American women are dying in childbirth.
I was nearly one of them…
“Don’t let me die! Don’t let me die!”
In excruciating pain and out of my mind with terror, I screamed this refrain over and over again. I was hemorrhaging blood as the placenta for one of the twins abrupted, sheering itself away from the uterine wall, and the contractions became ever more painful. I was bleeding to death. I knew this because the doctors had previously warned me that if this happened I may only have moments to live if they did not rush me into an emergency surgery quickly. I also knew this because my body could sense that it was dying, as an overwhelming and foreboding doom washed over me.
“Don’t let me die!” I screamed and screamed, my mind no longer connected with my body, my words no longer my own – only fear, instinct, and the panic of self-preservation remained. The doctors tried to calm and reassure me as they rushed me to the operating room, but their promises fell flat as they frantically called for more units of blood.
As a trained minister, I would like to say that in this moment of near death I communed with God and a sense of divine peace comforted me. I would like to have imagined that my last words would have been profound and poetic. Instead, all I could feel was pain, and with the gas mask covering my face, I let out a primal scream, yelling – “FUCK!”
At least, in that moment, I had the presence of mind to think, “If my family asks, THAT cannot be my last word.” So in desperation, I grasped for something more beautiful, inspirational, or loving to leave with my family after I was gone. But in pain and filled with terror, nothing came. Instead, I turned to my doctor and through the plastic mask I begged, “Please don’t kill me.” My last words, followed by blackness as the surgeons put me under.
Six units of blood later, I lived. But my babies – my twin sons born too soon – died before they could draw a breath.
Tragically, my story is rare but unfortunately not unique in America, even today. Approximately 700 – 900 women still die every year during childbirth in the United States, and another 65,000 women, like me, nearly die from pregnancy or childbirth related complications. And these numbers are on the rise.
According to the World Health Organization and other studies, in every other developed nation around the world, maternal mortality rates are falling. (Check out this New York Times article for more info). This is true in many developing countries as well. Yet, uniquely, in the United States, mothers continue to die during birth in increasing numbers.
This week, the search for why American mothers keep dying during birth inspired ProPublica and NPR to release a lengthy expose examining the death of one particular mother, Lauren Bloomstein, who had worked as a neonatal nurse and delivered a healthy baby girl, only to unexpectedly die 20 hours later.
In their research, this report concluded,
While maternal mortality is significantly more common among African Americans, low-income women and in rural areas, pregnancy and childbirth complications kill women of every race and ethnicity, education and income level, in every part of the U.S.
These reporters identified more than 450 expectant and new mothers who had died since 2011, including women who had been teachers, insurance brokers, homeless women, journalists, a spokeswoman for Yellowstone National Park, and more than a dozen doctors and nurses.
And perhaps worst of all, they found,
60% of American maternal deaths are preventable
The potential reasons they list are numerous. New mothers are older than they used to be. Half of all pregnancies are unplanned. There is a greater prevalence of C-sections, leading to more life-threatening complications. Other sources make correlations with the rise in obesity and with the unequal access to health care, especially for minority groups and for those who live in poor or rural areas. Some link a rise in deaths to slashes in family planning funding.
Yet, what ultimately led me to almost die during birth, as they list it –
The fragmented health system makes it harder for new mothers… to get the care they need.
Confusion about how to recognize worrisome symptoms and treat obstetric emergencies makes caregivers more prone to error.
I am convinced that this is why I came so close to death. My death would have been preventable – if the doctors had only listened or had been better trained, if the health care system was not so broken.
I started spotting mere days before we were set to announce our pregnancy to the world at the beginning of our second trimester. Haunted by the memories of our miscarriages, we rushed to the Emergency Room. And we breathed a sigh of relief when we saw two healthy heartbeats and babies kicking each other on the ultrasound. We followed up with my OB-GYN, who reassured me that the babies looked fine and spotting was normal. All would be well, they said.
The spotting continued for weeks, yet we received continued reassurances. Even when the spotting increased to blood clots, our concerns were dismissed and sugarcoated. They were so convinced, in fact, the doctors gave us the green light to travel to my sister’s wedding, hundreds of miles from my home and a good distance from a decent trauma hospital since it was in a national park. One of the nurses even unhelpfully quipped, “It’s not like they could do anything anyway if something should happen.” Meaning, there was nothing that they could do to save the babies since they were still not old enough to be viable outside of the womb. There was no discussion about the potential dangers to my health.
On the day of my sister’s wedding, the blood clots grew larger and more menacing. And on the day that we returned, I passed a blood clot that was the length of my hand. I called my doctor. I was in and out of his office and Emergency Rooms. Each time I was reassured that I could go home. Yet, I was growing increasingly terrified and frantic. Any bleeding in pregnancy is not “normal.” But massive and monstrous blood clots especially should not have been so easily dismissed.
It wasn’t until the bleeding grew even heavier that the tone in the nurse’s voice changed. When I described the size and severity of the blood clots, she warned me that I needed to get to the doctor’s office immediately, and if I started bleeding heavily along the way, I needed to call 911 so I could be transported to the hospital for this life-threatening emergency.
Yet again, though, even with these dire warnings still ringing in my ears, I was again sent home by my doctor. When I pressured him for an answer as to why I was bleeding so heavily, he shrugged in confusion and said simply, “I really don’t know. We will just have to watch it and see.” I knew then that I needed a specialist, since my own doctor was at such a loss.
Even with my doctor’s referral, the specialist at the high-risk hospital refused to schedule an appointment for another four weeks. I called repeatedly, sometimes daily in desperation, explaining the situation and begging for an earlier appointment. The bleeding was getting worse. The bedrest was not helping. My doctor was at a loss, and I was beginning to believe simply had no idea how to deal with such a dire complication. Yet, my appointment remained unchanged. “If you are having any problems, speak with your doctor,” they said. I called another high-risk specialist, and thankfully, we were able to get a consult. But when I called them as I could feel that the bleeding was becoming more life-threatening, they too turned me away. “We are just a consultant,” they said. “If you have any problems, speak with your doctor.”
I did, and my doctor again sent me home on a Friday morning to “wait and see.” By Saturday, I was bleeding so much that my bathroom looked like a murder scene, with blood splattered even on the walls. I could feel my desperation rising. I did not feel safe. I needed help. I called the hospital and demanded to be admitted.
It was then, and only then, that I found a doctor who would advocate on my behalf. Yet, when she too realized that my care was beyond her hospital’s capabilities, and when she too called the same high-risk hospital that had so often denied my pleas for help, they still refused to take me as a patient. At first, I was “too stable.” Mere moments later, however, I was “too unstable.”
I began hemorrhaging. My water broke. The contractions started. My advocate doctor heroically tried to pump me full of blood and medicine. Yet, I could feel myself dying.
I turned to my husband that night, barely lucid from all of the medications and blood loss, and through tears and fear, we said our goodbyes.
Somehow, I was stabilized. Yet, shockingly, after all of this trauma, the high-risk hospital in town would still not accept me. Through some contractual agreement that I do not understand, even though there was a trauma hospital mere minutes away, I had to be transported by ambulance to another trauma hospital over an hour and a half away to be seen. It was there, in that hospital, where I almost died during birth.
While trying to process the trauma of it all, I find myself thinking of all the “What Ifs.” What if I had not advocated for myself and I was still at home when I started hemorrhaging? What if I did not find a doctor to finally advocate on my behalf? What if I had not stabilized enough to be transported to the other hospital?
Or, I wonder, what if I lived in a rural or impoverished area, too far from an adequate trauma hospital to be safely transported? Or what if I did not have access to the same education or did not speak English and could not understand the doctors or navigate this complex system? What if I did not have a job that was able to offer me time off from work on paid disability, enabling to go to so many doctor’s visits? What if I did not have access to health insurance, and I feared going to the hospital may push my family to financial ruin?
In all of these situations, I fear, the most likely scenario would have ended in my demise…
My preventable, tragic, and all too common death during birth.