Can it be true that women giving birth in America are more at risk than women in dozens of other countries? Erin Moriarty has the stories behind the statistics:
Fearless is how Charles Johnson describes his wife, Kira. "We're talking about a woman that was a marathon runner, that raced cars, that was a skydiver," he said.
It never occurred to him that the greatest danger Kira would face would be going to one of the best hospitals in California to have a baby, their second son, Langston: "For us, we were really and truly expecting this experience the second time around to be a walk in the park."
Kira's doctors recommended she have a C-section because she'd had one before. The first sign of a problem came in the late afternoon of April 12, 2016, shortly after Kira gave birth. "I was sitting by Kira's bedside and I began to notice the catheter turn pink with blood," Johnson said.
A doctor ordered a CT scan. Johnson says he didn't worry at first. "Something's not quite right and I was aware of that, but we've got a plan. And she's in what I thought were great hands."
According to Johnson, Kira was feeling lethargic: "I'm continuing to advocate and ask, 'Look, when are we taking her for the CT scan?' So, 7:00 rolls around. 8:00 goes by. 9:00 comes. 10:00 comes. There's still no CT scan."
Shortly after midnight, his wife was taken into surgery. "She's holding my hand, and she's saying that she was scared," Johnson recalled. "And I'm telling her that everything's going to be OK.
"And that was the last time I saw my wife alive."
When they took Kira back into surgery, there were three-and-a-half liters of blood in her abdomen, and her heart stopped immediately.
Kira Johnson was 39 years old. And her death isn't just a personal tragedy; she's part of a disturbing national trend.
Dr. Mary-Ann Etiebet said, "The United States is the only industrialized country where the rates of maternal deaths have increased, not decreased. And so, young women actually have a higher risk of dying during pregnancy and childbirth than their mothers did."
Dr. Etiebet is executive director of Merck for Mothers, a program run by the pharmaceutical giant Merck to reduce the number of maternal deaths throughout the world. She never guessed that one of the countries most in need was the U.S. "Sixty percent of the deaths in the United States are preventable," she said.
Moriarty asked, "And where do we compare to other developed countries, like Great Britain, Canada?"
"The United States is ranked 46th when it comes to maternal mortality. That's behind countries like Saudi Arabia and Kazakhstan."
In the U.S., that means at least two women are dying every day. And it's not just deaths on the rise. So are "near deaths" … 60,000 a year across the country.
Amber McLaughlin was 29 years old and eight months pregnant when she began to feel an excruciating pain that would come and go. "When it was happening, it would go on for anywhere from 15 minutes to an hour," she said. "It felt like my body just wanted to crumble."
She says her doctor wasn't alarmed.
"They're telling you, 'No, don't come in, we've seen you, you're fine'?" asked Moriarty.
"They told me to go home and rest. They said, 'You're 35 weeks, you're probably uncomfortable. Go home and rest.' And I said, 'I'm not going home. I'm coming in today.'"
Even then, a nurse practitioner hesitated, and then relented, sending McLaughlin for tests. "I get hooked up to the monitors, and a few minutes, I mean it felt like two, they came rushing in and they said, 'Where's your husband? This baby has to be out in ten minutes,'" McLaughlin said.
She had developed a rare condition that caused her blood pressure to skyrocket, putting both her life and her baby's at risk. "I'm thinking to myself, I was right this whole time. Why has it come to this? And so at that moment, even five years later, it's one of those things, like, when nobody believes you."
When McLaughlin's son was delivered by emergency C-section, he weighed just three pounds.
Moriarty asked, "Was there a time when you really wondered whether you'd ever get to see your son?"
"That first day he was really struggling. They told us that he was pretty close to the end," McLaughlin replied.
"Was your life ever at risk?"
"Part of when I was saying, 'I think I'm dying.' That's because I truly believe that my kidneys and my liver were starting to shut down."
So, what's causing this spike in maternal deaths? There are a number of factors. More women wait until they're older to have babies, and often they begin their pregnancies less healthy, with chronic conditions like obesity, high blood pressure and diabetes.
But some medical professionals say the real problem is how those babies are delivered. They blame much of the increase in deaths and near-deaths on a dramatic rise in C-sections.
"If you have a C-section in 2018, you have a 90 percent chance of having a C-section the second time," said Dr. Neel Shah, a professor of obstetrics at Harvard Medical School, and a practicing physician. "But the second time it's a more complicated surgery. And the third time it can be like operating on a melted box of crayons. And in those cases, women can bleed to death."
"Are you saying that some of these C-sections are just not necessary?"
"Probably more than half of them."
And when complications do arise, says Dr. Shah, doctors don't always listen to their pregnant patients. "I think there is a dimension of gender discrimination," he said. "If a woman after a birth goes into a hospital with concerned signs of a complication, there are no rules for how quickly an obstetrician has to see her. And in fact, it's a routine case that it will take hours."
And statistics indicate that it may not just be gender that plays a part in dangerous delays, but also race. "if you're a woman of color in this country, especially if you are black, your odds of dying in childbirth are three to four times higher on average in our country," Dr. Shah said.
Moriarty asked, "Why? You're not talking about access to healthcare, you're not talking about money or education."
"No, and this is gonna be hard to hear: we believe black women less when they express concerns about the symptoms they're having, particularly around pain. And that's the common thread in all of the stories we've been hearing in the media, including Serena Williams."
Yes, even Serena Williams, the world-class athlete who developed a pulmonary embolism after giving birth to her daughter last September. Williams says, had she not insisted on receiving a CT scan, she could have died. If women with resources are at risk, imagine what happens to women without access to proper health care?
Thirty-two-year-old Akila Collier works as a full-time substitute teacher in Orlando, Fla., but she couldn't afford health insurance when she became pregnant with her second child.
"My first proper prenatal visit was at 16 weeks," she said. "It was terrifying. I had been bleeding for about 11 weeks before I was able to get an understanding to why.
"I went to the emergency room, and that's where I got my prenatal care for the first three months."
During four visits to the ER, Collier racked up more than $20,000 in medical bills. "And they mis-diagnosed me every single time," she said. "They were saying that it looked like I was having a miscarriage."
And there's 30-year-old Ashley Lacayo, who also lives in Florida. "I have insurance, but I've never been told 'no' so many times by people who are, like, have no emotion – 'Oh, I'm sorry, no, no,'" Lacayo said.
She told Moriarty she initially was able to get prenatal care by agreeing to pay her entire deductible, $2,600, by her 28th week of pregnancy. But when that date rolled around and she couldn't afford the full amount, her doctor refused to see her again. "I called 15 or so different clinics in the area; everyone denied me," Lacayo said. "It was just a never-ending – 'Oh, how far along are you? Oh, no, sorry, we don't accept patients past 25 weeks.'"
Midwife Jennie Joseph, who moved from London to Florida nearly thirty years ago, says she is deeply concerned by the number of women who are shut out from proper prenatal care.
"Women are literally shut out, left wandering the streets, trying to find someone who will help them, and running to the emergency room in lieu of prenatal care," Joseph said. "We are standing by literally as mothers and babies are suffering. And I feel like my little piece is to be able to make a difference in that."
In 2006, Joseph opened a practice specifically for them called the Easy Access Clinic. It's run by nurses and midwives who include doctors when necessary. They turn no one away.
"There isn't anything you can come up with that would have us say no," Joseph said. "You can be indigent. You may be homeless. We're still gonna see you. And the simple reason is because you're carrying a baby. Like, what else would we do? There isn't any ethical way to say, 'No, go away.'"
Two months after being refused treatment by her first doctor, Ashley Lacayo heard about the clinic. Joseph saw her the next day. "I mean, this place saved me. It did!" Lacayo said. "I mean, I'm due in a week. Where would I be without her?"
Both Lacayo and Collier gave birth to healthy babies in May.
But his problem is not going away. Since 2000, hundreds of hospital maternity wards, too expensive to operate, have closed across America, leaving half of all rural counties without obstetric services.
Low-cost health centers like the Easy Access Clinic could fill the need, but Joseph warns that that may not be enough.
"Women are sent out of the hospital two days after they've delivered and basically told to wait for a six-week postpartum check, which is useless to them, given that most of the postpartum concerns, the morbidity and the mortality, occurs within the first couple of weeks after the baby's born," Joseph said.
But when deaths do occur, Dr. Etiebet, from Merck for Mothers, says each one must be counted and investigated. "And is that being done right now?" Moriarty asked.
"It's not being done in every state," Dr. Etiebet said. "So, if they're not paying attention to the issue, they're not only not going to know that there is an issue, they're not going to know how to solve it."
More than two years after his wife Kira died, Charles Johnson is now a single dad raising their two sons in Atlanta. Determined to keep her memory alive, he is suing the hospital and speaking out, hoping to put a face – a deeply-missed face – on an American crisis.
"It's immeasurable how much I miss Kira," he said. "And particularly, as I see these amazing gifts that she's left us with. There're so many things about our journey together that are bittersweet. They're so painful because she's not here to share them with us."
Moriarty asked, "Do you think Kira's death probably means other mothers will get better care?"
"I hope so," he replied. "When you go into the hospital, ask them, 'Do they know about Kira Johnson's story? Ask them, 'Do they know about what happened to her?' And then ask them directly, 'What are you doing to make sure the same thing doesn't happen to me?'"
- Maternal mortality fell by almost half in developing countries between 1990 and 2015 (UNICEF) … but doubled in the United States (Gates Foundation).
- U.S. Maternal harms and deaths by state (USA Today)
- Pregnancy Mortality Surveillance System, Centers for Disease Control and Prevention
- Advocate for yourself: Lifesaving tips for a safer birth (USA Today pdf)
- State of the World's Mothers 2015 (Save the Children pdf)
- Reach Every Mother and Child Act – Referred to Senate and House committees in August and October of 2017, no action to date
For more info:
- Easy Access Clinic, Orlando, Fla.
- For information on the Easy Access Women's Health Clinic fundraising effort visit their GoFundMe page
- Dr. Neel Shah, Harvard Medical School
- Merck for Mothers
- Maternity Care Coalition
- Preeclampsia Foundation
- Ariadne Labs, Boston
Story produced by Sari Aviv.