MOTHERS IN MEDICINE
STORIES OF THE TWO KENTUCKYS FOR MATERNAL
MORTALITY AND MORBIDITY
AUTHOR Tom James, MD
“Motherhood is the greatest thing and the hardest thing.” -Ricki Lake (American Actress)
“Children are the anchors that hold a mother to life.” -Sophocles
The American view of motherhood
is one of optimism, renewal of life
and a happy growing family. Fortunately,
most women have uncomplicated
pregnancies and deliveries:
joyful outcomes! But that is not the
case for too many women. This is
not a new problem. In 1933, the
Maternal Mortality in New York City report was published. That
study showed that two-thirds of the 689 maternal deaths per 100,000
were preventable. That was shocking at that time and helped jumpstart
efforts to improve maternity results. By the 1960s, the mortality
rate had dropped to 37 per 100,000 live US births. To a large extent,
this was the result of the introduction of antibiotics, improved
anesthesia, nutrition and delivery techniques.
Roughly 50 years later in 2016, the maternal mortality rate
nationally had dropped to 17.4 deaths per 100,000 live births. However,
compared to the Healthy People 2020 goal of 11 deaths per
100,000, our national statistic is not close to goal. The US rates of
maternal mortality are twice that of Western Europe, with 8 deaths
per 100,000. Making these statistics even more grim, the Centers
for Disease Control and Prevention indicates that currently 60%
of US maternal mortality is preventable.
What are the leading causes of maternal death in the US?
» Hemorrhage 16.3%
» Hypertension 14.0%
» Sepsis 10.4%
» Other direct causes 9.6%
» Abortion 7.9%
» Embolism 3.2%
In review of these factors and others leading to the death or
serious morbidity among mothers, there tends to be a breakdown
between the socioeconomic determinants of health (SDOH) versus
the “systems factors” in the management of pregnancy, labor and
delivery. Among the SDOH are the physical issues such as housing
instability, inadequate nutrition, transportation difficulties and
physical safety. These barriers often have emotional and behavioral
consequences. Any of these issues may preclude access to appropriate
first and second trimester care.
Language barriers for women not fluent in English lead to the
risks of miscommunication with subsequent inappropriate actions
on the part of the woman and/or the health system. For women
of color, there is also the documented issue of institutional racism.
White physicians have implicit racial bias born of upbring-
16 LOUISVILLE MEDICINE