The phrase “maternal deaths” tends to conjure up images of awful complications of delivery: uncontrollable bleeding after birth or the Cesarean section that goes terribly wrong. But these heartbreaking catastrophes account for the minority of maternal deaths.
Two-thirds of them happen either before birth or more than a week after delivery. In most cases, the woman is home when whatever will kill her — uncontrolled high blood pressure, heart failure, blood clots, suicide, drug overdose — initially strikes.
The maternal death rate in the United States is a public health embarrassment. At an unacceptable 17 deaths per 100,000 births, we’re behind most developed countries including Bosnia and Bulgaria.
Obstetricians and others have worked hard to prevent in-hospital tragedies, but these efforts can’t prevent the majority of maternal deaths. Some publications I’ve read recently make me think we need to turn our attention to what happens outside the hospital — in the community and in the home — and also learn how we can better leverage digital technology to prevent these deaths.
Both within and beyond the health care system, women of color are more likely to die or experience complications just before, during, or soon after giving birth. In a report in the journal Obstetrics and Gynecology last month, Dr. Rebekah Gee and colleagues analyzed maternal deaths in Louisiana over a six-year period. During that time, black women represented 37% of births but 70% of maternal deaths. The researchers also found that while 9% of deaths among white women were preventable, an overwhelming 59% of deaths among black women were preventable.
Another study showed that within any hospital in New York City, black women were more likely to experience serious maternal complications than white women, regardless of their insurance status.
To frame these findings positively, I could conclude that the American health care system is unable to adequately address the unique clinical needs of minority patients. To frame it less charitably, I’d conclude that the American health care system is inherently racist. Since either explanation is endemic, institutionalized, and unlikely to change soon, we’re going to have to be creative to find ways to prevent maternal deaths.
Among the leading causes of these deaths —high blood pressure, bleeding, infection, heart failure, blood clots, pre-eclampsia, and mental health conditions — only bleeding is obvious in its presentation. High blood pressure can be silent or written off as a headache; the symptoms of blood clots ignored; depression chalked up to “the baby blues.”
Think about it: this epidemic strikes women at home, is subject to systemic racism, and isn’t obvious in its typical presentation.
Our challenge is to create largely from scratch a surveillance system — what exists today is inadequate — for the first signs of conditions that kill women and to encourage families and the primary care health system to recognize the signs of trouble and raise warning flags. We must deploy tools that can be used at home and in the community to identify women at risk or those in the early stages of a medical crisis and get them seen quickly by the proper physician or midwife.
This epidemic presents digital health companies like the one I work for with opportunities to be part of the solution. Health apps could become integral parts of the surveillance system. Most women use one or more pregnancy apps on their phones or tablets, so I encourage these app makers to include postpartum blood pressure checks and provide guidance for abnormal readings. Apps and non-digital sources of information can develop content targeted to women of color, conduct depression screening, provide referrals for patients who are at risk, and be sources of information for women and their families that distinguishes “normal” from early signs that something’s very wrong.
Apps won’t replace clinicians or wise and vigilant family members at preventing maternal deaths. But we must come up with new ways of identifying women who are in the early stage of a life-threatening condition and get them the care they need. The current approach — focused within the health care system — isn’t working.
You can be part of the solution, too, by offering your thoughts below on how we can collectively solve this public health crisis.
Adam Wolfberg, M.D., an obstetrician, is the chief medical officer for Ovia Health. He blogs at www.adamwolfberg.com.
Preventing maternal deaths
Using the rate Maternal Deaths to market an app is unconscionable. An App won’t identify systemic racism and inherent misogyny. In the US, low income pregnant woman, work at stressful, physically demanding minimum wage jobs, and spend hours on public transportation. They often suffer complications for trying to maintain their jobs. Pregnancy makes women more vulnerable to abuse, and exploitation.
Always Be Selling, no topic is off limits for commerce in our For Profit Healthcare System. An App that may or may not violate privacy or even be beneficial, since it was not tested, there is no requirement. More useless, untried technology foisted on vulnerable pregnant women is not the answer.
This kind of marketing should really be outlawed. Apps are not going to remedy the long standing problems in our healthcare system and our society. It is clear that women are patronized, ignored or Gaslighted, when seeking basic healthcare. Racism and misogyny are well documented in healthcare. An App won’t protect a pregnant woman from substandard care, or the ideology of healthcare workers. The corporate healthcare system, drives a wedge between patients and doctors to preserve profits. Some healthcare workers actively blame and discriminate against low income people. There is no App to track any of this.
The corporate media only uses pregnancy as a marketing tool, leaving women misled and misinformed about, their risks of complications. There has been a news blackout on many pregnancy issues, while advertisers paint a rosy picture, and TV shows distort reality. A simple inexpensive tech fix, serves to offset the facts, and give the false appearance of safety. There is no factual scientific evidence that these Apps, improve survival rates. The Tech industry peddled Apps to teens to “prevent Suicide” there was no evidence that worked either, the teen suicide rate went up. American healthcare is all about marketing and misleading “consumers.”
“There is no factual scientific evidence that these Apps, improve survival rates.”
While you are here squawking and clutching your pearls, the author is looking for solutions that will save lives. We don’t know any intervention will work before we try it, that is why we start new companies/programs and do clinical trials. Why would you balk at the prospect of a cheap bit of software saving a woman’s life? Would you rather she died bearing a hammer and sickle free from the bourgeois taint of the market, or survived? Get out and start looking for cures with the rest of us.
“subject to systemic racism”
How? Is it not high blood pressure?
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