Research

Serena Williams and Maternal Mortality in the U.S.

Have you read the Vogue interview with Serena Williams? Her story could easily have become a case of “failure to rescue.” This term is used when someone in a hospital is having signs and symptoms of a fatal problem, but the staff does not respond to the changes. There are many reasons it can happen; putting too much faith in faulty technology and not trusting what you see, trying to do too much at one time and missing important indicators, being inexperienced and not recognizing a potentially lethal pattern. It is the same problems that happen in any type of industry, it is just that in health care we are protecting lives; when we miss something, it can be fatal.

I bring this up because in this particular case, Serena Williams’ brush with maternal mortality was predictable. She entered pregnancy and birth with a clotting disorder and was likely receiving more frequent surveillance than the average post-cesarean new mother. The details are not in the story, but I try not to make assumptions about the care she received form this story because she is telling the story from a mother’s point of view and it is being retold by an interviewer with a storyteller’s point of view.  If her nurse, midwife, or obstetrician was telling the story I would hear different details. So what if she hadn’t been receiving more frequent surveillance? What if she had been the average first-time mother with no known risk factors, could her story have had a different ending?

Maybe. clinical audits have revealed that up to 50% of cases of preventable maternal mortality in the United States occurred because the health care either came too late or not at all.1  This is not unique to the US, 70% of cases of preventable morbidity in New Zealand were related to late care.2 But remember, these percentages are only measuring the health care provider role in “preventable” cases — so if something was preventable, but it happened anyway, we may assume either the mother didn’t act (didn’t go back to the hospital) or the staff didn’t act (didn’t recognize the signs, didn’t give the right treatment).

Why are we talking about this on a natural birth website? Because to date, the best way we have found to stop preventable morbidity and mortality is to use standardized care. By ensuring 1)all women are assessed for risks 2) all women with a particular risk are given the same type of care and 3) all women are monitored for early warning signs, we have actually reduced maternal morbidity and mortality.3 As a public health midwife and researcher, I see this is one of the most important interventions since hand washing. As an advocate of physiologic birth, I am concerned that viewing pregnancy and birth through the lens of “risk” will increase cases of unnecessary intervention.  I sit in this tension daily. My new projects are positioned in this tension — examining how to balance these two factors.

1.
Geller S, Koch A, Martin N, Rosenberg D, Bigger H, Illinois D. Assessing preventability of maternal mortality in Illinois: 2002-2012. Am J Obstet Gynecol. 2014;211(6):698.e1-11. [PubMed]
2.
Lawton B, MacDonald E, Brown S, et al. Preventability of severe acute maternal morbidity. Am J Obstet Gynecol. 2014;210(6):557.e1-6. [PubMed]
3.
Zuckerwise L, Lipkind H. Maternal early warning systems-Towards reducing preventable maternal mortality and severe maternal morbidity through improved clinical surveillance and responsiveness. Semin Perinatol. 2017;41(3):161-165. [PubMed]
Jennifer (Author)