Utah maternal mortality rates not improving despite preventive measures

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Editor’s note: This story pairs with “Nurses, students work toward reducing maternal mortality

Bethany Hillary, a mother of four, has type 1 diabetes, meaning all her pregnancies are high-risk.

Hillary attended nonstress tests twice a week toward the end of her pregnancy with her fourth child. Doctors monitored Hillary’s contractions and her baby’s heart rate during these tests.

Bethany Hillary holds her newborn baby, Eden, after delivery in July 2017. (Bethany Hillary)

In July 2017, during a nonstress test a week before Hillary’s scheduled cesarean section delivery, her doctors decided they needed to perform the C-section immediately.

“It was a little bit rushed,” Hillary said. “My husband barely made it there and we only live 10 minutes away, so that’s how fast they were moving with this one.”

Riverton Hospital doctors made an incision in Hillary’s abdomen and removed her baby.

Although her diabetes had been “very well controlled” during the pregnancy, her baby weighed almost 11 pounds at delivery. When the doctors removed the baby, the incision expanded, which affected some major arteries around the uterus, according to Hillary.

“Delivery went great until the very end when they realized I had lost a ton of blood — at least double what they typically expect to see during a C-section,” Hillary said.

Hillary received a blood transfusion that day and a second transfusion the next day.

Hillary said she usually feels better immediately after delivery simply because she’s not pregnant anymore, but it took her at least a week to notice the difference after this delivery, “because I had just been so absorbed in, ‘Oh my gosh, I feel like I’m dying right now because I have no blood.’”

Hillary’s feelings aren’t just hyperbole — her life was in danger, and it’s an experience that’s far more common for expectant mothers in the U.S. than in other wealthy countries.

Maternal mortality — when a woman dies during pregnancy or within 42 days after delivery — reached 26.4 per 100,000 in the U.S. in 2015, up almost 50 percent since 2000. Only 12 other countries’ maternal mortality rates have risen since 1990.

The U.S. rate is more than three times Canada’s rate. Between 20 and 50 percent of these deaths are preventable, according to a report from the CDC.

The U.S. maternal mortality rate was three times that of Canada in 2015. (Ashley Lee)

After a statewide pregnancy-associated mortality review, California hospitals started using evidence-based toolkits to address postpartum hemorrhage and pre-eclampsia, two major causes of maternal mortality.

By 2013, California’s maternal mortality stood at 7.3 per 100,000, according to the California Maternal Quality Care Collaborative.

Maternal mortality in Utah is 15.6 per 100,000 as of 2014, according to Utah’s Public Health Indicator Based System.

Utah has introduced preventive measures similar to those California has been using, according to BYU nursing professor Debbie Edmunds.

Yet according to these figures, Utah’s rate is lower than the national average, but still twice as high as California’s.

“Despite efforts, despite changes in educational strategies, we’re not seeing the same decrease in maternal morbidity (illness) more than mortality (deaths),” said Christina Elmore, who teaches intrapartum complications to doctorate midwifery students at the University of Utah. “We’re kind of seeing those rates more stable.”

Two of Hillary’s four children were born outside Utah, at the Maternal and Infant Care Clinic in the University of Washington Medical Center in Seattle. The clinic caters specifically to expectant mothers with diabetes, whether type 1, type 2 or gestational.

Washington State’s maternal mortality rate has not risen over time, unlike the U.S. rate, sitting at 9 per 100,000 for 2014-2015, according to that year’s Maternal Mortality Review from the Washington State Department of Health.

But Hillary said she had more complaints about her first delivery than her most recent one.

“I was really happy with the care I had,” Hillary said. “I don’t have any complaints about how things were handled. It would have been nice if the stars aligned and I didn’t lose blood, but they couldn’t have avoided that. They treated it very well once it did happen.”

Emily Peterson delivered her first child in June 2017 at Timpanogos Regional Hospital.

Her pregnancy was normal and low-risk up until around 34 weeks, when she started having high blood pressure and was diagnosed with pre-eclampsia. Peterson was induced into labor five days before her due date because of her high blood pressure.

She couldn’t hold her baby for more than 30 seconds immediately following the delivery because she was weak from losing so much blood. She received a blood transfusion that day, but her condition continued to get worse, according to Peterson.

Several hours later, her doctors discovered pieces of her placenta were still stuck inside her body and performed surgery to scrape the placenta out.

Peterson received three more transfusions before leaving the hospital. She didn’t realize how serious the situation had been until days later.

“If I hadn’t had transfusions or anything, if I hadn’t been at a hospital, if I hadn’t been in a country where there’s blood available, I would’ve lost my life,” Peterson said. “So it was lucky to be in a hospital, in a place where they could handle it all.”

And Peterson, too, insists her doctors were “amazing” and couldn’t have done anything to better care for her.

Both Peterson and Hillary said they knew very little about what could go wrong during delivery.

“I hadn’t really researched a lot, where I really wasn’t prepared for things to go wrong,” Peterson said. “I was just kind of hoping for the best, and I didn’t give much thought to what could go wrong, so I was pretty ignorant in that matter.”

Hillary said she didn’t hear about potential problems until more of her peers had also had children.

“I was kind of the first of my cohorts in grad school to have a baby, the first of my friends from high school that I was still really close with to have a baby, and so I hadn’t really been exposed to problems,” Hillary said.

But each situation is unique, and “there’s no way to prep for it, absolutely no way,” Hillary said. “Even if you’ve delivered one or two or three other babies, it could very likely be a totally different situation.”

Hillary said as long as expectant mothers trust their medical professionals with their lives and the lives of their babies, they’ll be fine.

“(Medical professionals) will know what to do because they have more experience,” Hillary said.

Peterson said she wishes she had known every birth isn’t the picture-perfect, Instagram-worthy one where the mother is able to hold her newborn immediately.

“Everything worked out fine; I guess I just wish that I had been more prepared to not have a perfect delivery,” Peterson said. “I had a lot of resentment after birth because I just felt like I didn’t get that bonding time for a long time.”

Peterson said she felt better after hearing about other women’s birth stories.

“I realized it happens a lot more than you think,” Peterson said.

But even if it takes some time, “you can still bond with your child, even if you don’t get that immediate bonding experience,” Peterson said.

Hillary said it’s important to be flexible about delivery.

“If you are really particular about how certain things go during the delivery, just make sure it gets communicated,” Hillary said. “Otherwise, just trust that if you’ve picked a good provider, things will be fine.”

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