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On average, two mothers die from complications of pregnancy and childbirth every day in America. That's a rate far higher than in other wealthy countries. NPR's Renee Montagne and ProPublica's Nina Martin are investigating the reasons why. This morning we hear that the most vulnerable time for a mother is after she has her baby.
RENEE MONTAGNE, BYLINE: It is a fact that can surprise even the experts. Debra Bingham is a perinatal nurse with a doctorate in public health and a leader in the movement to bring down maternal mortality. She remembers sitting in a meeting a few years ago where she was struck by the number of deaths that can happen in the days and weeks after giving birth.
DEBRA BINGHAM: And all of a sudden, a big light went off in my mind. And it's like, oh, my gosh - the bulk of the deaths, 61 percent, are occurring in the postpartum period.
MONTAGNE: Sixty-one percent, a CDC statistic that floats up and down but has stayed consistently over 50 percent. Most women die within six weeks of birth, many in the very first week.
BINGHAM: No one can predict. The women can't predict; the nurses can't predict nor the doctors predict which women are going to have certain types of complications. Every woman should know about the post-birth warning signs. What are the symptoms? Which ones are emergencies?
MONTAGNE: But most women are not educated about postpartum risks, like Lindsay Averett in Decatur, Ga. When she gave birth to a healthy baby girl, it was more difficult than with her earlier twins. Lindsay's placenta wouldn't come out, so her obstetrician had to remove it in pieces. Here's how she remembers being discharged.
LINDSAY AVERETT: And you get the folder of aftercare instructions. And the nurse comes in and, like, (laughter) speed-reads this list of things to you. And, you know, you're still in vampire mode and hiding from sunlight as they're opening the blinds and trying to get you out of the door. And so it's possible that, you know, they mentioned things about how long afterpains should continue. But I don't recall that ever happening.
MONTAGNE: For her, those severe afterpains when she nursed her baby never stopped. And she was clammy and feverish. But...
AVERETT: A lot of what I was feeling, I - you know, I attributed to the hormonal regulation and sleep deprivation.
MONTAGNE: And it wasn't until a lactation consultant told her that those pains were not normal two full weeks after birth that Lindsay made an emergency call to her obstetrician. When he discovered her uterus was full of placental tissue and that she had a temperature of 105, her husband rushed her to the hospital.
AVERETT: Yeah, I'm a very left-brained, rational person. But I just had this overwhelming sense that I was going to die. And my response was to just to start telling my husband, you know, what to do for our children and to let them know that I loved them. And, you know, our 2-week-old baby's in the back backseat screaming. And I just kept telling him, I have to tell you this now, I said - because I just had the sense that I didn't have a lot of time. And I wanted him to understand.
MONTAGNE: When they got to the hospital, a nurse told Lindsay it looked like she was going into septic shock and that she needed to give the baby to her husband so they could prep her for surgery.
AVERETT: And I just - for the first time, that day, I just became just wild with grief and sadness and rage. I mean, I just couldn't - I couldn't have her taken for me because I was - in that moment, I just realized this could be the last time I hold my baby. (Sobbing) And I said you can give me the IV in the hallway. You know, I'll sign a release or whatever. You can treat me here. I said, but if this is the last time, I'm not going to let her go before I have to.
MONTAGNE: What should have been a 30-minute operation took two hours. But Lindsay Averett was able to go home that day. If there is a front line for educating mothers like Lindsay about postpartum troubles, it is the nurses. A new survey of what they know is online today; 372 members of the Association of Women's Health, Obstetric and Neonatal Nurses responded. Study author Debra Bingham says the results point to a critical gap in their knowledge.
BINGHAM: Some of the striking findings for us was that 46 percent of the nurses surveyed were not aware that maternal mortality rates had increased in the last decade. In fact, 19 percent thought maternal mortality had decreased.
MONTAGNE: A majority did not know that most maternal deaths occur postpartum. And two thirds of the nurses reported spending less than 10 minutes going over the warning signs. Plus, lead author Trish Suplee says many shied away from talking about the postpartum complications that could prove fatal.
PATRICIA SUPLEE: One of the things that we did hear from nurses was, well, we don't want to scare them.
MONTAGNE: Certainly, some mothers will be frightened. Marie Rose McCausland is not one of them. The week before she gave birth in Cleveland, she came across our NPR/ProPublica story on the forum Baby Bumps on Reddit. Someone had posted it under trigger - scary because it detailed the sad death of Lauren Bloomstein. So you weren't scared away. But it is scary, I think.
MARIE ROSE MCCAUSLAND: Yeah, I mean - I almost wanted to read most of the ones that said trigger warning because I wanted to know the scary things that might happen.
MONTAGNE: And five days after her son's birth, Marie did recognize something scary, the symptoms of pre-eclampsia she'd been reading about, swelling and high blood pressure. When an ER doctor did not recognize those symptoms and tried to send her home, she pushed back until she was admitted to the hospital and spent the next 24 hours on a magnesium sulfate drip, a key treatment for the complication.
MCCAUSLAND: I hate feeling like I'm, you know, complaining or being dramatic or something. And I - you know, we had just come home. And I probably would have just wrote it off just so that I could be home with the baby.
MONTAGNE: Kind of toughed it out.
MCCAUSLAND: Yeah. And thank God I didn't because it was pretty bad. I really don't - I don't know if I'd be here. (Laughter) I really don't.
MONTAGNE: Since NPR and ProPublica posted a call-out for childbirth stories, more than 3,000 women have clicked on the category, I Almost Died. And that dramatic number fits a grim reality. According to the CDC, about 65,000 American women do nearly die every year from complications of giving birth. Renee Montagne, NPR News.
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