In medicine, we routinely ask people about their family health history. Knowing that your mother had diabetes, or that your grandfather battled alcoholism, helps us be alert for health conditions to which you may be predisposed. Sometimes, though, what is revealed by those histories isn’t a medical problem, but a family tragedy.
Earlier in my career, my older patients commonly told me that their grandmother, or even their mother, died in childbirth. Today, it is all too easy to forget just how perilous it can be to be pregnant. In the early 1900s, nearly one mother died for every 100 live births. Even today, approximately 800 women around the world die from pregnancy related causes every day, and a woman’s lifetime risk of dying as a result of pregnancy hovers around one in 200. In some countries, that risk is around one in 20. In others, it is less than one in 10,000. Infants, and their older siblings, face a grim future without those mothers. Many infants don’t survive to their first birthdays. Older siblings have an increased risk of death before age five.
Although most maternal deaths occur in the developing world, where access to trained birth attendants or clean birthing conditions is limited, the United States ranks disturbingly high among developed nations. In fact, our rates were higher in 2017 than in 2000. A woman’s risk of death varies with her age, education, socioeconomic status, and most dramatically, race. Black women face a risk of pregnancy related death more than triple that of white women, and indigenous women face approximately twice the risk. Wealth, health, and education are not enough to close these gaps. Serena Williams and Beyonce have both spoken publicly about their own life-threatening pregnancy complications. More research is needed to understand and address these disparities, and maternal mortality rates in general.
Sometimes death is caused directly by a pregnancy: bleeding, eclampsia, embolisms of amniotic fluid into the mother’s lungs, infections. Sometimes death results from the added stress of pregnancy combined with another disease. Weakened hearts, for example, may not meet the additional demands of pregnancy and delivery. Historically, influenza has killed disproportionate numbers of pregnant women. My own great grandmother was one of them. Similarly, a pregnant woman who contracts Covid is 20 times more likely to die than one who doesn’t. Women who struggle with depression or substance abuse may fall victim to overdoses or suicides triggered by the stress of pregnancy and caring for a newborn. Domestic violence may start or escalate during pregnancy, and too many women die at the hands of current or former partners.
The good news is that nearly two thirds of maternal deaths are thought to be preventable. We simply need the societal will to make changes and save lives.
Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc®. For free and easy access to the entire Prairie Doc® ® library, visit www.prairiedoc.organd follow Prairie Doc® on Facebook. Debra Johnson, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota.
