America’s Maternal Mortality Crisis, Part 1

I remember her brother just yelling, and I just remember I'm just looking around at all these people that I love so much and that love cure so much and so much pain, and I'm just standing there in shock. It's like no, no, no, no, and just insisting that they something didn't happen, because literally twelve hours earlier we walked into this hospit but with a woman that and only was in good health, it was an exceptional health.

Not only that, I was just talking to her when she walked away from me, I was holding her hand, I was talking to her. How did this happen? On April two thousand sixteen, Charles Johnson and his wife Kia became a part of a shameful statistic America's maternal mortality rate in the US and estimated two women die every day from pregnancy and childbirth related causes, and six of

those deaths could have been prevented. What's scary now is that those numbers don't take the coronavirus into consideration and the effect a pandemic could have on an already fragile maternal health system. The fact is the situation was bleak long before COVID nineteen hit the US in early Over the past three decades, while the world has drastically reduced its maternal more vality rate, the U s is the only developed nation to see its rate go up, and

go up significantly. The US now has one of the highest mortality rates in the developed world, a fact that was so shocking to me, that seems so incongruous, that I set out to understand how this could be possible. And so today part one of our look into America's maternal mortality crisis and my next question, what's behind this devastating trend. To answer that question, we have to go back to cure a story. We were just over the moon,

ecstatic to welcome our first son, Charles. It was just such a tremendous blessing We've always talked about having back to back boys. You know. The first time around, we talked about all the politically correct stuff. We're not really worried about what jenitors. As long as it's a healthy baby, we don't care. But by the time the second one came around, Kira had her mind made up. She was like, I'm a boy's mom. This is where I get in, where I fit in. Kira and Charles were married in

two thousand and twelve. Two years later, they welcomed their first son, Charles the fifth, via C section in Atlanta, and two thousand and fifteen, a job opportunity moved the young family out to Los Angeles, where they were preparing for the birth of their second son, who they decided to call Langston. We interviewed about I think about three or four different O. B. G Yan's, and we had also made the decision very early on that we wanted

to deliver at Cedar Sinai Hospital. It was our understanding that Cedar sign I was supposed to be, you know, one of the best places, certainly in the state of California, and it had a reputation of being, you know, one of the best places in the country. Particularly in the area of eccentrics and delivery. Beyond a little bit of nausea early on, Kira's second pregnancy passes without incident. She's thirty, she's fit, she's healthy, and she has the resources to

choose her care. Because Kira had a C section with her first delivery, her doctor recommends they do the same for the second. She's scheduled for a routine C section on April twelve, two thousand and sixteen, at Cedars Sinai Hospital in l A. So we walked in for Lengthson's delivery for the scheduled C section at two o'clock, and so Lengthon is born, perfectly healthy, tin fingers, tin toes,

you know, super super handsome, looking just like me. And it's just we're just overwhelmed with all this, just joy and pride of just welcoming this precious gift into our lives. And so shortly after the delivery, they take us back to recovery. You're sitting in the bed resting, and Lengthon

is there and the little incubator toaster thingy. And as I'm sitting there, I looked down here's bedside, and I begin to see the calf that are the fully catheter coming from her bedside begin to turn pink with blood. And so this was around four o'clock in the afternoon, and I brought it to the attention to the doctors and the nurses and cedars, and they come in, they examine cure, They examine her physically and take her vitals.

They do an art sound, but very importantly, they order a CT scan to be performed stat When the results from those initial tests come back, they're not good. Kira's blood levels are abnormal and the ultrasound shows fluid filling her abdomen, but there's no action from the staff. As CIA's condition continues to deteriorate, she's forced to wait for the next step. The CT scan. Six o'clock comes, no

CT scan. Seven o'clock, no CT scan, eight o'clock, Still no CT scans, Still haven't take her back to surgery. Ten o'clock comes, no CT scan. E eleven o'clock comes, no CT scan. At this point, Kira's pale, shivering, uncontrollably, and sensitive to touch. In the seven hours since Charles first noticed blood and Kira's catheter, he and his family have been relentlessly advocating for her, asking for help, asking for that CT scan, for attention, for anything. Were you

going crazy, Charles? I can only imagine that you were, uh, you know, I think about Shirley McClain in terms of endearment, that you were just furious. I was doing my best to stay calm in this In this moment, I have a wife who is clearly um fighting for her life. I have a newborn baby. I have family members that are all looking and saying, what's going on? We need answers. And Kira's whole time, even her most vulnerable, her thing to me was, baby, just stay calm in that moment.

As much as I wanted to yell and scream and slam my fists on the nurses station or grab a doctor by the collar, what Kira knew, even her most vulnerable state, was that the moment I raised my voice, the moment I become too aggressive as an African American male, I become seen as a threat. And ultimately she was concerned that I would be then that they would call security,

and then I'd be removed from the situation. Um. And so even in my most heightened the point of anger, I do my best to stay calm and communicated as effectively as I can, and even to the point around nine o'clock Katie, I pulled a nurse to the side of Cedars and as I grabbed her by her hands and I just said, look, I looked turned eyes and said, I need help. My wife isn't doing good. They're telling us they're gonna take her back to surgery. They're telling us that they need to do a CT scam, but

nobody's coming. They haven't done anything. We need help. And the woman looked me in my eyes and said, sir, your wife just isn't a priority right now, and then she just walked away. That CT scan never comes and it isn't until after midnight that the staff makes the decision to take your back to surgery. At this point, she's extremely weak, but she's conscious and has been since Charles first alerted the staff that something was wrong more

than eight hours ago. I'm frustrated, I'm angry, I have all this mix of emotions, but a certain part of me is relieved because they're finally doing something. And you know, as we're walking down the hall uh towards the o R and I'm walking next to her bedside and I'm holding here's hand. She's holding my hand, and she's saying, baby, I'm scared. I can't even really think of many times and the you know, years I've known this woman that

she's ever uttered those words. And as I'm walking next to her, I'm doing the only thing I know how to do as a husband, which is just trying and tell her that maybe everything's gonna be okay. It's gonna be okay. They wheel her away and finally get to this point where these double doors open and they close

behind her. Ah. They take me into a waiting room, the exact same waiting room that we were in that afternoon, full of mothers with these humongous bellies and balloons and families with cameras and all this wonderful, beautiful, anxious anticipation

to welcome these new lives into the world. And now it's almost one o'clock in the morning and I'm in the I'm the only person in the room, all by myself, and it is just eerily silent, and the only thing I hear is literally the janitor's vacuum going back and forth. And about twenty minutes go by, and the set of double doors open and a set of two residents come walking through the doors, and as they get closer to me, I can see that the looks on their face it

was not good. He said, look, we couldn't be back there any longer without letting you know what happened. Um when he opened her up, there was a lot of blood and she coded. And then they go on to tell me situation is critical and they're continuing to work on her. And at that point, it's you know, Cure's energy, the way I am, the way we are. I was

just I'm just I'm just an optimist. When you told me that you're continuing to work on her in her situation is critical, that's all I needed to hear, because I'm thinking, it's Kira. She's the closest thing that I've ever met to a superhero. She's gonna be okay. Right, we had to scare but she's gonna be okay, is what I was thinking at that point. And I probably told him I said, look, thank you for coming out and telling me, but you're not doing anything for me

by being out here. I need you to get back in there and bring me my wife back. Minutes later, surrounded by Kira's loved ones, Charles gets the unimaginable news. They told me that um she had passed and there was nothing else that they could do to Saber. Literally twelve hours earlier, we walked into this hospital with a woman that not only was in good health, it was an exceptional health. And what you're telling me, it's not computing.

This doesn't make sense. How can this happen? What did happen is that Kira's bladder was nicked during her C section, and for nearly ten hours from incision to returning to the o R, Kira bled to death. When they opened her up, they found three and a half liters of blood in her abdomen and her heart had given out. That was the last time I saw my wife. A laar, We'll be right back. On April two thousand sixteen, Kira Johnson became one of the approximately nine women who die

every year from pregnancy and childbirth related causes. To understand how we got to Kira, we have to go back to the nineteen eighties. For much of the twentieth century, the US enjoyed decades of essentially an uninterrupted decline in its maternal mortality rate, but then in the nineteen eighties, that rate started to tick back up. We thought maternal mortality was essentially solved, as we could um make improvements, we could bring down by a few deaths. But I

had no idea that actually deaths were increasing. That's Dr Deborah Bingham, founder and executive director for the Institute for Parnatal Quality Improvement and associate professor at the University of Maryland. Deborah has also been working as a pernatal nurse, bedside and administration, and in public health since nineteen seventy eight. By the two thousand's, she was the director of nursing

for two hospitals in New York City. We only had one death in like a five year period, so we I didn't have any data to tell me Otherwise, I had no personal experiences to say this is a problem. I didn't think this was a crisis, but Deborah soon found out it was in two thousand and six. She was working on her doctorate when she accepted a position in California to form the state's first Maternal Quality Care Collaborative,

an initiative to improve maternal outcomes. During the fall of two thousand and six, she was pulled into a private meeting with leaders from the California Department of Health. In this private meeting, we we were shown, um that rates of maternal death had been rising in California, and they didn't know why, nor did we. It was shocking. We knew our rates um even in the nineties were still higher than other countries, so we not significantly higher, but

slightly higher than other developed countries. So UM, I should say I knew that. I knew that our rates of maternal deaths in the United States were a little higher than other developed countries. So to even have any increase was just is very shocking. I thought we were getting better, not worse. And I still remember the room I was in and how that felt to just like, oh my gosh, what is going on? And is l And I didn't know at that time whether that was just unique to

California or was that issue for the entire country. The issue was not unique to California. It was a national trend that would only continue to rise. In n seven, the maternal mortality rate was seven point two, meaning for every one hundred thousand live births, about seven women died. Today, that rate has more than doubled to seventeen point four. Now to really understand why more mothers are dying today than they were thirty years ago. Debra says, you have

to look at what's changed in the medical industry. You can't ignore the fact that we've had a sixty nearly a six increase in cesarean birth. Now about one third of all women give birth surgically. And then there's fewer women having vaginal births after cesarean and so there's more repeat c sections, which add more risks to have the same scar open multiple times, leads to all kinds of

potential complications. Another thing that has changed over the last thirty years, more women are being admitted earlier in labor and what that means that that in the United States, we don't have a lot of hospitals, don't have like labor lounges or places where women can keep moving around, so they're often put in bad and um don't have freedom of movement in the early stages of labor, where in the past we used to help women UM have confidence go home, walk around at home, UM and come

back several hours later or maybe even their labor would stop, which now they're being admitted, and once they're admitted, then all this whole what's called a cascade of interventions happen, which then lead them down a path that could have been avoided previously. You can think of it as a path of interventions that could start with something like medication to induce labor and then end with an emergency c section. Interventions aren't necessarily dangerous, but each one has the potential

to at least introduce risk to the mother. I am a high risk perinatal nurse, meaning that I take care of Over many years, I've taken care of very, very sick women with very serious medical conditions, So I'm not opposed in any way to using induction agents or interventions medical interventions. I personally have helped intervene in many ways when needed, but as I've learned, we should not intervene for the heck of it. Devor says, there's one final

element that's worth noting here. When we're talking about this increase in the maternal mortality rate over the last thirty years, we started counting better, So we need to acknowledge that some of this increases due to better counting, which is a good thing because every death deserves to be counted and needs to be counted. So we can learn from all all of the deaths. It's a way to honor the women who died. It's a way to honor the

teams who tried to save their lives. But changes in the medical system still don't give us the full picture. There are other forces, major structural issues that caused between seven hundred and nine hundred women to die every year. A really major problem and cause is the focus on babies and fetuses rather than mothers. It's a problem that's been developing over five decades. Nina Martin is an investigative reporter at pro Publica. She spent her career reporting on

women's health. In two thousand and seventeen, Nina, along with the team at pro Publica and her partners at NPR, released a massive investigative report on the maternal mortality crisis. It was called the Lost Mother's Project, and it would go on to win a Peabody Award. Women used to die, you know, hundreds of thousands of women used to die probably a year in the turn of the twentieth century

um from pregnancy and childbirth complications. And there was enormous progress over many, many decades to to bring those numbers down and then UM. Somewhere around the fifties and the sixties UM the numbers got to be good enough where people started taking the eye off there there, you know, started really thinking about it differently. Before the nineteen sixties, the fetus was essentially inaccessible to doctors. They literally couldn't examine it, so care had to focus on the mother.

But then technological advancements and new techniques like testing amniotic fluid and sonogram imaging made it possible for doctors to monitor the fetus in utero. With the fetus now a patient, the next few decades saw a pronounced shift of care and attention away from the mother. Today, Nina Martin says, it's clear where the priorities are. You know, think about smoking and and and sort of some of the messaging around smoking during pregnancy. It's not about the fact that

smoking is really bad for moms. It's about smoking for the babies. Think about when you're giving birth. You go in and you get hooked up to monitors and everything, and the monitor is mostly there to check the fetal heart rate and to make sure that the baby signs are okay. And if the baby signs aren't okay, then it's you know, rush, rush, rush in to get the

C section. Mom signs are monitored at a much lesser rate, So much of the attention in the maternity ward after mom gives birth is around feeding the baby, taking care of the baby. What do you do? Do you know, how are you to have the car seat? You know, all of that. It's not about well, who's going to take care of you when you go home? And do you know warning signs and everything. We just kind of kick her home with the baby and don't pay any

attention to her. I mean, it's just really shocking. But there's still another structural issue putting so many American mothers at risk. Will explore that right after this. When Kia Johnson died in April of two thousand sixteen, the cause of death would be listed as hemorrhage shock. But the truth is much more complicated. What happened to Cira was not just a medical tragedy, was a medical catastrophe. Everything

that could have went wrong, in fact did so. Not only did that doctor failed Kira, but the hospital and their policies and procedures failed her. Let's talk about the role race might have played. Do you believe that it did do you believe that you were you and Kira were dismissed or not treated seriously because of because of

your skin color. Absolutely, and the reality of the situation is this is that what is clear about what happened on April twelve of two thousand and sixteen Seater Sina is that the staff and the doctors and the nurses that were responsible for Cura's life failed to seek Kira in the same way that they would see their daughter, or their mother or their wives. I thought that what

happened to here was an isolated incident. I thought that a woman who is an exceptional health who has access to care, who does all the things right, walking into a hospital like Cedar Sinai in exceptional health and not walking out to raise her boys, I thought that it was an anomal I thought, this is something that doesn't happen in two thousand and sixteen in our country. But it does happen. And of that nine hundred or so women who die every year, the vast majority are black.

Black women are more likely to die during pregnancy, three to four times more likely to die during pregnancy than white women. Monica Rose McLamore is an associate professor at the University of California, San Francisco. She has dedicated her

entire career to reproductive health and justice. So when you think about that, that group of between seven hundred and nine hundred, you know, maternal deaths in the United States, you can argue that you know, three hundred of them potentially could be black and brown women, and so that disparity or that difference is actually huge. And that's when you control for education, income status, um, insurance type, place of care, that risk is equally shared by Black women. Regardless.

If you ask Monica what's causing such a disparity, what's killing so many Black women like Kia Johnson, he agrees with Charles it's racism, pure and simple. The truth of the matter is is that you know, black death during pregnancy, in my opinion, is a canary in a coal mine. It tells us where our priorities are. It tells us. You know that that again, you know, we don't listen to and or believe black women, whether it's about pain

or whether it's about pregnancy related symptoms, contractions, whatever. We we don't value black women. It's because our lives aren't worth saving to some people. And so you know, to say that as a black woman is a really hard thing. But that that's what my gut tells me, That's what my lived experience tells me. Every time I use the word racism, people always go to the you know, interpersonal level. I am calling you a bad person in there for

your racist That's not what I'm talking about. I actually think most people actually inherently are trying to do as well as they can do with what they have, and when you know better, you should do better. But the truth of the matter is, structural racism is a different beast altogether, um because it's really about institutions, policies, and structures that actually privilege one group over another based on

race or ethnicity. We know that there is an overrepresentation of of of black people in poverty, and again that's a structural racism problem. When you think back to things like you know, red Line, where you know people were denied mortgages or given high risk mortgages, like it is a structural reason why Black people are overrepresented in being poor. I think it also shows up in terms of the differential treatment that people receive based on insurance status. Why

are we giving people different care? You know when clinical guidelines are standard based on who's paying for it back in hospitals. Systematic racism also shows up in the actual makeup of who is overwhelmingly caring for black mothers. We have not had enough courage and diversifying our health care workforce. The fact that you know, I believe one percent of physicians in the United States are are Black Americans, and I don't think nursing is much better. UM, we need

to diversify our healthcare workforce. A structural problem is if we don't believe that people of color and black people in particular have the aptitude or capacity to be able to care for communities that we come from, live and work and serve UM. I think that's just like a really really racist thing to think. At both the individual level and at a structural level. We can see the effects of institutional racism play out right now with the

coronavirus pandemic. While anyone can get COVID nineteen, racial data shows that more Black Americans are contracting and dying from COVID than whites. One analysis showed that in Chicago, black residents so far make up of the deaths there, get the account for only nine percent of the city's population. In New York City, the epicenter of the pandemic. COVID is hitting black and brown neighborhoods the hardest, like in Jackson Heights, Queens, which is the most ethically diverse neighborhood

in the country. It's a very underserved community and the community right now is being hit very, very hard by the COVID epidemic. You may recognize Dr Tracy bone Hemmerdinger from last week's episode. She's the chief of Obstetrics at the Elmhurst Hospital Center. The population that we generally see at Elmhurst is mixed community of new immigrants. We see all different ethnic backgrounds. The number one language spoken is Spanish,

followed I think very closely by Bengali. And I think that a lot of the patients that we see fall into the category of people who can't social distance because they live with large numbers of people in their homes, people who are responsible for caring for not only many children, but also their parents and their extended family uh and and people whose jobs are either domestic workers or you know, people whose jobs and livelihood may be cut off completely

and not have any access to their regular daily needs, and so I think that that puts them at significant risk for any illness. Before COVID nineteen hit, Elmer's was running programs in partnership with the Maternal Hospital Quality Improvement Network, a part of a citywide plan to reduce maternal deaths and life threatening complications among women of color. There are other initiatives as well. In California, for example, a bill that passed last year requires implicit bias training for all

healthcare workers. But Monica Macklemore says, it's just to start to really address something so widespread, prevalent, and daunting as institutional racism, you have to begin by making things better for those who have it the worst. If you're centering the people who are most vulnerable, everybody's care should actually get better because then those innovations should be translated for everybody.

But a lot of people don't believe that that if you center to people who are experiencing the greatest amount of burden, they think they're losing something. And I'm like, no, you don't understand. If we are really really like making things better for the people who have it worse, everybody should should actually experience an improvement in their care in industrialized nations. Our maternal death rate is one of the highest for income countries. We can do better. It doesn't

have to be like this. Tomorrow on a special episode of Next Question, Part two of our look at America's maternal mortality crisis. Don't worry your little head about it, because you're fine now in your baby spine, and go home and live your life and be happy that everything's okay. And so her experience was completely erased. Why maternal deaths are only the tip of the iceberg being a professional athlete,

I just thought that will never happen to me. An intimate conversation with Olympian Alison Felix and the courageous people who are working to save American mothers. That's tomorrow on Next Question. To understand how the coronavirus is affecting pregnant women, check out last week's episode called how Do You have a Baby during a Pandemic? On Apple podcast, the I Heart Radio app or wherever you listen to your podcasts. Next Question with Katie Couric is a production of I

Heart Radio and Katie Curreic Media. The executive producers are Katie Currik, Courtney Litz, and Tyler Klang. The supervising producer is Lauren Hansen. Our show producer is Bethan Macaluso. The associate producers are Emily Pinto and Derek Clements. Editing by Derrek Clements, Dylan Fagan and Lowell Berlante, Mixing by Dylan Fagan. Our researcher is Gabriel Loser. For more information on today's episode, go to Katie Currek dot com and follow us on

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