Childbirth educators could save women’s lives


US maternal mortality has rightly captured the nation’s attention. Perhaps the most shocking fact about it is that so many of the women who die during and in the aftermath of pregnancy die from preventable causes.


Everyone involved in the care of pregnant women seems to have forgotten the single most important thing about childbirth: it is inherently dangerous and has always been a leading cause of death of young women. Not surprisingly, providers can’t diagnose a complication if they don’t think of it.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]What if normal birth meant avoiding complications not avoiding interventions?[/pullquote]

Obviously obstetricians and midwives need to do a better job of warning women about postpartum complications. Healthcare websites need to do a better job, too.

As Nina Martin reports in the latest installment in the ProPublica/NPR series on US maternal mortality, Trusted Health Sites Spread Myths About a Deadly Pregnancy Complication, most trusted healthcare websites are failing to provide accurate information about postpartum preeclampsia.

The large majority of deaths occur after delivery, often from strokes.

But you’d never know it from the incomplete, imprecise, outdated and sometimes misleading information published by some of the most trusted consumer health sites in the country.

What’s especially disturbing about postpartum preeclampsia is that it often occurs when women are no longer being monitored: after discharge from the hospital and before the 6 week postpartum check. That’s why it is critical that women themselves know how to recognize the symptoms. What do leading internet health websites have to say on the topic?

After reading reports about Beyoncé, ProPublica took a look at how top health sites discuss preeclampsia. We sent screenshots and links to Tsigas, one of the leading experts on the condition in the U.S., for review last week.

Virtually every site we asked her to look at contained some problematic language, Tsigas noted in her written comments. Her biggest area of concern: A number of sites flubbed how they explained postpartum preeclampsia — sometimes mentioning it only in passing, or sometimes failing to mention it entirely…

ProPublica only looked at mainstream medical sites that are presumably maintained or overseen by physicians. But many women often look to natural childbirth websites for information about pregnancy. How do they do?

1. The Childbirth Connection, which describes itself as promoting “safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families,” has NO information on postpartum preeclampsia.

2. Lamaze International, which claims its “education and practices are based on the best, most current medical evidence available,” has NO information on postpartum preeclampsia.

3. Evidence Based Birth, which claims to offer “evidence that empowers,” offers NO information on postpartum preeclampsia.

They aren’t offering women the information they need, either.

What if we used childbirth educators, the people whose job it is to educate women about childbirth, for that very purpose? At the moment, most childbirth educators think their job is to promote “normal birth.” But what if normal birth meant avoiding complications not avoiding interventions?

At the moment, childbirth educators teach women about what to expect during labor and delivery. That’s entirely appropriate. They also spend an inordinate amount of time teaching women that they should avoid epidurals, C-sections, and other childbirth interventions. But if we truly face a crisis in maternal mortality, shouldn’t they be spending that time in trying to avert it?

Let’s reform childbirth education to include the information that women need to protect themselves and their babies from death and serious disability.

Let’s give women:

Information on pregnancy complications like preeclampsia and premature labor. What should they worry about and what should they ignore? Who should they contact when they are concerned?

Information on stillbirth. How much should the baby be expected to move? When should they be concerned about lack of movement? What can they do to encourage the baby to move when they are concerned? When should they insist on fetal monitoring to assess the baby?

Information on postpartum complications like hemorrhage and postpartum preeclampsia. How much bleeding is too much bleeding? What should they do if they begin to hemorrhage? What are the signs of postpartum preeclampsia? Where can they go to get their blood pressure checked besides the doctor’s office? When should they insist on being seen by an obstetrician instead of a midwife or nurse practitioner?

Information on heart complications. Cardiac complications are the leading cause of maternal mortality and women should be taught to recognize their onset. What should they do if they feel unusually weak and short of breath? How quickly should they be seen and by whom?

Information on blood clots. Blood clots are a major, often preventable cause of maternal death. They typically arise in the leg. What are the signs and symptoms? What can women do to prevent blood clots? A blood clot can kill if it breaks off and reaches the lungs (pulmonary embolus). What should women do if they feel chest pain or sudden onset of shortness of breath?

Everyone has a role to play in preventing maternal deaths. Obstetricians and midwives have the primary role, and purveyors of childbirth information have a role, too. Up until now childbirth educators have not been recruited to the effort despite the fact that their mandate is to educate women. Let’s change that. Let’s train childbirth educators to prevent death rather than to prevent interventions!