Why are American Women Dying in Childbirth?
by Sharon Tjaden-Glass
American women are more likely to die from complications in pregnancy and childbirth compared to women in any other developed country.
It’s true.
But why?
***
At 1:27 p.m. on February 2, 2017, I gave birth to an 8 lb. 10 oz. boy.
Because there was meconium in my amniotic fluid, a NICU team was paged to be present at the birth to make sure that the baby’s lungs were clear.
Those first minutes after birth were very blurry. There was just too much going on to fully appreciate everything that was happening. From my perspective as the birthing mother, I remember my son turning his head upward and looking me in the eyes (that really happened). I remember seeing that he was a boy. (A boy!?! Really!?! What?!?!)
I remember dropping my head back against the bed and crying in relief that it was over. I remember thinking, “Well, that’s the last time I’m doing that.”
I was euphoric and so, so grateful. We had made it. We had survived that. Both of us. That was what I was thinking.
I did not know that I was hemorrhaging.
This is the thing about hemorrhaging: It happens so fast.
It happens while mothers are crying from happiness that their baby is alive and breathing. It happens while they’re trying to get a good look at their baby’s face. It happens silently as the room’s atmosphere turns from the intensity and suspense of the pushing phase into joy and excitement of the delivery phase.
No woman wants to believe that it’s going to happen to her. I had none of the risk factors associated with postpartum hemorrhage.
But it still happened to me.
While we were celebrating and crying and basking in the joy of the birth, my midwife was tracking my blood loss. I remember looking down and seeing her furrowed brow every time more blood poured out of me. But I didn’t think anything terrible was happening. I was flooded with joy and gratitude that labor was over.
But in the first ten minutes after birth, more and more nurses entered the room and the treatments started. My midwife told me each treatment that she was doing to stop the bleeding. By this time, I had lost about 1200 mL of blood, about 2.5 pints of blood. In other words, I had lost about 25% of the blood in my entire pregnant body.
Surviving postpartum hemorrhage requires a medical professional who quickly realizes what is happening and starts treatment immediately.
In my case, the midwife tried a shot of Pitocin. When that didn’t work, she gave me Cytotec. When that didn’t work, she gave me IV Pitocin. She kept massaging my uterus. She was on her last treatment before starting a blood transfusion: a shot of methergine.
That’s how close we were to a true emergency.

My heart rate during labor. You can see exactly when the hemorrhage begins and how my body responded.
Hemorrhage is one of the leading causes of death in childbirth.
Still.
Let me be clear: postpartum hemorrhage isn’t caused by a lack of care. This would probably have happened to me if I had given birth anywhere else.
But women die from hemorrhage when doctors and nurses don’t quickly recognize the amount of blood loss and begin treatment. Some states, like California, have codified and implemented standardized procedures and training for nurses and doctors so that teams can quickly and efficiently follow protocol to prevent postpartum hemorrhages from killing mothers. Instead of “eye-balling” how much blood a mother loses during delivery, nurses were taught how to collect and measure postpartum blood loss to help them quickly identify hemorrhage.
“Hospitals that adopted the toolkit saw a 21 percent decrease in near deaths from maternal bleeding in the first year; hospitals that didn’t use the protocol had a 1.2 percent reduction.”
But not all states have such standardized protocol.
***
A joint investigation by NPR and ProPublica found that more women are dying of complications related to pregnancy and childbirth compared to any other developed country.
In every 100,000 births in the United States, 26 women die. In other developed countries, the numbers range between 5 and 9 births. And those numbers have climbed from 17 to 26 deaths from 2000-2015.
Seriously.
Seriously.
It seems unimaginable. Really? In the United States? But we have so much technology. We have some of the best hospitals in the world.
What the hell is going on?!?
There were several major findings from this investigation.
- The U.S. is spending more money on research, equipment, and training for improving infant outcomes. Think of how much progress we have made in helping premature babies and treating newborns born with previously fatal deformities and diseases.
- Decreased education and training about caring for birthing mothers, for both doctors and nurses. This leads to a lack of knowledge that is passed on to the mother when she is discharged from the hospital.
- Lack of standardized best practices for caring for birthing mothers among the states. Unlike other developed countries, there is no nationwide effort for reducing the maternal death rate in the United States. Responsibility has been left to individual states to decide if and how they investigate maternal deaths.
America has not conquered maternal mortality. We like to think that because we have advanced technology and highly trained medical professionals that tragedies like a woman dying in childbirth just simply don’t happen anymore.
At least not nearly as much as it used to.
It’s a kind of hubris, really. To think that we have mastered childbirth. We have tamed it and told it who’s boss. In fact, we’re so good at childbirth that we should just focus most of our attention on the infants. They’re the ones that are the most vulnerable, right?
But the truth is…
“In recent decades, under the assumption that it had conquered maternal mortality, the American medical system has focused more on fetal and infant safety and survival than on the mother’s health and well-being.”
~Nina Martin & Renee Montagne, “The Last Person You’d Expect to Die in Childbirth”
***
If there was one major takeaway from this report that I want to share with everyone it’s this:
Women still die in childbirth.
Giving birth in the United States does not guarantee that both mother and baby make it out alive.
I completely agree with the report’s observations that labor and birth put women in the most vulnerable position in their entire lives. They don’t know what’s going on. They’re immersed in the pain and process of labor. Birthing women depend on everyone around them, doctors and nurses alike, to notice the signs that an emergency is unfolding.
If you or someone you know will be giving birth in the United States in the near future, I strongly encourage you to read ProPublica’s full investigative report on this topic.
This is not a political issue. ProPublica is an independent organization that is not funded by political donations.
This is a human issue.
American women are not immune to maternal mortality.
For the women who die every year from pregnancy and childbirth from preventable or treatable conditions, let’s raise our awareness of this problem and insist that we study this at the national level, not just the state level.
We can do better than this.
The death of a new mother is not like any other sudden death. It blasts a hole in the universe.
~Nina Martin and Renee Montagne, “The Last Person You’d Expect to Die in Childbirth“
Without turning this into a political issue, I think another heavy factor is the quality of care that is expected when it comes to women’s health (or perhaps healthcare in general).
An acquaintance of mine passed away shortly after childbirth because she suffered a stroke that wasn’t caught in time. Her husband was devastated and so angry because she told her doctors and nurses that her head hurt and she felt funny and they shrugged it off as a side effect of the epidural. I was shocked that they weren’t able to catch it despite her being in a hospital, surrounded by health care providers, complaining about all the symptoms.
The hospitals are often understaffed and overburdened making thorough care the exception. Burnout is becoming more and more common within the profession. There are too many politics and games being played with insurance companies and coverage.
We need healthcare reform. (Not insurance reform like what’s been debated for the past 10 years now) Something needs to change about the way we are treating our mothers.
On another note, I’m glad that you survived no worse for wear. Sounds like you had an excellent midwife that handled the situation well.
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Wow, that is truly horrible, and it sounds eerily similar to Lauren’s story (https://www.propublica.org/article/die-in-childbirth-maternal-death-rate-health-care-system). I think it further supports what the writers were trying to point out in the investigative report. In other developed countries, like the UK, maternal mortality is seen as a “system failure.” At some point in the woman’s care, the system failed her, usually over and over again. Other developed countries study these cases and implement a *nationwide* effort to prevent systems from failing to catch the warning signs.
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Lauren’s story was a complete fail on the healthcare system if they knew going in that she was already have BP issues and didn’t monitor it closely. It’s so heartbreaking to think that so many new fathers and babies lose their mothers to “system failure”.
What might be borderline bad for one patient could be life threatening to another depending on the individual’s history. Maternal mortality needs to be addressed and taken in a new direction.
I guess I was incredibly lucky. I had a terrible pregnancy that had me in and out of the hospital for months. So when my BP started to rise and I started gaining weight at the end (39 weeks), my doctor insisted on inducing right away to avoid Pre-E all together.
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Good call on your doctor’s part! Preeclampsia is nothing to mess around with.
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Wow. That is so scary! I’m so sorry you went through that but I am so glad you made it out okay. I’ve always felt so blessed to live in Australia where we have excellent, free healthcare… but it’s scary to know that women still and often die in childbirth in developed countries.
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Al-hamdulilah they were able to help you. In our small village of approx 2,000 people I am aware of two women who have died this year in childbirth, one from a clot the other from loss of blood due to a botched cesarean. Both young women in their early 20’s. : (. I saw this article not long ago on the BBC about tranexamic acid that is a cheap easy to manufacture med which could reduce maternal deaths from bleeding by a third, Insha’Allah. Insha’Allah this medicine will help the developed and undeveloped world improve outcomes for women. http://www.bbc.com/news/health-39717694
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Maternal mortality is doubly horrific because it takes away someone’s mother. I feel for the families of these young women.
On a sidenote, happy Ramadan!
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Yes, I agree. Loss of any life is sad, hard, terrible but when there is this new little life, and the time should have been one of joy and wonder, the loss stings all the more somehow. I feel for them too, and partly why I decided because my third birth was such a blessing, that I didn’t want to do it again, Insha’Allah. Al-hamdulilah I feel very grateful for what I have (my three healthy children) and the fact my births were only difficult and not life threatening.
Ramadan Mubarak to you too sister.
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