HJNO Sep/Oct 2024

MATERNAL MORTALITY CRISIS 10 SEP / OCT 2024 I  HEALTHCARE JOURNAL OF NEW ORLEANS   WHO, UNICEF, UNFPA, World Bank Group and the UNDESA/Population Division.” Feb. 23, 2023. https://www.who.int/publications/i/ item/9789240068759 4 Petersen, E.E.; Davis, N.L.; Goodman, D.; et al. “Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report 68, No. 35 (Sept. 6, 2019): 762–765. https://www.cdc.gov/mmwr/ volumes/68/wr/mm6835a3.htm 5 Shields, K. “Doctors for America Condemns Louisiana’s Reproductive Drug Reclassification.” Doctors for America, press release, May 28, 2024. https://doctorsforamerica.org/la-repro-drug- reclassification/ 6 Hoyert, D.L. “Maternal Mortality Rates in the Unit- ed States, 2020.” National Center for Health Sta- tistics, Centers for Disease Control and Preven- tion. Health E-Stats, February 2022. https://www. cdc.gov/nchs/data/hestat/maternal-mortality/ 2020/maternal-mortality-rates-2020.htm 7 Ligten, C.V. “Louisiana child well-being rat- ed second-worst in US, report says.” 4WWL, Aug. 20, 2022. https://www.wwltv.com/article/ news/local/louisiana-child-well-being-rated- second-worst-us-report-says/289-583f6b8f- ee8c-420e-a545-f0ae35272eaf 8 Kaiser Family Foundation. “The Louisiana Health Care Landscape.” Fact sheet, June 8, 2016. https://www.kff.org/affordable-care-act/ fact-sheet/the-louisiana-health-care-landscape/ 9 Hoyert, D.L. “Maternal Mortality Rates in the United States, 2021.” National Center for Health Statistics, Centers for Disease Control and Pre- vention. Health E-Stats, March 2023. https://www. cdc.gov/nchs/data/hestat/maternal-mortality/ 2021/maternal-mortality-rates-2021.pdf 10 Sung, S.; Mahdy, H. “Cesarean Section.” Stat- Pearls, last updated July 9, 2023. https://www. ncbi.nlm.nih.gov/books/NBK546707/ 11 World Health Organization. “WHO State- ment on Caesarean Section.” Human Repro- duction Programme, World Health Organi- zation, 2015. https://iris.who.int/bitstream/ handle/10665/161442/WHO_RHR_15.02_eng.pdf 12 Declercq, E.; Zephyrin, L.C. “Maternal Mortality in the United States: A Primer.” Issue brief and report, Dec. 16, 2020. https://doi.org/10.26099/ ta1q-mw24 13 Kindelan, K.; Cobern, J.; Afrahimi, S.B. “US Olym- pian dies from pregnancy complications that disproportionately impacts Black women.” ABC News, June 13, 2023. https://abcnews.go.com/ GMA/Wellness/us-olympian-dies-pregnancy- complication-disproportionately-impacts-black/ story?id=100045363 14 Gardner, S. “Serena Williams describes near- death experience she had after giving birth to daughter Olympia.” USA Today, April 7, 2022. https://www.usatoday.com/story/sports/ten- nis/2022/04/07/serena-williams-near-death- childbirth-complications/9504616002/ 15 Eiselt, P.; Lee, T.L. Aftershock. 2022. https:// www.aftershockdocumentary.com/home#about have included institutional racism and structural bias have left women of color (and particularly Black and Brown women) at a significantly higher risk than their White counterparts. In years past, commentary was aimed at socioeconomic factors playing the largest role in maternal mortality. The truth of the matter is that despite socioeconomic status, women of color remain at a higher risk. Consider that a Black college- educated woman has a 60% greater risk of dying as a result of pregnancy or birth than does a White or Hispanic woman with less than a high school education. 13 Recently, the three-time Olympianmed- alist track runner Tori Bowie died from ec- lampsia, a complication of pregnancy. She was just 32 years old and approximately a month shy of her due date when she went into labor at home and died in the early stages. 14 By media accounts, people who know Bowie reported that she held a deep distrust of hospitals and was fearful to give birth there. Since her death, her teammates, also women of color, who ran the second- fastest 4x100-meter relay in history have come forward to publicly declare that 3 of the 4 team members of their 2016 Olym- pic relay team have either died (in Bowie’s case) or nearly died (in the case of Tianna Madison and Allyson Felix) in pregnancy or during birth. Women who undoubt- edly were in excellent physical shape and health all developed pre-eclampsia or eclampsia, a disorder of pregnancy that manifests with elevated blood pressure, visual disturbances, headache, and epigas- tric discomfort. I ask again, in a country with purportedly one of the best health systems in the world, how is this possible? Consider also Serena Williams, the ten- nis phenom, who had a prior health histo- ry of pulmonary embolism, a condition for which pregnant and postpartum women are particularly at risk. The day after giv- ing birth to her first child, she experienced the symptoms of a pulmonary embolism — with which she was more than familiar having experienced it prior — which has a mortality rate of up to 30%. When she re- ported her symptoms to the medical team caring for her as an inpatient, not only was she not taken seriously, but she was also patronizingly encouraged to take her pain medication and rest. Williams insisted on imaging being performed and being given blood-thinning medication. Likely only because of her celebrity status was she thankfully able to obtain the care that she needed and deserved — and she was cor- rect in the diagnosis. Had she been placat- ed with the response to simply take pain medication and rest, she very likely may not be here today to raise her daughter. 14 The outcome is sadly not the same for so many women of color who experience symptoms of pregnancy complications. All too often, women experiencing a com- plication of pregnancy are not heard and their concerns brushed aside. I highly recommend the recent Hulu documen- tary and Sundance Film Festival winner, Aftershock, which shines a spotlight on this very issue, following two women of color within two different well-known and respected health systems in the state of New York whose families’ lives are forever altered as a result of the care that they re- ceived during and after their pregnancies. 15 There is much work to do in this space. Next up in the series, the potential for nurse-midwives to change the landscape of maternal and child care in Louisiana. n REFERENCES 1 Hoyert, D.L. “Maternal Mortality Rates in the United States, 2022.” National Center for Health Statistics, Centers for Disease Control and Pre- vention. Health E-Stats, May 2024. https://www. cdc.gov/nchs/data/hestat/maternal-mortality/ 2022/maternal-mortality-rates-2022.pdf 2 One Health Trust. “Worldwide Maternal Mortality Rates.” Feb. 3, 2020. https://onehealthtrust.org/ publications/infographics/worldwide-maternal- mortality-rates/ 3 World Health Organization. “Trends in ma- ternal mortality 2000 to 2020: estimates by