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A Crisis of Maternal Care

Jun/03/2023 / by Lindsey Galloway
Image credits: GettyImages

Women continue to die from pregnancy-related deaths at an alarmingly high rate in the US. Here’s how we can start to change the statistics.

Mothers are facing an unprecedented crisis as maternal mortality rates continue to rise in the US, but doctors are advocating for systemic change

Despite having the largest economy in the world, the United States still continues to lag woefully behind when it comes to women’s healthcare. But new research shows that this crisis of care has reached even more alarming levels. In 2021, the US had one of the world’s worst rates of maternal mortality, as measured by the death of women related to pregnancy- or birth-related causes. 

For every 100,000 live births, there were 32.9 maternal deaths — a rate more than 10 times that of similar high income countries where levels remain at 2 to 3 deaths per 100,000. What’s worse, the levels for women of color are even more stark. Black women suffer nearly 70 deaths per 100,000 births, nearly 2.6 times higher than the rates for white women. While data on South Asian women in the US is sparse, healthcare providers know that implicit biases continue to affect care and maternal outcomes. 

Doctors say there’s no reason these rates should be this high in this country. In fact, the CDC says 84% of these deaths are preventable. But changing the status quo will have to mean structural changes, more informed and equitable care, and women and their support systems advocating for their needs. 

Combatting the Data Divide

Understanding and addressing healthcare disparities continues to be one of the most challenging aspects of care in this country, but a lack of data makes it even more difficult to accurately address the scope of the problem. For South Asian women in particular, a lack of research and specific data makes it challenging to address community-specific concerns, which is especially alarming considering South Asian women can be more likely to suffer from specific maternal-related conditions. 

“Some studies have looked at why South Asians get excluded from so much research.   Most commonly there are logistical challenges, language and cultural barriers, distrust of research , and concerns about adverse consequences of participating in research,” says Dr. Sameena Rahman, a board-certified OB-GYN, Clinical Assistant Professor of OB/GYN at the Northwestern Feinberg School of Medicine and founder of the Center for Gynecology and Cosmetics. 

Though South Asians make up nearly 25% of the world’s population, they suffer more than 50% of the world’s heart disease and heart attacks under the age of 50, as well as a higher risk of diabetes, hypertension, coronary artery disease, and PCOS. “With this much metabolic dysfunction, we are epigenetically inclined to higher risks of diabetes during pregnancy, as well as higher risks of preeclampsia and other complications of pregnancy,” says Dr. Rahman. This is even when correcting for weight and socioeconomic status, she notes. 

A Crisis of Maternal Care
Image credits: GettyImages

The Care Gap

Data suggests that women in rural communities may also struggle to get proper care, compared to their urban counterparts, says Dr. Himali Maniar, an OB-GYN at Nisha Women’s Hospital & IVF Centre who also works with ClinicSpots. “There is a lack of health education available for many women who otherwise wouldn’t know how to improve their own health outcomes due to language barriers or cultural norms,” says Dr. Maniar. “These two factors contribute significantly to the already existing maternal mortality crisis in South Asian/Indian communities.”

Women from poorer backgrounds are also more likely to experience higher levels of maternal mortality, as it can be harder to access the right healthcare resources needed. “Those with higher incomes are sometimes able to afford better care,” she says. “The alarming disparity between these two groups can cause extreme anxiety and fear for many pregnant women.”

Combating Implicit Bias

South Asian women also have reported perceiving discrimination in their healthcare encounters, which may also lead to complications and a lack of taking concerns seriously in the delivery room. 

“We know implicit bias exists in medicine and this is one of the reasons for health care disparities.  Every race of doctors, nurses, support staff, and therapists take their biases from what they have been exposed to environmentally and culturally and inadvertently will treat patients differently,” says Dr. Rahman. “Most studies demonstrated bias in favor of white patients and negatively toward people of color, worse for women of color.”

While physicians often receive implicit bias training, she notes that this needs to be done across the board in all systems and all levels of healthcare in order to improve maternal mortality. One of the biggest problems in her view is the lack of time most healthcare professionals are allotted with patients. 

“With the push from CEOs and hospital administrators to see more volume of patients, quality healthcare is impossible to deliver in those settings,” she says. “Money is at the bottom line for most hospital administrators or private equity groups that are buying out practices. Taking time and checking your bias does take time during patient encounters as does listening to patients without assuming what they have.” 

Advocating for Care

Though wider systemic changes are needed to combat the maternal mortality crisis, pregnant women and their support systems can play a big role in advocating for their own care throughout the birth and delivery process. 

Dr. Rahman says the first thing to do is to stay off social media when it comes to finding reputable information. She recommends seeking out reputable sources like the American College of OBGYN, rather than accounts that might be trying to sell supplements or other products. 

Finding the right doctor or midwife early in the process can make all the difference as well. “Find one who you are comfortable with who actually listens to you,” advises Dr. Rahman. “Once you have the knowledge to know what is normal and abnormal in your pregnancy journey (ask your doctor if you are uncertain), make sure you trust your gut instinct and be persistent until someone listens to your complaints.” 

This can also mean having a healthcare advocate come to appointments or the birth with you, like a spouse of a family member, who can help advocate for the quality of care. 

A Bigger Battle Ahead

In order to truly change outcomes for the better for women, governments need to improve information and access to marginalized communities, and prioritize the ability for pregnant women to exercise their right to quality healthcare. 

“This includes providing adequate maternity leave provisions for employed women and increasing welfare payments for those on low incomes,” says Dr. Maniar. “Additionally, it is important that fathers are given equal parental leave rights so they can provide the necessary support during this time.” 

Staying involved around the politics of healthcare also has long term implications. Some doctors worry that the tightening of abortion restrictions across the US after the overturn of Roe vs. Wade will continue to worsen maternal outcomes, as proper pregnancy care is delayed or denied. 

Finally, simply just raising awareness and improving education around maternal mortality, especially in the South Asian communities, can be a simple first step toward solving the problem. “By raising awareness of the issue, more people can be encouraged to take action and advocate for better health outcomes,” says Dr. Maniar. 

Gestational Diabetes on the Rise for South Asian Women

The CDC recently revealed a 30 percent increase in gestational diabetes mellitus (GDM), from 2016 to 2020, with the highest rate occurring among Asian-Indian women at 16.7 percent

In pregnancy, the placenta blocks a mother’s body from using insulin, which results in the pancreas working to produce more. Because this insulin doesn’t lower blood sugar, this can cause excess sugars which result in gestational diabetes. This can increase the risk for other delivery complications, as well as raises the risk for the baby to have insulin resistance. 

South Asian women also may need extra care and advocacy after pregnancy. Research shows they were more likely to develop dysglycemia, a blood glucose abnormality, within two years of childbirth. Advocating for extra follow-up care post-partum can ensure proper screening and treatment. 

Urgent Maternal Warning Signs

According to the CDC, if you were or have recently been pregnant, don’t ignore these warning signs (which can happen even a year after pregnancy) and seek medical attention right away. 

  • Headache that won’t go away or gets worse over time
  • Dizziness or Fainting
  • Changes in your vision
  • Fever of 100.4°F or higher
  • Extreme swelling of your hands or face
  • Thoughts about harming yourself or your baby
  • Trouble breathing
  • Chest pain or fast-beating heart
  • Severe nausea and throwing up
  • Severe belly pain that doesn’t go away
  • Baby’s movement stopping or slowing during pregnancy
  • Vaginal bleeding or fluid leaking during or after pregnancy
  • Severe swelling, redness or pain of your leg or arm
  • Overwhelming tiredness

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