Even for healthy women, birth can be unpredictable and dangerous. It is strange to think that in this day and age, the maternal mortality rate in the US is actually increasing. Maternal death in the US increased by 27%! It went from 19 per 100,000 to 24 per 100,000, between 2000 and 2014.

More women die in the US due to pregnancy and birth-related complications than in any other developed, high-income country. Moreover, it is estimated by the CDC Foundation that at least 60% of these deaths could be prevented.

In contrast to this, California has been making leaps in the opposite direction. Saving more and more mother’s lives.

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How California has managed to go against America’s

maternal mortality trend:

Kristen Terlizzi’s Story:

Terlizzi had been diagnosed with the condition called Placenta Accreta six weeks prior to giving birth.

In normal childbirth, what will typically happen is the placenta will detach itself from the uterine wall after giving birth. But with placenta accerta, the blood vessels and other parts of the placenta grow too deeply into the uterine wall and therefore does not get detached and excreted. Like in Kristen’s case, the conditions can also cause the placenta to grow out of control.

“They couldn’t see anything not affected,” she said.

Terlizzi woke up in the intensive care unit on July 16, 2014, at the Stanford University to find out that her entire pelvis had been taken over by her rogue placenta. It had spread like cancer and her life was now in danger.

Shockingly, five minutes is all it takes for a woman to bleed to death during childbirth. Luckily for Terlizzi, she was in California where they decided to take the rate of America’s maternal mortality rate seriously and implemented strategies to be more prepared for events just like this.

Because Terlizzi had a C-section prior, with her first son, it put her at risk for acceta. The doctors planned to remove her placenta surgically after the birth of her first son, but when they saw the severity of the overgrowth they decided it was too risky to operate.

Then, several weeks later while she was still in the care of the hospital the leftover tissue caused her to develop a life-threatening blood clotting condition and the doctors then decided to take another shot at removing the overgrown placenta. Unfortunately, during the surgery where they removed the overgrown tissue along with her uterus, cervix appendix, and repaired her bladder and ureter, she began to hemorrhage. Thankfully the team of 20 doctors and nurses helping her were well prepared with precise hemorrhage guidelines. With Careful measuring, she ended up receiving 26 units of blood to effectively replace the blood she had lost.

1 in 14 women with accreta dies in America due to hemorrhaging too much blood. Yet, American hospitals are still ill-prepared for when such complicated pregnancies occur.

CMQCC: (California Maternal Quality Care Collaborative)

Based out of Stanford, CMQCC is a multi-disciplinary health collective that proves that it is possible to make childbirth safer for mothers in the state even with America’s less than perfect health care system.

David Lagrew is the creator of the “hemorrhage guidelines” that form a part of Standford’s CMQCC initiative. He is an obstetrician-gynecologist and has played a crucial part in making birth safer for mothers for over 30 years, decreasing the maternal mortality rate in California.

Risk Of C-sections:

After seeing his first case of placenta accreta David Lagrew wondered how much of it could be preventable. Seeing that there was a rise in popularity with c-sections that were not medically necessary and the link it has with placenta accreta, he decided to educate his fellow clinicians about the risks they were taking by doing so many unnecessary c-sections. Creating awareness on the subject, he hoped, would reduce the C-section rates and in doing so, also reduce related complications like placenta accreta.

His tactic was a success. Within five years, the C-section rate in Saddleback Hospital, where he was the medical director, was reduced by 50%. From there, his success only grew.

CMQCC believes in collecting data about maternal health complications that can be prevented and then finding the steps, according to the evidence gathered, on how to prevent them and then educating others on how to follow those steps.

A maternal mortality review board was started by Elliott Main, CMQCC medical director, and a group of other concerned doctors nurses, midwives, and hospital administrators to investigate each maternal death and pinpoint the root causes of each. In their research the noticed quickly that the two most common and preventable causes of death were hemorrhage and preeclampsia (pregnancy-induced severe high blood pressure). This was a huge step in preventing future deaths. Surprisingly, about 50% of the US states do not do this type of research.

C- sections is a big risk factor in developing placenta accreta that can cause complications in your next pregnancy. The placenta sticks and embeds itself onto the scar tissue from the prior cesarean section.

In the 50s this condition was quite rare with only in 30,000 deliveries in the US compared to today where it’s occurring in one in 500 births. This is mainly due to the rise of cesarean sections.

The global maternal mortality rate dropped by 44% between 1990 and 2015 worldwide after efforts to save mother’s lives were made.

The US, however, saw an increase in maternal death since 1990.

A Woman’s Worth:

Part of the reason why America’s maternal deaths have increased is the lack of proper reporting of deaths. But according to MacDorman, and other researchers of maternal health, that’s by far not the only explanation.

In many parts of the US, there has been a reduction in access to abortion and contraception that undoubtedly results in a greater amount of unplanned, unwanted and more dangerous pregnancies.

The health of women in the US also plays a big role in safe, successful births. Rising childbirth age and bodyweight are also risk factors. The use of opioids and poor access health care in low-income communities has not helped in making births safer either.

But, in other well-developed countries with similar health trends have not seen the same incline of maternal deaths, why is this?

“The argument we make internationally is that [a high maternal death rate] is often a reflection of how the society views women,” Eugene Declercq, maternal health expert at Boston University, says. “In other countries, we worry about the culture — women are not particularly valued, so they don’t set up systems to care for them at all. I think we have a similar problem in the US.”

Declercq believes that the problem with America’s maternal mortality rates is the lack of value they put on women.

Medicaid, a budget health insurance program, illustrates this perfectly. They will only cover women that are currently pregnant or shortly after pregnancy. “Nothing has captured it better for me than that: Get on when you’re pregnant, but get off when you’re not,” Declercq said.

Hemorrhage Carts:

CMQCC created evidence-based, free-to-download, step by step, toolkits to prepare hospitals and health care providers for when life-threatening maternal complications occur during childbirth.

The hemorrhage toolkit was the first which Lagrew created. It is hard to know who might be at risk for hemorrhage that is why it is so important to be prepared.

The hemorrhage cart is a simple rolling cart with drawers filled with tools and medicines specifically to manage a hemorrhage quickly and effectively. It is similar to the “code blue cart” used to treat cardiac arrest patients.

“No one had ever made the code blue for obstetrical hemorrhage,” Lagrew added. “They just said, ‘Use this drug, you need these drugs. You need to measure blood better.’”

When hemorrhaging occur in childbirth it is important to know the amount of blood being lost so that it can be adequately replenished.

Surprisingly doctors and nurses eyeball the amount of blood loss and their estimations are typically incorrect.

The CMQCC encourages what they call “quantitative blood loss”, a practice where they weigh dry sponges and pads before the surgery and then again after they have been used to soak up the blood that has been lost. This is a more accurate way of calculating how much blood the mother has lost.

Siddarth Satish, the founder of Gauss Surgical, notices that blood loss was the only vital sign in the operating room that was not carefully monitored. This sparked an idea to create an FDA-approved blood loss monitor called Triton OR. It has an iPad interface and allows healthcare providers to digitally and accurately measure their tools before and after surgery.

CMQCC wants to take their work national by teaming up with other healthcare groups. Unfortunately, the odds are against them as the federal government is moving in the opposite direction. Senate Republicans want to repeal and replace Obamacare with the Better Care Reconciliation Act. This will make access to reproductive health care and family planning services even harder for American women.

Kristen Terlizzi started the National Accreta Foundation to raise awareness about the condition that affected her.

“I had this perception that maternal mortality was a faraway issue or an issue of the past. I thought this happened in other places. I had no idea healthy mothers in this country were experiencing things like this.” She said


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