NPR special - maternal mortality in United States INCREASING!

Bryan Anselm for ProPublica

Larry floated around on his own cloud of euphoria, phone camera in hand. In one 35-second video, Lauren holds their daughter on her chest, stroking her cheek with a practiced touch. Hailey is bundled in hospital-issued pastels and flannel, unusually alert for a newborn; she studies her mother's face as if trying to make sense of a mystery that will never be solved. The delivery room staff bustles in the background in the low-key way of people who believe everything has gone exactly as it's supposed to.
Then Lauren looks directly at the camera, her eyes brimming.
Twenty hours later, she was dead.
"We don't pay enough attention"

The ability to protect the health of mothers and babies in childbirth is a basic measure of a society's development. Yet every year in the U.S., 700 to 900 women die from pregnancy or childbirth-related causes, and some 65,000 nearly die — by many measures, the worst record in the developed world.
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American women are more than three times as likely as Canadian women to die in the maternal period (defined by the Centers for Disease Control as the start of pregnancy to one year after delivery or termination), six times as likely to die as Scandinavians. In every other wealthy country, and many less affluent ones, maternal mortality rates have been falling; in Great Britain, the journal Lancet recently noted, the rate has declined so dramatically that "a man is more likely to die while his partner is pregnant than she is." But in the U.S., maternal deaths increased from 2000 to 2014. In a recent analysis by the CDC Foundation, nearly 60 percent of such deaths are preventable.
While maternal mortality is significantly more common among African-Americans, low-income women and in rural areas, pregnancy and childbirth complications ? women of every race and ethnicity, education and income level, in every part of the U.S. ProPublica and NPR spent the last several months scouring social media and other sources, ultimately identifying more than 450 expectant and new mothers who have died since 2011.

The list includes teachers, insurance brokers, homeless women, journalists, a spokeswoman for Yellowstone National Park, a cofounder of the YouTube channel WhatsUpMoms, and more than a dozen doctors and nurses like Lauren Bloomstein. They died from cardiomyopathy and other heart problems, massive hemorrhage, blood clots, infections and pregnancy-induced hypertension (preeclampsia) as well as rarer causes. Many died days or weeks after leaving the hospital. Maternal mortality is commonplace enough that three new mothers who died, including Lauren, were cared for by the same ob/gyn.
The reasons for higher maternal mortality in the U.S. are manifold. New mothers are older than they used to be, with more complex medical histories. Half of pregnancies in the U.S. are unplanned, so many women don't address chronic health issues beforehand. Greater prevalence of C-sections leads to more life-threatening complications. The fragmented health system makes it harder for new mothers, especially those without good insurance, to get the care they need. Confusion about how to recognize worrisome symptoms and treat obstetric emergencies makes caregivers more prone to error.

In 2009, the Joint Commission, which accredits 21,000 health care facilities in the U.S., adopted a series of perinatal "core measures" — national standards that have been shown to reduce complications and improve patient outcomes. Four of the measures are aimed at making sure the baby is healthy. One — bringing down the C-section rate— addresses maternal health.

Meanwhile, life-saving practices that have become widely accepted in other affluent countries — and in a few states, notably California — have yet to take hold in many American hospitals. Take the example of preeclampsia, a type of high blood pressure that only occurs in pregnancy or the postpartum period, and can lead to seizures and strokes. Around the world, it kills an estimated five women an hour. But in developed countries, it is highly treatable. The key is to act quickly.

By standardizing its approach, Britain has reduced preeclampsia deaths to one in a million — a total of two deaths from 2012 to 2014. In the U.S., on the other hand, preeclampsia still accounts for about 8 percent of maternal deaths— 50 to 70 women a year. Including Lauren Bloomstein.



Loss was less common in labor and delivery, and when a new mother suffered life-threatening complications, the news did not always reach the NICU floor. Thus, when a 29-year-old special education teacher named Tara Hansen contracted a grisly infection a few days after giving birth to her first child in March 2011, the tragedy didn't register with Lauren, who was then three months' pregnant herself.
Hansen lived in nearby Freehold, N.J., with her husband, Ryan, her high school sweetheart. Her pregnancy, like Lauren's, had been textbook perfect and she delivered a healthy nine-pound son. But Hansen suffered tearing near her ? during childbirth. She developed signs of infection but was discharged anyway, a lawsuit by her husband later alleged.
Hansen was soon readmitted to Monmouth with what the lawsuit called "excruciating, severe pain beyond the capacity of a human being to endure." The diagnosis was necrotizing fasciitis, commonly known as flesh-eating bacteria; two days later Hansen was dead. One of Vaclavik's colleagues delivered Hansen's baby; Vaclavik himself authorized her discharge. According to court documents, he said nurses failed to inform him about Hansen's symptoms and that if he'd known her vital signs weren't stable, he wouldn't have released her. The hospital and nurses eventually settled for $1.5 million. The suit against Vaclavik and his colleagues is pending.

Vaclavik did not respond to several interview requests from ProPublica and NPR, including an emailed list of questions. "Due to the fact this matter is in litigation," his attorney responded, "Dr. Vaclavik respectfully declines to comment."

Citing patient privacy, Monmouth spokeswoman Elizabeth Brennan also declined to discuss specific cases. "We are saddened by the grief these families have experienced from their loss," she said in a statement.
"I don't feel good"

Larry Bloomstein's first inkling that something was seriously wrong with Lauren came about 90 minutes after she gave birth. He had accompanied Hailey up to the nursery to be weighed and measured and given the usual barrage of tests for newborns. Lauren hadn't eaten since breakfast, but he returned to find her dinner tray untouched. "I don't feel good," she told him. She pointed to a spot above her abdomen and just below her sternum, close to where she'd felt the stabbing sensation during labor. "I've got pain that's coming back."
Larry had been at Lauren's side much of the previous 24 hours. Conscious that his role was husband rather than doctor, he had tried not to overstep. Now, though, he pressed Vaclavik: What was the matter with his wife? "He was like, 'I see this a lot. We do a lot of belly surgery. This is definitely reflux,'" Larry recalled. According to Lauren's records, the ob/gyn ordered an antacid called Bicitra and an opioid painkiller called Dilaudid. Lauren vomited them up.

Lauren's pain was soon 10 on a scale of 10, she told Larry and the nurses; so excruciating, the nurses noted, "Patient [is] unable to stay still." Just as ominously, her blood pressure was spiking. An hour after Hailey's birth, the reading was 160/95; an hour after that, 169/108. At her final prenatal appointment, her reading had been just 118/69. Obstetrics wasn't Larry's specialty, but he knew enough to ask the nurse: Could this be preeclampsia?

Preeclampsia, or pregnancy-related hypertension, is a little-understood condition that affects 3 percent to 5 percent of expectant or new mothers in the U.S., up to 200,000 women a year. It can strike anyone out of the blue, though the risk is higher for African Americans, women with preexisting conditions such as obesity, diabetes or kidney disease, and mothers over the age of 40. It is most common during the second half of pregnancy, but can develop in the days or weeks after childbirth, and can become very dangerous very quickly. Because a traditional treatment for preeclampsia is to deliver as soon as possible, the babies are often premature and end up in NICUs like the one where Lauren worked.

As Larry suspected, Lauren's blood pressure readings were well past the danger point. What he didn't know was that they'd been abnormally high since she entered the hospital — 147/99, according to her admissions paperwork. During labor, she had 21 systolic readings at or above 140 and 13 diastolic readings at or above 90, her records indicated; for a stretch of almost eight hours, her blood pressure wasn't monitored at all, the New Jersey Department of Health later found. Over that same period, her baby's vital signs were being constantly watched, Larry said.

In his court deposition, Vaclavik described the 147/99 reading as "elevated" compared to her usual readings, but not abnormal. He "would use 180 over 110 as a cutoff" to suspect preeclampsia, he said. Still, he acknowledged, Lauren's blood pressure "might have been recommended to be monitored more closely, in retrospect."

Leading medical organizations in the U.S. and the U.K. take a different view. They advise that increases to 140/90 for pregnant women with no previous history of high blood pressure signify preeclampsia. When systolic readings hit 160, treatment with anti-hypertensive drugs and magnesium sulfate to prevent seizures "should be initiated ASAP," according to guidelines from the Alliance for Innovation on Maternal Health.
When other symptoms, such as upper abdominal (epigastric) pain, are present, the situation is considered even more urgent.

This basic approach isn't new: "Core Curriculum for Maternal-Newborn Nursing," a widely-used textbook, outlined it in 1997. Yet failure to diagnose preeclampsia, or to differentiate it from chronic high blood pressure, is all too common.

California researchers who studied preeclampsia deaths over several years found one striking theme: "Despite triggers that clearly indicated a serious deterioration in the patient's condition, health care providers failed to recognize and respond to these signs in a timely manner, leading to delays in diagnosis and treatment."

rickmogul wrote: »

Good, Devil's off springs time clock is up! We got enough devil's out this ? . Our infants and children were gator bait with a smile from these EDO'S so I don't give a ? ? about a cave ? baby. She should go with it. Thin this ? herd!

Black women are increasing higher than anyone else! @rickmogul

http://www.theroot.com/the-black-maternal-mortality-rate-in-the-us-is-an-inter-1790857011