Everything Below the Waist by Jennifer Block

Author:Jennifer Block
Language: eng
Format: epub
Publisher: St. Martin's Publishing Group

WIDESPREAD FAILURES

It’s worth putting this moment into context. For one, we’ve had this conversation before: in the early 1980s, the NIH appointed a task force on cesareans, and the media called it a “crisis” because the national rate had tripled—to 15 percent. Back then, it was the watchdog group Public Citizen that was shaming hospitals by publishing their C-section rates. We also had physician leaders calling for obstetric reform, and hospitals and HMOs instituting review committees in which obstetricians had to justify every cesarean. These hospitals swiftly reduced their rates of C-sections (counting all births, not just those deemed “low risk”) by several points: at one hospital from 25 to 19 percent, at another from 17.5 to 10.2 percent, and at yet another from 28 to 11 percent.21 Crop tops, high-waisted jeans—the ’80s have circled back. But today we are celebrating a national goalpost that matches the worst-performing hospitals of that decade.

Meanwhile, we’re not counting maternal deaths systematically—the United States hasn’t had an official nationwide estimate in a decade. “Our maternal data is embarrassing,” Stacie Geller, a professor of obstetrics and gynecology at the University of Illinois College of Medicine, told ProPublica. “Preventable maternal deaths are not in the basement of our priorities, they are in the sub-basement.” Another epidemiologist, who has led studies of maternal mortality, Marian MacDorman, made a direct connection between data and survival: “People are dying because the federal government is not publishing this data.”22 Her 2016 study estimated the number of maternal deaths rose by 25 percent between 2000 and 2014.23

Building on the work of Amnesty International, in 2017 Nina Martin of ProPublica and Renée Montagne of NPR revealed in bracing narrative detail—for which they won a Peabody Award—how even women with the most resources (in one case, a neonatal intensive care nurse and wife of a physician, both white, educated, and from a wealthy New Jersey suburb) can be virtually ignored following delivery, even when they report concerning symptoms—even when their physician husband raises hell about concerning symptoms.24 USA Today followed in 2018 with an investigation of dozens of hospitals that revealed “a stunning lack of attention to safety recommendations and widespread failure to protect new mothers.” Reporters wrote that “women are left to bleed until their organs shut down. Their high blood pressure goes untreated until they suffer strokes. They die of preventable blood clots and untreated infections. Survivors can be left paralyzed or unable to have more children.” They estimated that 50,000 women are injured during birth each year in the United States, making it “the most dangerous place in the developed world to give birth.”25

According to AIM, the main cause of deadly complications is “denial and delayed response from the healthcare team.” But there’s more driving this trend. Women who die or nearly die are three to four times more likely to be black. The maternal death rate for black women in Fulton County, Georgia, an area that includes Atlanta, is three times the national average, while the rate for white women there is “too insignificant to report.

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