America blaming pregnant women for their own deaths? Only in overheated imaginations, not reality.

wooden cube with word " FACT & FAKE " concept

In 2018 there is reality and what certain segments of society prefer to believe.

Reality is that immigrants enrich our country, take jobs that no one else wants, and are no more likely to come to our border than they ever were. In the overheated imaginations of our president’s followers, immigrants steal from our country, take all the desirable jobs, and have begun coming to our border in massive numbers.

Brooks’ New York Times piece is inaccurate, disorganized and based on personal beliefs not supported by facts.

Why the discrepancy? Because cognitive dissonance won’t allow blue collar white workers to blame the real authors of their misery: the Republicans who promote the interests of the rich over the needs of the working poor.

In 2018 there is the reality of maternal mortality and what certain segments of society prefer to believe. This includes Kim Brooks, the author of America Is Blaming Pregnant Women for Their Own Deaths, an opinion piece in the NYTimes.

Reality is that maternal mortality is disproportionately a problem of black women, that the leading causes of death are heart disease and pre-existing chronic medical considitions, and that women are dying from LACK of high tech interventions not too many interventions. In the overheated imagination of Kim Brooks, an individual with no professional education or training in obstetric issues, the problem is that doctors are mean to women.

Brooks’ piece is inaccurate, disorganized and based on personal beliefs that are not supported by the facts.

This appears to be the key sentence:

For experts studying the United States’ maternal mortality and injury rates — which are estimated to far surpass those in other developed countries — and for women in labor, the failure to treat mothers as people is neither antiquated nor dystopian, but absolutely pressing.

That’s is sheer, unadulterated bullshit, the intellectual equivalent of claiming that immigrants are ruining our country. Reality is very different.

Reality #1: Women of African descent die at much higher rates than women of other ethnicities.
Reality #2: Maternal mortality rates are a function of “whiteness” of the country.
Reality #3: The leading causes of maternal death are cardiac disease and pre-existing medical conditions
Reality #4: Women are dying in the days, weeks and months before and after childbirth, NOT in labor.
Reality #5: Women are dying because of lack of access to high tech interventions.
Reality #6: Maternal mortality is a social problem as much as it is a medical problem.

I could write reams about these issues but a few graphs and charts make reality quite clear.

1. This graph shows the stark difference between maternal mortality rates for black women and all other women:

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2. This disaparity is true for all industrialized countries and in some it is even larger. As a result, the “whitest” countries have the lowest maternal mortality rates and international comparisons that don’t account for ethnic composition within nations are meaningless.

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3. Why do women die in pregnancy, childbirth and the year afterward?

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The most important message in this graph is that fully 41% of US maternal deaths are caused by cardiovascular (including cardiomyopathy) and non cardiovascular diseases. And that reflects the fact that pregnant women are now older, more obese and suffering from more chronic diseases than ever before.

4. In her piece Brooks refers repeatedly to dying in childbirth, but as Neel Shah, MD notes, more than 80% of maternal deaths don’t occur on the day of delivery and more than 60% aren’t even within a week of delivery.

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5. Brooks, like most people imagines that maternal mortality is a problem of too many interventions and unnecessary interventions (“too much, too soon”) when in reality it is a problem of LACK of interventions (“too little, too late”).

Brooks approvingly quotes an executive of the California Health Care Foundation:

“Women know what they want when it comes to labor and delivery, and it turns out the things they want (midwives, doulas, fewer unnecessary interventions and cesarean sections) are less expensive and produce better outcomes.” The problem is not that pregnant women are uneducated or uninformed; the problem is that those in charge aren’t listening to them.

There is precisely ZERO evidence that midwives, doulas, fewer interventions and fewer C-sections could reduce maternal mortality. Indeed, just this month the New England Journal of Medicine published What We Can Do about Maternal Mortality — And How to Do It Quickly recommends four strategies to reduce maternal deaths:

  • Best practice bundles for common obstetrical emergencies
  • Enhanced preparedness for complications
  • Drilling for emergencies
  • Timely transfer to high resource hospitals

6. Pointing out that maternal mortality is in large part a social, not a medical problem is not blaming pregnant women for their own deaths anymore than pointing out that drug abuse is primarily a social problem not a medical one.

The leading causes of maternal death are cardiac disease and pre-existing medical conditions; that’s because maternal age is increasing, obesity is increasing and therefore the prevalence of chronic medical conditions is increasing. No one is to blame for that and refusing to acknowledge it is a lazy attempt to protect women’s feelings at the expense of their lives.

The bottom line is that America is NOT blaming women for their own deaths. Claiming that midwives, doulas and fewer interventions will prevent maternal mortality is like claiming that a border wall will protect blue collar workers from economic harm. Some people may prefer to believe it, but it’s not reality.

  • Amazed

    Hey, you know who I just think I spotted on a facebook page I saw at Dr Amy’s own Facebook? No other than Ruth Fowler. I think she featured heavily in some old posts of Dr Amy’s, defending her near death in homebirth as a sane choice. Let’s say that her tune is quite different now.

    How people change.

  • Amazed

    A look at Dr Amy’s Facebook page brought me to this.

    http://gatehousenews.com/failuretodeliver/?fbclid=IwAR3y5IXtt9ERSpfpSpn9gXktsOj3iwCXRz6BO10Mud8xkkz0lCAB29qedDw

    Oh my freaking God.

    I’m speechless.

    I was particularly impressed with midwives’ readiness to call EMS and then have them wait. All other emergencies on hold because midwives want to handle it themselves but also want the security blanket of actual medical professionals present (and the opportunity to drop the ball into said professionals’ laps when they fail).

    OT: A woman I know was all about natural. She was about to have a natural delivery. A naturally brought up child without unnatural pacies and the like and whatnot. She managed the paci. The rest was an emergency C-section and a determination to get a VBAC next time.

    Last week, her baby arrived. Guess what? Another C-section. Twelve hours with her water broken and nothing else going on brought the doctor to her side with a, “It’s getting dangerous. It’s a C-section now.” Her reply? “Oh well, I really wanted this VBAC…” and the rest is history. She wanted a VBAC but not at the cost of endangering her baby,

    Funny thing? This baby does have a paci… and now, her toddler has one too.

    • guest

      Yeah, I was all prepared to do the natural childbirth, exclusive-breastfeeding, baby-wearing, rooming-in thing.

      But then I had an emergency C-section, and gave birth to a fiercely independent daughter who hated baby slings, only wanted to sleep in her own crib and room, and who (in spite of my best efforts) weaned herself off of breastmilk at 6 months.

      Kids have their own plans.

    • RudyTooty

      That series from Gatehouse news is FANTASTIC journalism.

      I anticipate that Dr Tuteur will have something to say about it. I hope she does.

  • fiftyfifty1

    OT: https://www.npr.org/sections/health-shots/2018/11/24/662451106/twins-difficult-birth-put-a-project-designed-to-reduce-c-sections-to

    Another NPR anti-CS story, focusing on Dr. Neel Shah’s project to reduce the CS rate. Boy does this story make me NEVER want to be included in one of his projects. A VBAC of twins where twin B is transverse and needs rotation and breech extraction…but instead the shoulder and arm fall out and need to be replaced. And the mother is quoted as saying it is “better for the babies.” Such horrible science/health reporting I don’t even know where to begin.

    • Amy Tuteur, MD
    • Who?

      So now Atul Gawande is into this nonsense as well? Gaah!!

      And can someone tell me how having a doctor reach into your uterus to turn a baby around is less invasive than a nice tidy cs? She had an epidural, so she didn’t feel it while it was happening, but she would have been mighty sore after, surely?

      • fiftyfifty1

        Gaah!! I didn’t even notice the part where they included Atul Gawande! Bummer.

    • PeggySue

      TRANSVERSE? Why did ANYONE think this was a good idea? I guess they lucked out, but… maybe I am crazy, but it seems as if this could have gone terribly, terribly wrong.

      • fiftyfifty1

        Yeah, and not just transverse, but also twins, and also VBAC, and also failing placenta. But a vaginal birth is safer for the babies (sarcasm).

      • RudyTooty

        It could have all gone terribly, terribly wrong. You are correct.

    • RudyTooty

      Thank you for sharing this.

      SMH.

      Pfft – too many memories dredged up by listening to this one.

      Yeah – but I also think it’s a pretty good story – because it demonstrates the uncertainty and tension of that situation (maybe just for me) because I’ve been in THAT ROOM more than once.

      I’m glad they mentioned that an epidural was not optional in her circumstance.

      I know the parents felt like the physicians and staff were cool and collected…. I could feel the mental energy in the room – they were mentaly at the starting blocks ready to splash and go in a split second if they needed to.

      And THAT is not a pretty c-section, friends. It’s just not. Necessary. Gets the job done. But it’s tense and not pretty.

  • Petticoat Philosopher

    America certainly blames individuals in general for the conditions highlighted here, like obesity and heart disease. And the fact that these conditions are epidemic in our country is in large part due to social factors. We could address those social factors but we’re not going to with these assholes in power, who are perfectly happy to have so many Americans be chronically poor and unhealthy as long as they can enrich themselves. So yeah, there very much are people to blame for this, if indirectly. It’s just that the people aren’t necessarily doctors.

    That being said, medical professionals sometimes do shame patients for their health conditions and their consequences and otherwise treat them shabbily, especially poor women and women of color. Your important point that this problem disproportionately afflicts Black women is really of a piece with that problem. A lot of Black women have had pretty horrible experiences with the medical system. I know several who have some pretty horrifying stories specifically about their experiences being pregnant and giving birth. Racism is everywhere, why not in hospitals? Of course, the answer is “less racism” not “less medicine” but we should not dismiss the experiences of so many women who have felt dehumanized in medical settings. That is a good point stuck in an op-ed which unfortunately undermines it with a lot of other problems.

    • Madtowngirl

      Yes. So much this. Since getting my gestational diabetes diagnosis, I have been utterly shocked at my own response to my diagnosis, and the respires of other people. I blamed myself for a while – “if only I hadn’t eaten that cookie!” I made the mistake of being open about my diagnosis to a few people, and they were utterly insistent that it was caused by diet soda. No, no, not the placenta.

      I’ve also seen the ugly way people who develop Type 2 are treated, and it disgusts me. People love to believe that you get what you deserve, but the reality is that a lot of these health issues are the result of genetics and bad luck. And social issues, as you mentioned.

      • KeeperOfTheBooks

        Ayup. SIL weighed perhaps 125 dripping wet at 7 months pregnant and was still running several miles several times/week. The girl practically lived on grilled chicken, brown rice, and veggies. Nonetheless, she got herself a nice GD diagnosis.

    • B.E. Miller

      Re; your comments about black women being pregnant and giving birth,
      It reminds me of Serena Williams experience with her recent pregnancy and birth of her daughter Olympia.

  • guest

    NPR has been really bad about tacking on an irrelevant screed about c-sections and hospital births being evil on the end of every women’s health-related news piece. Often it has no relevance to the story at all, and no evidence to back up their claims. It is really sad to see this kind of anti-science (and anti-woman) bias in mainstream journalism.

  • guest

    Yeah, so, as a person of color who also has the lousy luck to be high risk, I really want more access to traditional obstetric care. More prenatal checkups. More access to doctors. More intervention, damnit.

    I don’t check myself into the hospital at 40 weeks expecting a hands-off approach. I want to walk out alive and with a healthy baby. But no, every clinic in the area is all about the “natural approach”. Every appointment, I have to sit through a talk about how women’s bodies are built for having babies without intervention. Well, not mine, apparently.

    I do my part – follow doctors orders, eat right, exercise, meditate, and do everything I can to stay healthy and keep my babies healthy, too.

    I am really tired of being called a selfish, lazy c-word because I would rather have an elective c-section than wait out the last week of a difficult and medical complicated pregnancy and labor and put both our lives at risk.

    Trust me, I don’t want major abdominal surgery, either, but it is preferable to the alternatives. How can our lives have so little value that a vaginal birth experience takes priority over safety?

    • MaineJen

      Also, I’m sick of the argument that those of us who DON’T want to go all-natural just aren’t ‘educated’ or ‘informed’ enough. It’s so condescending.

      • space_upstairs

        Elitism. The tendency of members of a high-status subculture to assume that those who do not follow the subculture’s norms are at best misguided and at worst malevolent. It incorporates classism and sometimes even racism but is not limited to such things. It manifests in a variety of areas but seems especially prominent in matters of politics and health.

    • PeggySue

      Guest, I so hope that everything goes well for you and your baby. Pulling like crazy for you both! Let us know how things go.

  • attitude devant

    I’m glad you responded to this opinion piece. If every an article was crying out for an editor, this one was. She went on and on about rising maternal mortality rates and noted that California had reversed the trend but never bothered to mention what worked in California was aggressively managing maternal illness, not doula and midwifery care. I’ve got no problem with doulas or CNMs but Dr. Shah is right: maternal death does not typically occur in labor. And I never thought I’d be agreeing with Neel Shah but here I am! Funny world.

    It was doubly odd because this came up on my browser while I was literally in the middle of a course on critical care obstetrics. I’m not a critical care specialist at all—I’m a general Ob/Gyn—but lately my patients are so alarmingly sick that I felt the need for the brush-up. I wish you all could have been there during our simulation debrief when I discussed this piece. The looks of utter disbelief on all the doctors’ and nurses’ faces was something to see.

    To say that mothers are more likely to die because of medical illness is not to blame them. It’s to analyze what their risk factors are. Why are African-American women more likely to have hypertension? Why are Latinas more likely to have diabetes? We can argue all day over the causes, from weathering to diet to genetic predisposition, but the truth is that women with pre-existing medical problems (and women with undiagnosed medical problems) are more likely to suffer severe complications in pregnancy. We need to be clearheaded about this. We need to see pathology when it’s right in front of us and manage it aggressively. I’ve said this before: I nearly had a mother die right in front of me earlier this year, and she had been planning a home VBA2C. She insisted she was healthy because she felt fine right up until the moment she couldn’t breathe. She was not healthy before or after her pregnancy. I have no doubt her delivery is a traumatic memory for her. Frankly it is for me too.

    So, Ms. Brooks advocates we listen to our patients preferences for delivery. I do listen, and then I tell them what they really need. If they don’t want to hear what I have to say, I’ve at least discharged my duty. It’s unfortunate that our fantasies of lovely uncomplicated pregnancy is becoming less and less common, but hiding from reality is not going to save mothers.

    My office staff just asked me if I would do ‘shadow care’ for a woman who is planning a home birth. She has a midwife but wants to see me ‘just in case.’ I could have cried when I pulled up her old records: she had a post-partum hemorrhage requiring a Bakri balloon with her last delivery (for those who don’t know this is an intervention used only in the worst cases of unmanageable post-partum bleeding). She wants a lovely peaceful home birth without all those interventions she had last time. I sincerely wish her luck with that but there’s nothing about her pregnancy that makes her low-risk this time, no matter how ‘healthy’ she considers herself.

    Sorry for the rant, but Ms. Brooks made me want to scream.

    • The Bofa on the Sofa

      To say that mothers are more likely to die because of medical illness is not to blame them. It’s to analyze what their risk factors are.

      I wonder if this doesn’t come from the apparent belief that we can control everything? That there has to be a specific, identifiable and deliberate reason for everything?

      Obesity is what it is, and with obesity comes complications. It doesn’t matter if that obesity is the result of poor choices or genetics or whatever, obesity still requires management. It’s not about blaming anyone, it’s about providing care.

      • attitude devant

        Exactly. It’s all chaos theory. You can’t tell who’s going to die; you can only look at the various complications that result in death, assess who has those complications, and be ready to manage the underlying problems. I’ve come close to losing a couple of moms and it scared the crap out of me each time. In each case, the mom had an underlying medical problem, and sometimes she vigorously denied that she had any medical problems at all. Pregnancy is a marathon extreme stress lasting 10 months, and if you’re not in really great shape, watch out! I don’t care how healthy you eat and how great your affirmation tape is, hypertension, obesity, diabetes, and (yes) being over 30, put you at extra risk.

        (And before anyone yells at me, both my kids were born after 30—-and I nearly died)

        • Mel

          Do the patients know they have an underlying medical problem? When I was in maternity triage with Spawn after the CNM got my sky-high blood pressure tamped down, I got a well-meant lecture about how common untreated high blood pressure is among women.

          I listened politely – and explained that I had med-check appointments including BP every 3 months from my PCP prior to pregnancy plus 2-3 urgent care or same-day doctors appointments where my BP was checked per year. I’d never had blood pressure reading of over 115/70 except for one early second trimester appointment where I was at 144/80 while recovering from an asthma attack due to a diesel truck in a covered parking ramp. I came back in for a recheck the next day and was back to 110/70.

          But I can see how most women could have high blood pressure and be totally unaware of it….

          • attitude devant

            Sometimes they don’t know. Sometimes they insist that the diagnosis is incorrect. Hypertension is particularly hard because they have no symptoms. Heck I had no symptoms when my BP was 170/110 either.

      • Petticoat Philosopher

        There are better and worse ways to do that and a lot of obese people report being treated pretty terribly by medical professionals. Our society has a very judgmental attitude about weight and medical professionals are only human after all and they internalize their society’s values as much as anyone else. One would hope that they’d be able to rise above some of the nastier values when dealing with patients and, of course, many of them do. But many also don’t. It’s not at all hard for me to believe that obese pregnant and birthing women are sometimes treated in a shaming, degrading way. And, as I said elsewhere, the problem isn’t ultimately about too much medicine, it’s about too much socially inculcated asshole behavior. But it’s an important thing to talk about, even if this op-ed didn’t do it very well.

        • RudyTooty

          “…too much socially inculcated asshole behavior…”

          [applause]

      • I have been criticized on other forums for “racism” by writing that there are racial differences in maternal morbidity and mortality. Viva PC! Everyone has the same DNA, I’ve been told.

    • space_upstairs

      Holy cow, that story of that patient of yours. Sounds like a believer in “The Secret” almost…if she doesn’t think bad things will happen, they won’t. The tyranny of optimism. That’s what I like about places like this: a refreshing break from that cultural mandate toward optimism that personally never suited me.

      I take the complete opposite approach with my pregnancy, of course: after a modest 7-hour bleed last week whose cause was undetermined and which didn’t seem to affect my fetus, I readily went to the hospital and submitted to what I’ve since read are basically the treatment protocols for a mild placental abruption even though that was ruled out by the ultrasound as the cause of the bleeding. As much as I’d like to get off restricted activity before the doctor gives me the OK, and didn’t like those cortisol injections to prepare for a possible premature birth, I’m not throwing the dice with my future kid even though my pregnancy went remarkably smooth until last week and no new problems have arisen so far.

      • attitude devant

        Good for you. Please be aware that ultrasound will not pick up most abruptions, so you are right to be careful. Please keep us updated. Third-trimester bleeds are to handled very cautiously.

        • space_upstairs

          Good to know that it could have been a very mild abruption, although my doctor said it was probably from some source closer to the cervix after seeing the hospital data. (I do not have placenta previa.) Even then, he warned me that any bleeding in the later stages of pregnancy can potentially provoke premature labor, so it’s better to minimize the risk of repeating the incident until they can tell me with confidence that said risk is extremely low. Next week I will get a new ultrasound and a follow up with my doctor, but so far, so good: no more bleeds, normal fetal movements, weight and blood pressure stable, no labor-type pains.

          • PeggySue

            We’ll all keep pulling for you!

          • space_upstairs

            Awww…thanks. Being a nerd and a pessimist and a lurker here for quite a while before conceiving, I knew I was not signing up for scented candles and pools and producing new life like an earth goddess when I decided to try for a kid at age 38. 2 weeks of activity restriction bites, but having a baby on machines already or a bereaved husband would have bitten far harder.

    • guest

      May I ask a question? I hope this is not rude.

      How do you feel about pregnant patients who are sick, who have a complicated medical history?

      I am one such. I try to take care of my health, but have struggled with many illnesses and had my first pregnancy at 37. It was a (welcome, happy) surprise, as I has thought I was infertile. (This was after 20 years of marriage – so a big surprise!)

      I felt that doctors and nurses were often cold and dismissive of me due to my advanced age and disability. (I wear a back and leg brace due to an accident and have a history of SLE. Still, I remain active and take no medication)

      They often acted like carrying a child was a tragedy for me rather than something I should be celebrating. I knew the risks and decided to go through with it anyway.

      I had an uncomfortable pregnancy, and a cesarean, but delivered a healthy baby girl. She is the light of our lives.

      At my checkup after, a nurse told me I should not have more children because I was old and would not labor successfully, and it would necessitate surgery again and that was a waste of resources and time for the clinics and hospital.

      Having children is very important to me and to my husband, it is important for our religion and our culture. But I fear going back to the doctor if we are able to conceive again, because I fear that they will not want a patient like me and will treat me poorly.

      I hear so much about women with disabilities, hypertension, diabetes, obesity, etc becoming pregnant, and I wonder if doctors see it as a challenge, or view it with compassion, or are just disgusted by it and think they should not have children.

      • There AREa FEW women whose medical history is so bad that they need to be made very aware that, even with every possible modern medical advance, the odds are against their living to raise their baby. But the vast majority are not in that situation, even with fairly major disabilities. But neither the patient nor the doctor can ever be blithe about it, despite the reluctance to “play the death card”.

        • BeatriceC

          Me. That would be me. My obstetric history is the stuff of every OB’s nightmares. Yet still, not one medical professional made any sort of statement as awful as Guest’s nurse did. My lead MFM did make it very clear that he could almost completely guarantee any other babies would probably not survive and I stood a better chance of dying than surviving, but nobody ever made a single statement that even approached that level of unprofessionalism.

        • Mel

          I agree – but that’s not what the nurse told guest. The nurse told guest that she shouldn’t have a baby again because guest’s need for a repeat C-section use too time and resources for a hospital.

          Best case scenario – and I use that term loosely – is that we’re dealing with a natural birth wacko who happens to be a nurse and counsels every C-section mom to never reproduce again to save resources. (It’s still not a good scenario.)

          My more-likely scenario: guest has a visible disability so guest doesn’t deserve to reproduce. guest also mentioned she’s a member of a minority group. Minority groups don’t deserve to reproduce if they cost extra money. Horrible but common biases in society at large….

          • JDM

            Absolutely. There’s an enormous difference between “having another baby would be extremely dangerous for you and the baby” and “you’re not worth the time and money”.

            Not even close.

      • Cartman36

        I would strongly encourage you to call the clinic manager about the nurse at your checkup. What she said to you was completely inappropriate. Every couple has the right to decide how many children they want and to do their own personal cost benefit analysis. She has no business telling you not to have more children because it is a “waste” of resources. Bringing a child into the world is NEVER a waste of resources. I apologize for the ramble, but it makes me angry she said that to you. I wish you all the best.

      • BeatriceC

        If you can remember the nurse’s name, please report her. Only you get to decide if trying to have another child is worth the risk to you. A doctor, and maybe a nurse, can clinically discuss with you the risks, but cannot make a value judgement and remain professional.

      • attitude devant

        First of all, CONGRATULATIONS! How very wonderful! Secondly, like everyone else here I want you to register a complaint about that nurse. If she worked for me I’d want to know she was being inappropriate with patients. Finally, of course I welcome patients with a complicated medical history. If everything was straightforward I’d be out of a job. My sticking point would be if you didn’t accept the need for monitoring in labor, or frequent ultrasounds, or delivery by at an appropriate time. But it sounds like you’re an informed partner in your care. I had a patient very similar to you in for her post-partum check yesterday. Her pregnancy was arduous but she’s over the moon about her little boy. She wants another baby and we talked about not waiting too long because nothing about her medical condition is going to improve in the interim. That’s just reality. She’s going to switch to formula so she can go back on her meds, which she desperately needs, and she gets that her son needs her presence in his life more than he needs boob juice. She’s from an historically marginalized group, so having children is very important to her: she wants to pass on her culture. Both of you deserve a realistic assessment of the risks of pregnancy and enthusiastic support when you do have a baby. I’m very happy for you.

        • guest

          Thank you for the thoughtful reply, and the congratulations. And I appreciate your kindness to patients while still speaking the reality of the situation to them. It seems better to know all that can go wrong, so that we can prepare for it as best we can, and make wiser decisions. It is good to hear a little bit about your process and how you approach patients – it puts my mind more at ease.

          I see there are many replies, with concern about the nurse. I appreciate this. I have been undecided whether or not to say something. I had seen this same nurse for several prenatal visits, when my regular provider had to go on leave. I asked her at that first visit if I would be seeing her regularly, and she rolled her eyes and said “Yes. But you should know, I got into this profession to care for healthy pregnancies and catch babies. A doctor will likely deliver this baby. I’m getting no payoff from having you as a patient.”

          It seemed like a strange statement at the time, but I decided it was just an odd sense of humor, some sarcasm, maybe.

          The OB who checked on me after surgery in the hospital was only able to see me very briefly. She looked at the incision and notes, praised the surgeon for doing a very neat job, and said she thought I would heal well. She asked about lupus treatment and I said my symptoms abated during pregnancy. She gave me her card and said to call if I decided to try conceiving again. She also said don’t wait much longer than a year because of my age and health condition, which is similar to what you mentioned telling your own patient. It was less than five minutes, all in all.

          She was out of my insurance network, so I could not see her again. My insurance changes in February, and I think I will go back to see her and find out what advice she currently has for me. And maybe to sanity check, because I remember her visit being so very different from what the nurse practitioner told me. If I cannot see her, I will find another OB or CNM who can clarify what would be recommended in my case.

          Thank you all for the discussion. And attitude_devant, I wish you success in your practice. It is good to read your comments

          • space_upstairs

            Care for healthy pregnancies and catch babies? Should have been a homebirth CPM with exclusive low risk rich clients, not an actual nurse and backup to an OB. That would be like saying that as a college professor I wanted to work with only brilliant, motivated students who’d advance my field of research ASAP. Nope…gotta teach freshmen non-majors and students who fall behind and/or lean away from academia, too. Totally unrealistic and unfair.

          • demodocus

            The more I hear of that nurse, the more I want to toss her into a lake. She sounds like a combo of my elderly nurse aunt and that shrink my husband was seeing. The aunt means well, but occasionally gets judgy on issues of finances and weight. (I met her mother, Aunt is quite an improvement.) The shrink spent an hour trying to tell us that my blind husband cannot be the parent in charge, despite 5 years proof otherwise.

          • Lilly de Lure

            “Yes. But you should know, I got into this profession to care for
            healthy pregnancies and catch babies. A doctor will likely deliver this
            baby. I’m getting no payoff from having you as a patient.” Her disappointment in the realities of her chosen career is your problem how? That is so shockingly unprofessional I don’t know where to start and I am so sorry you had to deal with that during your pregnancy.

          • PeggySue

            What a 24K solid gold rhymes-with-witch that nurse is. Toxic doesn’t even begin to describe it. I’m so sorry that happened to you.

      • space_upstairs

        This particular nurse’s reaction to you smells like prejudice. I agree with others that she should be subject to formal complaints for that kind of thing. I think that, sadly, there are a significant number of doctors and other medical professionals who hold everyone up to the physical, financial, and behavioral ideals of successful affluent white professionals, and so are quick to judge those who don’t fit the ideal – overweight and/or with cardiovascular/metabolic illness, history of substance abuse problems, poor, etc., and probably more so if they’re also of color or disabled – as unworthy.

        • Sarah

          That was also my thought. And completely inappropriate.

          It’s perfectly fine to counsel a patient about the risks of future pregnancies and any limitations on their delivery options, indeed that is information all women should have. Expecting an individual patient to consider the resource implications to the hospital is not.

      • Mel

        Congratulations!

        I suspect that the nurses and doctors were reacting more to your visible disability than your advanced age. I say that as the identical twin of a deaf adult woman; I’ve spent my whole life watching people write her off as dumber and less capable than me as soon as they realize that she’s deaf.

        I had our first (and so far only) kid at 35. I’m obese and have a history of depression and anxiety managed well by therapy and an SSRI. My care team treated me very well – but my mild cerebral palsy isn’t visible to people outside of sharp-eyed PTs and an occasional neurologist.

        Actually, the high risk L&D staff was grateful that I was aware of my “normal” hyperreflexia in my legs. I was reeling with shock at the fact that I was going to be delivering at 26 weeks when the nurses did the general care check-up for unstable pre-eclamptic patients like me – so I forgot to warn them that my legs respond enthusiastically to reflex testing.

        I came out of the shock-fog when I realized both of the nurses looked like they had seen a ghost and I said “Look, this is normal for me – strong response without clonus on the left while righty gives a consistent clonus with my toes pointing inward during the clonus. Been like that as long as I can remember. I’ve kicked two medical students in the groin when they tested my patellar reflex while standing right in front of me after I warned them to move.” The nurses visibly relaxed and jotted that into my notes.

      • PeggySue

        A WASTE OF RESOURCES??? A healthy baby and healthy mother are a WASTE OF RESOURCES????? Puh-leez. Congratulations on your little girl, and may you have the best of care should you conceive again. It sounds as if you would like to do so—so I hope for another baby for you! Yes, report the idiotic, judgmental nurse. WASTE OF RESOURCES, my ass.

      • RudyTooty

        Thanks, guest, for sharing your words and experience.

        This is a problem that goes far beyond that one nurse, and that one clinic.

      • demodocus

        First, Congratulations on your daughter!

        Second. Ugh. Who asked her? Waste of resources indeed! Tragedy indeed! They can go pound sand. That nurse was so far out of line, I’m not sure she could even see it anymore.

  • LaMont

    Eh, I think women *are* often blamed, at least in part, for their own deaths in the discourse, it’s just that the solutions proposed to fix the situation are absurd and wrongheaded.

    • Petticoat Philosopher

      This.

    • RudyTooty

      You mean the suggestion that dying women just need more doulas, homebirth and candle-lit waterbirths?

      Yes. Completely absurd.

    • AirPlant

      When I read just the headline of the piece I had actually assumed quite a different conclusion.

      I assumed the piece was saying that women are blamed for poor birth outcomes because when things go pear shaped we say that they should have done more to be the type of women who do not need birth interventions as opposed to thinking that they should have had access to life saving interventions.

      I was deeply surprised to find out that the proposed solution to the problem of “women are dying in childbirth for lack of the medical establishment taking them seriously” was “Try encouraging them more to have complication free births!”

  • RudyTooty

    Kira Johnson is dead.
    She died a preventable death.
    Listen to her husband (in part 2) explain how the physician responsible for caring for her suggested that she’d had ‘an undiagnosed heart condition’ that caused her death.

    This is blaming women for their deaths. This right here.

    And Then She Was Gone – Kira’s Story (Part 1)
    https://www.youtube.com/watch?v=QvUkR-mmrpU

    And Then She Was Gone – Kira’s Story (Part 2)
    https://www.youtube.com/watch?v=DrT0VX1bVEw

    • attitude devant

      Rudy, I’m sorry but I literally do not have 35 minutes to watch. Can you tell me what happened?

      • swbarnes2

        Here’s one article about her. She was in the hospital after giving birth, exhibiting really bad symptoms, and the staff dawdled for hours at getting her tested further.

        https://www.theroot.com/kira-johnson-spoke-5-languages-raced-cars-was-daughte-1829862323

      • RudyTooty

        The article posted by swbarnes2 has a 7 minute video.
        It is worth watching. It is worth 7 minutes of your time.

        She had a scheduled repeat LTCS,
        Blood noticed in her urinary catheter in post OP.

        CT scan ordered at 1600.

        Patient continued to deteriorate over the evening.
        An US performed at 1800 – US reveals free fluid in abdomen
        2100 – blood transfusion ordered

        After 0000 – pt taken to OR for surgical eval
        She had massive internal hemorrhage – and she died.

        • attitude devant

          Oh yes. Now I remember this case. Absolutely horrible and a disgusting example of institutional racism. That poor woman should not have died and I’m sadly certain her race had everything to do with it. I’m sorry. I just don’t ever have time to watch videos, although what I did see of the one you posted was beautifully and lovingly produced.

  • space_upstairs

    I think there two common extremes when it comes to blame for deaths in America. One extreme represents the worst of mainstream, individualist, capitalist society that tends to be part of what attracts people to the stuff this blog speaks out against: blaming everyone for their own deaths. In this case, people would look at the higher obesity and chronic illness rates and higher maternal ages and say, as RudyTooty points out, that they brought these problems upon themselves by not taking good enough physical care of themselves or by being too selfish or foolish to have reproduced sooner. They would not consider how the current economy makes physical self-care harder or less attractive for the working classes or makes reproducing early less attractive for all social classes. It’s unfortunate, but this attitude does exist.

    The other extreme, of course, is the one this blog tends to speak out against: blaming the entirety of mainstream medicine itself for people’s deaths, and thus seeing the solution in “alternatives,” missing all the subtleties in the complex reality of it all.

    • Ozlsn

      But of course if they had reproduced earlier they would have been irresponsible and should have waited until they were financially secure, had a long term partner, were more mature etc. Seriously you cannot win – I have no idea when the perfect time to reproduce is, somehow I missed the magical moment when the stars align and the universe is in harmony or something. Not that it would have mattered even if I had noticed it – still took me 12 rounds of IVF to conceive once. I didn’t intend to be a geriatric primagravidae, my body just doesn’t conceive without a truckload of interventions, or get to late enough for the baby to go to NICU without interventions either apparently. (I find it blackly amusing that breastfeeding was relatively easy – it’s apparently the one pregnancy/infant related function that my body has no issues with. Yay?) Who knows, maybe that moment of universal harmony was the one time I could have had a (much cheaper) natural conception, a term pregnancy and a totally natural birth. I bet I was asleep for it…

      • space_upstairs

        Or you could have been richer, fitter, and eaten an organic gluten-free low carb diet and treated every illness you ever got with homeopathy and acupuncture. 😉

        • Ozlsn

          Kale. I’m sure it was lack of kale. Hate the stuff…

  • RudyTooty

    “The bottom line is that America is NOT blaming women for their own deaths.”

    It’s hard to distill “America” to a single entity or voice.

    You’ve written this entire post without using the word “racism” – which is a social problem that “America” has – not America singularly – but collectively – and some individual Americans have this racist problem more virulently than others.

    There *are* racist individuals – who work in healthcare – at all levels of healthcare – who blame pregnant women for their poor pregnancy outcomes and/or deaths. “They don’t come to prenatal care on schedule.” “They just use the emergency room as a walk-in clinic.” “She’s having her fifth baby in the fifth consecutive year with the fifth different baby-daddy.” “Why do **these people** expect US to just take care of them?”

    These attitudes contribute to and uphold a racist structure that allows African American women, and non-white women to die at higher rates within our American healthcare system. These attitudes are promulgated by white people (mostly) and they largely go unchallenged. The white frame of reference is seen as inherently objective and superior to the frame of reference of non-white people.

    I’d like to encourage you to listen to how healthcare workers talk about patients. Or listen to women of color tell you what the experience is like receiving health care in this system. They will tell you they’re being blamed, because they are on the receiving end of this injustice.

    You don’t need any more evidence that they’re dying at higher rates – because we have that data.

    But one thing I don’t hear directly from POC is that they’re dying because they’re just sicker. And genetically/ethnically somehow more predisposed to dying in pregnancy and childbirth.

    THIS I AGREE WITH:
    “women are dying from LACK of high tech interventions not too many interventions.”

    Though we must ask the question – why is there the lack of high interventions for our highest risk populations in the first place?

    • Amy Tuteur, MD

      Subtle racism is also a problem and Brooks’ piece is an example. Brooks exploits the tragedies of black women to make points that have little if anything to do with those women. Moreover, she assumes that black women’s death could be prevented by giving them what white women want.

      • RudyTooty

        Brooks appears to be from the camp that says patients are dying because of too much intervention, and co-opting the plight of women of color, particularly Black women, to further her mission to promote natural birth.

        It’s twisted. And it’s racist. And not subtly, at all (IMO). She is using the bodies of Black women to promote white ideas of empowered birthing. The NCB ideology does *nothing* to reduce injury and mortality for childbearing women of color, but because they’re addressing it – merely by admitting the system is racist (it is) – and they are winning the PR contest.

        The system is racist, the system *does* blame women of color for their poor outcomes. WOC need *better* care, more access to high-tech interventions, and care that is tailored toward them *as valued high-risk patients* within the system. But if we deny that the system itself is undergirded by anti-Black racism, we’ll continue to shrug and say it’s OK to have these horrific disparities in outcomes. If healthcare providers, and our institutions are not to blame for the poor outcomes of pregnant POC, who is to blame? Black women, just for being Black?

        Commenters are saying this right here, right now on this page.

        https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303313

        • Amy Tuteur, MD

          Of course there’s a lot of racism in the system. There’s a lot of racism everywhere and it’s not confined to the US. However, I’m not sure spending a lot of time naming it it accomplishes anything; the racists are going to continue to be racist and we have to improve care for WOC regardless.

          If I’ve learned anything in the last few years it’s that my wishful thinking that racism would eventually die out was stupidly, pathetically naive. Not coincidentally I thought anti-Semitism was also dying out. I was wrong about that, too.

          I agree with you that racism should be disavowed and I suspect nearly every regular commentor agrees with you. But railing against racism is like railing against war; it’s far too big a problem to stop merely by calling it out. In my view — which I understand you might consider wrong — we have to act to save lives in the face of racism, and simply calling out racism doesn’t do that.

          • swbarnes2

            But I think it’s worth mentioning, in that the issue isn’t “we lack the technology and medical know-how to prevent or treat the problem” or “we don’t have the resources to treat these issues at most hospitals”. This is a personnel problem.

          • RudyTooty

            I’m not merely calling out racism, I’m asking those of us who recognize it to address it as a real influence over patient outcomes.

            If we ignore it (which is a feature of white supremacy, and white privilege – we can’t always see it), we won’t ever address it.

            We’ll keep blaming deaths on hypertension, cardiac disease, hemorrhage, and obesity and say it’s completely out of our control. We’ll claim helplessness. Black women are statistically sicker, therefore they’ll die more often. There’s nothing we can do.

            Perhaps being a person of color in our American healthcare system is a risk factor, not because there is some inherent genetic or ethnic variant of health condition, but because the system itself is racist, They are at risk because they are being cared for within a system where their lives don’t matter. At least not as much as lighter skinned people’s lives matter.

            How do we make their lives matter?

            How do we – in your words – act to save lives in the face of racism?

            Can we even do that without naming it?

    • Petticoat Philosopher

      *Applause*

  • The Bofa on the Sofa

    Because cognitive dissonance won’t allow blue collar white workers to blame the real authors of their misery: the Republicans who promote the interests of the rich over the needs of the working poor.

    https://uploads.disquscdn.com/images/34f8aeb696c91311c284bf7cad278f209877c5ffcb86d737d4a6bbac910fbc5a.jpg