Olympic medalist Tori Bowie died in childbirth. What to know about maternal mortality, eclampsia and other labor complications.
Three-time Olympic medalist Tori Bowie, who died in early May at the age of 32, was eight months pregnant and in labor at her Florida home at the time of her death, her agent confirmed Monday — drawing renewed attention to the maternal mortality crisis in the U.S.
An autopsy report from the medical examiner's office in Orlando said Bowie's possible complications included respiratory distress and eclampsia. The baby she was carrying, a girl, was stillborn, the medical examiner reported.
"Tori's death exemplifies so many aspects of the challenges we face today in maternal health in the U.S.," says Dr. Alison Cowan, an OB-GYN and head of medical affairs at the health technology company Mirvie. "Just seeing a young woman in the prime of her life, in peak physical condition nevertheless lose her life and her baby's life to a pregnancy-related complication that was potentially preventable really says it all. ... While we can't know for sure the specifics in her case, it's an important moment for us to pause and think about how we can raise awareness more broadly for this potentially very preventable outcome."
The number of women who die during or shortly after childbirth in the U.S. is higher than in any other developed nation, and the risks are even greater among women of color. Black women are at least three times more likely to die from a pregnancy-related cause than White women, according to the Centers for Disease Control and Prevention.
Even those who were healthy before getting pregnant can experience complications, according to the National Institutes of Health. And a pregnancy-related death can happen at any stage, the CDC notes, including during pregnancy, at delivery and even up to a year postpartum.
Here's what to know about some serious and potentially life-threatening complications in labor:
What is eclampsia?
Eclampsia is when a person develops seizures — episodes of shaking, confusion and disorientation — during pregnancy, the Cleveland Clinic explains.
The biggest risk factor for eclampsia is preeclampsia, which is when a person who's pregnant has high blood pressure and protein in their urine.
Other individuals at increased risk include those who already have high blood pressure outside of pregnancy, those who have had preeclampsia in a prior pregnancy or who have a history of diabetes, Cowan says.
"There are a lot of women, perhaps like Tori Bowie, who don't have any identifiable risk factors for preeclampsia," she adds. "So the first thing is for women to have a conversation with their care provider about what their unique risk is."
Both eclampsia and preeclampsia are rare but serious.
"Left untreated, preeclampsia can lead to serious — even fatal — complications for both the mother and baby," the Mayo Clinic says.
Eclampsia affects less than 3% of people with preeclampsia, according to the Cleveland Clinic.
Studies have shown Black women in the U.S. are at greater risk for birth-related complications including preeclampsia.
"We know that Black women are dying at approximately three times the rate of White women in the United States, and they're dying from preeclampsia and eclampsia and an estimated five times the rate of White women. So they're bearing a— certainly a disproportionate impact of disease," Cowan says.
Bowie's Olympic teammate Allyson Felix had her own experience with the condition, being diagnosed with severe preeclampsia at 32-weeks pregnant. Felix underwent an emergency C-section, which may have saved her life.
For people considering pregnancy or already pregnant, Cowan says it's crucial to know your risk as much as possible and take action by creating a plan with your doctor. Her work at Mirvie includes efforts to develop a blood test to help predict preeclampsia and other pregnancy complications.
"There are so many different interventions that are available and evidence-based to reduce risk of preeclampsia developing or to identify it as soon as it does develop," she says. "If we do everything we can to reduce the risk of preeclampsia from developing and identifying it immediately when it does occur, we can prevent most cases of eclampsia."
Heart complications during pregnancy, birth
Heart disease and stroke cause the most deaths overall in pregnancy and after, according to the CDC, which estimates these complications account for more than 34% of pregnancy-related deaths.
"Many women may mistake their stroke symptoms, including headaches, dizziness, or tingling arms, for issues related to pregnancy and a new baby. If your symptoms appear suddenly, that may be a clue that you are having a stroke," the organization's website reads.
These symptoms may include sudden numbness, confusion, trouble seeing, trouble walking and severe headache.
While stroke is not common in pregnancy, pregnancy does put women at higher risk, the CDC says.
Problems that increase the risk for stroke during pregnancy and delivery include high blood pressure during pregnancy, preeclampsia, gestational diabetes and blood clots.
Postpartum hemorrhage
Severe vaginal bleeding after childbirth, also known as postpartum hemorrhage or PPH, is another life-threatening condition.
"Postpartum hemorrhage is when the total blood loss is greater than 32 fluid ounces after delivery, regardless of whether it's a vaginal delivery or a (C-section) or when bleeding is severe enough to cause symptoms of too much blood loss or a significant change in heart rate or blood pressure," the Cleveland Clinic's website says. The sharp decline in blood pressure can restrict blood flow to your brain and other organs.
Risk factors may include high blood pressure or preeclampsia, blood-clotting disorders, anemia, obesity, and older maternal age — but postpartum hemorrhage can affect anyone after childbirth.
It occurs in about 1% to 10% of pregnancies, according to the Cleveland Clinic, which also notes that about 40% of those cases happen in women who did not have any risk factors.
Racial disparity in maternal mortality
In 2021, during the COVID-19 pandemic, more than 1,200 U.S. women died during pregnancy or shortly after childbirth, according to a report released in March by the Centers for Disease Control and Prevention, marking a six-decade high. Studies have shown the risks are greater for women who are unvaccinated.
According to a 2020 report by the CDC, the maternal mortality rate in the U.S. for non-Hispanic Black women was 55.3 deaths per 100,000 live births — roughly 2.9 times the rate among non-Hispanic White women.
Determining the cause of racial disparity in maternal mortality poses "essentially one of the biggest challenges of public health," Dr. Henning Tiemeier, the director of Harvard's Maternal Health Task Force, said in an interview on CBS News' "Face the Nation" in July 2022.
"We see that as a top of the iceberg of poor health in women and poor health in Black women," Tiemeier said. "And there are several reasons, there seems to (be), from poverty to discrimination to poor care for this group of women."
Tiemeier also noted that "most of these deaths are preventable."
Cowan says a combination of awareness and and a personalized plan of action is important to help change these disparities and health outcomes.
"We're really looking to help individuals as much as possible with predictive testing," she says. "By translating that knowledge into action and prevention, that's going to be what really will move the needle in the right direction on maternal mortality."
–Aliza Chasan and Mikayla Denault contributed to this report.
