin's summary of articles published about labor induction via Cytotec (Misoprostol)
• Amnesty International's Deadly Delivery: The Maternal Health Crisis in the USA

Ways to Help:

Three panels of The Safe Motherhood Quilt on display at the Selby Public Library, Sarasota, 2009

• Host a display of the Safe Motherhood Quilt in your community
• Donate your time and talent to creating a quilt square for a lost mother
• Run or walk in a 5K on November 4th with Team Every Mother Counts
• Contact your elected officials TODAY and refer to the talking points listed below
• Contact your local hospital and ask them what their policies are on Cytotec, early elective induction and cesarean delivery, and postpartum visitation
• Talk to your colleagues, neighbors, mothers, daughters, sisters, aunts and friends about the importance of maternal healthcare in the United States and around the world

Ina May Gaskin's List of Steps to Reduce the Maternal Death Rate, from Birth Matters: A Midwife's Manifesta:

1. Make every one of the fifty states us the US Standard Death Certificate, so that for the first time in our history, we would have consistency in how data on maternal health is gathered.
2. Create effective penalties for misreporting, misclassifying, or falsifying information on death certificates.
3. Create and require training programs for doctors and anyone else authorized to fill in a death certificate in maternity hospitals.
4. Pass legislation at the national level to provide confidentiality to state maternal mortality review committees.
5. Require that insurance companies pay for an autopsy following the death of a woman of childbearing age in every case where the family agrees to the autopsy, to help contribute to research that will prevent deaths in the future. Countries with national health care systems do this as a matter of course, since it contributes to preventing more deaths (their main priority).
6. Encourage the American Congress of Obstetricians and Gynecologists to emulate the example of its UK counterpart, the Royal College of Obstetricians and Gynaecologists, by periodically publishing a detailed and informative book as part of its effort to identify, review, study and learn from maternal deaths in the US.