By Patricia Gail Bray, PhD, Director, BridgeUp at Menninger, The Menninger Clinic
September 4, 2020
This National Grandparents Day, I count my blessings twice as I celebrate with my daughter and one-year-old granddaughter, considering how our happy delivery day nearly became a tragedy. Having worked in healthcare and health systems for 30 years, with over half that time in executive positions, I share my story as a cautionary tale.
Nationally, the maternal mortality numbers are alarming. More than 800 U.S. women die annually because of pregnancy or delivery complications. The United States has the highest maternal mortality rate compared to all developed nations. In Texas, we see unacceptable rates of maternal mortality, as well as increased rates of maternal morbidity, which refers to the too many mothers developing serious health issues within the first year of delivering. All women, especially non-Hispanic black women, giving birth in Texas are dying at a disproportionately higher rate than in most states.
Due to these disturbing trends, the Houston Endowment convened a steering committee of Harris County leaders, with the goal to develop comprehensive, clinical, community-based and systems change strategies aimed at reducing both maternal mortality and morbidity numbers in Harris County. In the subsequent report from the Houston Endowment, it was discovered that between 2008 and 2015, Harris County’s overall incidence of maternal morbidity rose 53 percent, compared with a 15 percent increase for Texas!
Research shows that many incidents of maternal mortality and morbidity are preventable. That’s why I am encouraged that nearly every Texas hospital that delivers babies is participating in TexasAIM. This initiative of national and state health officials, hospitals and clinical experts helps hospitals and communities improve maternal health and safety by implementing nationally-recognized best practices. We must apply our best collective knowledge to provide delivering moms with their best chance to survive and thrive.
While childbirth is viewed as a normal part of a woman’s biological life, it is still a significant physical event where a mother’s health can be greatly impacted. Unforeseen complications can occur during labor, at delivery and in the first year afterward. Although hospitals are run by protocols and competent, highly trained professionals, mistakes happen. Sometimes, these variables can compound a potentially serious healthcare situation, especially one that is already complicated with an at-risk pregnancy. Pregnancy is a team effort, and I can assure you it’s not getting the attention it deserves.
In our daughter’s case, multiple incidents contributed to near-tragic consequences. At the urban hospital where she delivered, a few of these issues were out of their control, such as the fact that our granddaughter was a premature, breech baby. Our daughter experienced a crash Caesarean section on a Saturday afternoon by an obstetrician who drove 60 miles to get there. By Sunday morning, her life was in danger. Her blood pressure was erratic and dropping. She was in intense pain that caused her to cry out constantly until eerily, after three hours, it became a mere whimper.
Despite pleas from friends and family, many who work as healthcare professionals, our requests to the hospital for help went unanswered. Since I served on the Houston Endowment Steering Committee, the maternal mortality and morbidity statistics were painfully throbbing in my head. Things were made worse because it was a Sunday morning, with a hospital that was ghostly quiet with few staff. The attending physician on duty was called upon to play two additional critical roles: Hospitalist and Surgeon. The sole sonographer on duty in Labor and Delivery had to take care of the babies first, followed by moms second. When that sonographer finally arrived, he was unable to conduct the procedure due to our daughter’s escalating pain.
A fortuitous event saved her. The anesthesiologist from her C-section was making rounds and became alarmed by her pain and blood pressure levels. She was rushed to the OR, received blood and platelets, and her bleeding stopped. One of the leading causes of maternal death is postpartum hemorrhaging, which we were all excruciatingly aware of during that nightmare time. Gratefully, a year-and-a-half later our granddaughter and daughter are recovering and making progress, but not without the effects of trauma, which we all still share.
Trauma-induced postpartum post-traumatic stress disorder (PTSD) is a mental health condition that occurs due to a terrifying event or events. Often, as we discovered, moms presenting with postpartum mental health issues are dismissed cavalierly, only layering on more negative emotions and therefore delaying recovery.
Our daughter was diagnosed with this condition seven months after our granddaughter was born. She has struggled immeasurably, and finally just in these last few months she is on her way to recovery, I’m relieved to say. We struggled with her as did her husband and older children. With her recovery, ours comes now.
This is one family’s story of how we nearly became a statistic. Along with legislators and healthcare leaders, families can positively impact this problem. I encourage everyone to consider the importance of awareness regarding maternal mortality and morbidity. According to recent research, many social and economic factors contribute to these issues, including poverty, lack of access to health insurance and mental healthcare, contraception and other community supports.
I urge grandparents, parents and close friends to be a support team for the delivering mom in your life. Be ready to ask questions and to advocate for her physical and mental health during pregnancy, delivery and in the critical year afterward. It can make a lifetime of difference.