Why do so many moms die and suffer in the US? Stupid negligence

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The US has a shameful record when it comes to caring for its moms. As Ars has reported before, the rate of women dying during pregnancy or childbirth is higher—much higher—than in any other developed country. By some estimates, mothers die in the US at a rate six-times that seen in Italy and three-times the rate in the UK, for instance. And of those that survive, tens of thousands suffer devastating injuries and near-death experiences each year.

It’s hard to compare such stats with precision, of course, because official numbers don’t exist in this country. US hospitals either won’t reveal or don’t determine rates of maternal complications, and the country as a whole simply doesn’t monitor the deaths consistently or accurately. The US hasn’t reported an official maternal death rate since 2007—a situation health experts have called an “international embarrassment.”

Nevertheless, health researchers, hospital organizations, policy makers, and state task forces have been working to understand and reverse the horrific numbers—often doing so with limited resources and reliance on volunteers. While reports have offered glimpses of the problem, a new investigation by USA Today provides one of the sharpest pictures yet.

Many of the pregnant women and mothers who suffer and die in this country do so from easily preventable, common complications—and hospitals know exactly what safety features and practices are needed to spare mothers’ lives and suffering, they just aren’t using them. Women are left to bleed to death because doctors don’t bother monitoring blood loss. Women suffer strokes and seizures and even die because doctors and nurses fail to treat their high blood pressure in time. The bottom line is stunning, simple negligence.

For their investigation, a team of USA Today reporters scoured half-a-million pages of internal records from hospitals, contacted 75 hospitals individually, and reviewed cases of 150 women whose deliveries went horribly wrong.

Routine failures

At dozens of hospitals in New York, Pennsylvania, and the Carolinas, fewer than half of mothers were given prompt medication for dangerous blood pressure levels that put them at risk of having a stroke or seizure, the documents revealed. At some hospitals, the rate was less than 15 percent. For instance, at Women’s Hospital in Greensboro, one of the largest birthing hospitals in North Carolina, staff failed to give timely blood pressure treatment to 189 of 219 mothers between October 2015 through June 2016, according to internal documents.

While high blood pressure is one of the top causes of maternal deaths and complications, experts estimate that up to 60 percent of hypertensive deaths are preventable.

Hemorrhaging is another common but easily treatable complication. Women can bleed to death in as little as five minutes during childbirth. Yet experts estimate that 90 percent of maternal deaths from extreme blood loss are preventable. Such strategies to avoid harms are simple things, like weighing bloody pads to monitor blood loss (not relying on inaccurate visual estimates), having medications and supplies to curb blood loss readily available in a mobile cart, and responding promptly to signs of trouble.

Such simple steps have been recommended by experts for years. But in interviews with USA Today, many hospitals admitted they weren’t following guidelines.

To put the data in real terms, USA Today told the story of 24-year-old Ali Lowry, who bled internally for hours after delivering by Cesarean section in an Ohio hospital in 2013. Her blood pressure registered at alarmingly low levels—52/26, 57/25, 56/24, 59/27—for more than three hours before staff responded. By the time she was airlifted to another hospital for life-saving surgery, her heart had stopped and she needed a hysterectomy. She eventually settled a lawsuit with her doctor and the hospital, which denied wrongdoing.

In a 2015 webinar hosted by influential trade association the American Hospital Association, a trainer talked bluntly to hospital maternity staff about maternal deaths and injuries. "What we know about those deaths is that most of them were absolutely preventable,” the trainer said. “They were from causes that we could have done something about. We could have prevented it if we had recognized the emergency early on.”

In a 2016 webinar, another trainer summed up the situation succinctly: “We’re not talking about a Third World country, we’re talking about us, here. This shouldn’t be happening here.”