In recent years, more American women are dying in childbirth; doctors in California are working to reverse that trend. A woman giving birth in the US is three times more likely to die than a woman giving birth in Canada and six times more likely to die than a woman giving birth in any of the Scandinavian countries.
It wasn’t always that way. Back in 1950, the “Journal of the American Medical Association” (JAMA) happily reported that maternal deaths in childbirth in the US had dropped to one in 1,000. The rate of maternal deaths continued to decline for a couple of more decades, until the development of technologies like ultrasound that made it possible for doctors to effectively care for the developing baby. The doctors’ focus then shifted from treating the mother to treating the baby. As infant mortality declined to historic lows, maternal deaths gradually began to rise.
Doctors in California discovered a horrifying statistic in 2006; the number of women in their state dying from childbirth had doubled in recent years. Debra Bingham, a nurse specializing in public health, and Elliott Main, an obstetrician, and some of their colleagues formed the California Maternal Quality Care Collaborative to improve women’s chances of surviving childbirth. They began by studying records of maternal deaths going back five years to determine what had gone wrong.
The Collaborative found that the two most common and potentially fatal complications were hemorrhage and preeclampsia. The latter is a condition in pregnant women, and high blood pressure is the main symptom. The Collaborative also determined that early diagnosis, an established treatment protocol, and teamwork would save many women’s lives.
Rather than assume a pregnant woman would be fine, California doctors decided to prepare for the most common worst-case scenarios. They now receive training in how to treat such complications as preeclampsia and hemorrhage. During delivery, doctors keep a cart similar to crash carts used for cardiac patients. The obstetrician’s cart, however, contains the various implements a doctor might need to treat a hemorrhage. In many hospitals, for example, doctors and nurses still guess how much blood a patient has lost simply by sight. California doctors soak up the blood with pads and sponges and then weigh them to determine the amount of blood actually lost.
In 2017, the “American Journal of Obstetrics and Gynecology” reported a study describing the effectiveness of the new procedures. Over a two-year period, the researchers followed 99 hospitals that followed the new procedures and 45 hospitals that did not. They found that the new procedures reduced the chances of a hemorrhaging patient developing “severe maternal morbidity” like heart failure, shock, or acute renal failure by nearly 21 percent. Hospitals that did not follow the Hospitals that did not follow the new protocol showed improvements of only one percent.
