Mothers Dying After Childbirth Is A Medical Issue—But Cultural, Too

Even as the U.S. rate of infant mortality has decreased, the rate of maternal mortality has increased. Here’s what male-dominated medicine has to do with it.


Published:

When a woman has a baby, she loses an organ. The placenta, grown by her body for nine months of gestation, snaps off from her uterus and drops toward the birth canal. The meaty purple bag ribboned with thick blood vessels is pushed through the cervix five to 30 minutes after the baby and, depending on the culture, is carried away to be buried, rendered, or discarded.

And that’s just the part about the placenta. The physical trauma doesn’t stop there.

Expulsion of the placenta leaves a large internal wound on the inside wall of her uterus. Contractions do their best to control blood loss as her uterus gradually shrinks, but her vagina might have third- or fourth-degree tears, crossing from her perineal muscle into her anal sphincter. This is a common post-pregnancy injury, requiring weeks of healing. Over the next few days, her breasts will harden as they begin to produce milk. Breastfeeding will cause her nipples to ache, perhaps crack or even bleed. She’ll probably be constipated and have cramping from her uterine contractions. She’s profoundly exhausted.

The 3.9 million women who give birth each year in the United States all must recover from the physical trauma of it. Yet postpartum care is inadequate, according to obstetrics experts, and the reasons might have as much to do with patriarchal attitudes toward women’s bodies as with clinical procedures.

“There is no maternal health care after childbirth. Very little,” said Eileen Fowles, a registered obstetric nurse who teaches at Walden University and recently taught at the University of Texas at Austin. She points to a common statistic: The United States has the highest maternal mortality rate of any industrialized country—17.3 women per 100,000 live births in 2013, according to the Centers for Disease Control. A team at the Maryland Population Research Center estimated it’s worse: 23.5 women per 100,000 live births. The mortality rates for black women are even higher.

The CDC defines maternal mortality as the death of women during pregnancy or within one year of the end of a pregnancy from any cause “related to or aggravated by the pregnancy or its management.” The rate has been rising since 1987, when the agency started collecting data.

Fowles has been researching maternal care for more than 25 years and believes the problem is cultural.

In her view, birth is not allocated the same resources and medical consideration as other physical trauma. “We do a lot of research on heart attacks, but we don’t do anything on postpartum adaptation because it’s considered a normal process, and there isn’t a rehab component to it,” Fowles said. “It is a natural process. It’s like healing after surgery. But you have people who have surgery [in the U.S.] for any other thing, and they’re seeing their doctor every two to four weeks. And a woman who’s had a baby doesn’t.”

As many as 40 percent of women do not attend a postpartum check-up, according to the American College of Obstetricians and Gynecologists.

The typical first postpartum doctor’s visit is four to six weeks after delivery. But serious complications can arise during that time. Hemorrhaging is a risk between the first and 12th week. Other complications include vaginal bleeding, mastitis, perineal trauma, feet and leg swelling, vertigo, insomnia, depression, and anxiety. Having to travel to a doctor with a newborn puts additional strain on a recovering new mother. It can influence her decision whether to see a doctor at all.

Not everyone agrees that culture is the primary cause of the rising maternal mortality rate.

“People don’t know exactly why. They think there’s a host of factors,” says Elizabeth Howell, professor of obstetrics, gynecology, and reproductive science at Mount Sinai Health Services in New York. The increasing age of first-time mothers and rising rates of obesity and chronic illness impact health outcomes, complicating care for both pregnant and postpartum women.

She cites inadequate health care for women in general. “We don’t do enough around preconception care and making sure that women are getting their health needs met prior to becoming pregnant, and optimizing their health before they become pregnant. That’s an issue I think we need to do a better job with.”

Women’s health care in the U.S. has long been criticized for being treated as peripheral. The decline in postpartum support can be traced to the medicalization of birth in the late 19th century—when male obstetricians muscled out midwives as the sole birth attendants.

In fact, the dominant male perspective has undermined women’s health care overall, says Maya Dusenbery, author of Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick.

She sees gender bias in both medical research and treatment. Gender stereotypes put a “double bind” on female patients: They’re perceived by their doctors to be either hysterical or delusional, no matter how obvious their symptoms may be. Consequently, she says, they fail to receive proper treatment. Making matters worse, is the normalization of women’s pain, especially when it comes to gynecological conditions.

Gender differences in the treatment of coronary heart disease have been documented for more than a decade—women being less likely to receive intensive treatment. And within gynecology, the risks can also be serious. “Today, the widespread belief—shared by the medical system and the public alike—that menstrual pain is ‘normal’ poses a barrier to the timely diagnosis of endometriosis even before a patient steps foot in a doctor’s office,” explains Dusenbery in Doing Harm.

And then there’s this: As the rate of maternal mortality has increased, the rate of infant mortality has decreased.

To Fowles, the explanation is simple but “radical,” the medical manifestation of a society that values women’s lives less. “We take care of the mother during pregnancy so closely to improve the health of the baby, not so much for the health of the mother,” she says. “This even happens postpartum.”

The divergent outcomes between mothers and infants do suggest different approaches to care, and perhaps research, too. In the recent investigative series “Lost Mothers,” ProPublica and NPR reported that “the American medical system has focused more on fetal and infant safety and survival than on the mother’s health and well-being” in the last 50 years because of an aggressive public health campaign to reverse infant mortality trends.

In the effort to save babies’ lives, mothers lost out. Consider the emergent specialty of maternal–fetal medicine, which “drifted so far toward care of the fetus that as recently as 2012, young doctors who wanted to work in the field didn’t have to spend time learning to care for birthing mothers,” ProPublica and NPR found.

Both obstetric providers Fowles and Howell agree that changes in the timing and procedures for postpartum visits are necessary. Howell calls them the “low-hanging fruit” in an otherwise vast and complicated landscape of initiatives that extend even into workplace policy. Maternity leave in Sweden, for example, gives parents up to 480 days of paid parental leave when a child is born. But comprehensive solutions like that would involve time and resources to accomplish in the U.S., says Howell, that could distract from smaller changes that might be made right away.

The American College of Obstetricians and Gynecologists currently has a caucus assessing how to improve postpartum visits.

At the 4th Trimester Project at the University of North Carolina at Chapel Hill, medical investigators studying postpartum wellness advise a two-week, then a six-week, and then a three-month visit, along with easier access to lactation consultants and mental health professionals.

Project investigator Sarah Verbiest agrees that that recovery has been an afterthought to pregnancy, labor, and delivery. “Historically, the focus of maternal and child health programs and funding has been on baby, and then on woman as carrier of baby. I think that the maternal mortality and morbidity numbers that are really popping up [are] a sign that we need to take care of women, too.

“I think it’s cultural.”

So how does the culture change? Creating visibility and empathy for postpartum recovery in the broader public may be a start. For example, destigmatizing public breastfeeding, which lowers both physical and mental maternal health risks. Or addressing shame, says 4th Trimester investigator Kristin Tully, which discourages new mothers from seeking help.

“There is a lot of potential for a sort of #MeToo moment,” Dusenbery says. “There’s a lot of silence that prevents women from sort of recognizing how common their experiences are.”

Erin Sagen wrote this article for YES! MagazineErin is an associate editor at YES! Magazine. She lives in Seattle and writes about food, health, and suburban sustainability. Follow her on Twitter @erin_sagen.

This article was republished from YES! Magazine.

See also:
The Position Of Women In Science Has Changed For The Better, But Is Still Far From Ideal
For Native Mothers, A Way To Give Birth That Overcomes Trauma

Edit Module
Edit ModuleShow Tags
Edit Module Edit ModuleShow Tags

Daily Astrology

October 15, 2018

The working week begins under promising skies. Mental faculties are sharp and morning traffic flows smoothly. The industrious Capricorn Moon is favorably aligned with Mercury and Venus in Scorpio, a celestial “whistle while you work” signature…
Edit ModuleShow Tags

Alternative Health Directory

Browse all listings »

Edit ModuleShow Tags
Edit ModuleShow Tags

Calendar

October 2018

October 14 - 18 Join the acclaimed Grandmaster William C. C. Chen for an intensive five-day Tai Chi Chuan Fall Retreat. Knowledge of the Yang-style short form is a requirement for participation....

Cost: Please see our website

Where:
Eastover Estate & Eco Village
430 East St.
Lenox, MA  01240
View map »


Telephone: 866-264-5139
Website »

More information

October 14 - November 19 60 PDAs A 36 day retreat in which acclaimed Qigong master, Junfeng Li, will meditate and practice not only Sheng Zhen Gong daily, but will also share traditions that...

Cost: Please see our website

Where:
Eastover Estate & Eco Village
430 East St.
Lenox, MA  01240
View map »


Telephone: 866-264-5139
Contact Name: Yingxing Wang
Website »

More information

Lunare is open to magickal vendors and holistic practitioners wishing to offer their spiritual goods and services to an audience interested in all things mystical. General admission to...

Cost: Free general admission, lecture tickets $15

Where:
Hunt Memorial Building
6 Main St
Nashua, NH  03064
View map »


Sponsor: Lunare Mystics
Telephone: 603-801-2113
Contact Name: Alyssa O'Mara
Website »

More information

Show More...
Show Less...

Join Psychic Medium Diane Lewis for gallery style readings. Diane will be connecting to spirit delivering messages from those who have crossed over. Don't miss this free event sponsored by...

Cost: Free

Where:
Hopkinton Public Library
13 Main Street
Hopkinton, MA, MA  01748
View map »


Sponsor: Hopkinton Public Library
Telephone: 617-645-6415
Contact Name: Diane Lewis
Website »

More information

Break emotional patterns that keep you stuck in the pain of addictive habits. Heal mental trauma through physical practices involving movement, breath, and meditation.

Where:
Yoga at the Ashram
368 Village Street
Millis, MA  02054
View map »


Sponsor: Yoga At The Ashram
Telephone: (508) 376-4525
Website »

More information

Show More...
Show Less...
No Events

The class is a combination of qi gong, yoga, meditation, and relaxation followed by a cup of healing tea. The class, developed by Korean enlightened master Ilchi Lee, is based on Sundo, a...

Cost: $10

Where:
Divine Paradigm
58b Macy St
Amesbury, MA  01913
View map »


Contact Name: Brad Fanger

More information

With Carrie Rowan Wednesday evenings at 7pm, a 4-week introductory class that teaches quick energy medicine tools, mini meditations to help moms/dads and caregivers reduce stress and stay calm...

Where:
Fitzgerald Institute
Northboro, MA


Telephone: (508) 273-2610
Website »

More information

Show More...
Show Less...

October 18 - 21 Magnetic-harmonic vibrational therapist, Jay Emmanuel, A.K., N.S.,V.M. shares powerful energy techniques that use the forces of sounds produced by the human voice in combination...

Cost: Please see our website

Where:
Eastover Estate & Retreat Center
430 East St.
Lenox, MA  01240
View map »


Telephone: 866-264-5139
Contact Name: Yingxing Wang
Website »

More information

Course participant experiences:  “After this course, I learned how to recognize where I hold my tension and release it.”  “My favorite part of the program is the...

Cost: $650

Where:
CHA Center for Mindfulness & Compassion
26 Central Street
2nd Floor Community Room
Somerville, MA  02143
View map »


Sponsor: CHA Center for Mindfulness & Compassion
Telephone: 617-591-6132
Contact Name: Bridget Kiley
Website »

More information

The H.E.A.R.T. Program® (Health Empowerment and Real Transformation) is an innovative holistic curriculum addressing the current health crisis and epidemics of obesity, heart disease, and...

Cost: Free

Where:
Wilbraham Senior Center
45 Post Office Park, #4502
Wilbraham, MA  01095
View map »


Sponsor: Harmony Way
Telephone: 413-636-2475
Contact Name: Michelle Caron
Website »

More information

Daily practice for peace, healing, Christ mindedness, meditation, awakening.

Where:
Milton, MA


Telephone: 617-696-5685
Website »

More information

Show More...
Show Less...

14 CEU Credits for Massage/Bodywork Therapists! Oct 19-21: Chi Nei Tsang And...pre-weekend women only event: Oct 18: Women’s Sexual Ecstacy - 1-6pm/6CEUs Chi Nei...

Cost: Please see our website

Where:
Eastover Estate & Eco Village
430 East St.
Lenox, MA  01240
View map »


Telephone: 866-264-5139
Contact Name: Yingxing Wang
Website »

More information

October 19 - 20 (Workshop runs 10-5 both days) When the phase of the Sixth Sun began with the eclipse of July 11, 2010 it was time, according to Sergio’s teacher, for the ancient...

Where:
Natick Mariott Courtyard
Natick, MA


Contact Name: Sandy Corcoran
Website »

More information

With Yogi Amandeep Adi Shakti represents all divine energies. When activated, she manifests herself as creativity, prosperity, wisdom. Rare workshop uniting ancient science of Kundalini...

Where:
Yoga at the Ashram
368 Village St
Millis, MA  02054
View map »


Telephone: (508) 376-4525
Website »

More information

Connect with the ancient wisdom of yoga. Learn how yoga practices are designed to address life’s problems, such as work stress, relationship difficulties, and common mental health issues. Be...

Cost: $40

Where:
Yogalife Institute of NH
6 Chestnut Street
Lower Level
Exeter, NH  03833
View map »


Sponsor: YogaLife Institute of NH
Telephone: 603-867-3969
Contact Name: Alice Bentley
Website »

More information

No previous experience is required for this Friday evening event. It is essential for students who are unfamiliar with using the Pathway Prayer Process© and who plan to attend the 2-day...

Cost: $35

Where:
Circles of Wisdom - New location late Summer '18
386 Merrimack Street
Methuen, MA  01844
View map »


Sponsor: Circles of Wisdom
Telephone: 978-474-8010
Contact Name: Cathy Kneeland
Website »

More information

Bee Kind Music Class with Carrie Rowan inspires a love to music in little ones. 10am on Fridays for 8 weeks at Playtown Express in Southboro. To register call (508) 480-0022 or...

Where:
Playtown Express
150 Cordaville Road
Southboro, MA
View map »


Telephone: 508-273-2610
Website »

More information

The class is a combination of qi gong, yoga, meditation, and relaxation followed by a cup of healing tea. The class, developed by Korean enlightened master Ilchi Lee, is based on Sundo, a...

Cost: $10

Where:
Divine Paradigm
58b Macy St
Amesbury, MA  01913
View map »


Contact Name: Brad Fanger

More information

“For breath is life, and if you breathe well you will live long on earth.” — Sanskrit Proverb Join us for an evening of deep exploration and transformation using the healing...

Cost: $40 (limited hardship rates available)

Where:
Museum of Modern Renaissance
115 College Avenue
Somerville, MA  02144
View map »


Sponsor: HolotropicMA
Contact Name: Allen Howell M.Ed. LMHC
Website »

More information

Show More...
Show Less...

Refresh, refocus, simplify. Discover easy tools and strategies to prepare for an incredible holiday season. 8:00–8:30 Registration open 8:30–8:35 Welcome 8:35–9:20 Circle...

Cost: $99

Where:
Women’s Health Resource Center
9 Hanover Street
Lebanon, NH  03766
View map »


Sponsor: Almstrom Financial, Green Mt. Hypnosis, Patti Friedman, Eva Loomis
Telephone: (603) 650-2600
Contact Name: Women’s Health Resource Center

More information

October 20 - 21 Early Bird Special! Register before September 30 and save $45! Prerequisite: Be familiar with accessing the Akashic Records through the Pathway Prayer Process© either...

Cost: $350 before September 30

Where:
Circles of Wisdom - New location late Summer '18
386 Merrimack Street
Methuen, MA  01844
View map »


Sponsor: Circles of Wisdom
Telephone: 978-474-8010
Contact Name: Cathy Kneeland
Website »

More information

See all that is new at Dragonfly! Come and meet our new practitioners and teachers and learn about the innovative holistic modalities that are being offered. Participate in free classes, see...

Where:
Dragonfly Wellness Center
176 Jackson Rd.
Devens, MA  MA
View map »


Telephone: 978-487-7181
Website »

More information

October 20 & 21, 10:30am-6:30pm Practices and Approaches for PTSD, Depression and Anxiety with Erin Byron, MA, E-RYT500, C-IAYT, YACEP, Licensed Mental Health Professional Experiment with...

Cost: $325

Where:
YogaLife Institute of NH
6 Chestnut Street
Exeter, NH  03833
View map »


Sponsor: YogaLife Institute of NH
Telephone: 603-867-3969
Contact Name: Alice Bentley
Website »

More information

The shamanic rattle is a sacred tool that can be used to shift into an altered state of consciousness, sense and track energy, and heal the energetic body, which contains the codes underlying...

Cost: $40

Where:
Akasha Studio
20 Birch Street
Roslindale, MA  02131
View map »


Sponsor: Miriam Katz, Shamanic Healer
Telephone: 617-545-5142
Contact Name: Miriam Katz
Website »

More information

Show More...
Show Less...
Edit ModuleShow Tags
Edit Module Edit ModuleShow Tags