Written by: Danielle DeSimone, Executive Contributor
Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.
The United States is currently undergoing a maternal health crisis that’s impacting pregnant women and everyone who loves them. Maternal outcomes are the worst they’ve been since 1964, and more women are dying from complications of childbirth in the United States than in any other developed nation! If this fact infuriates and terrifies you, you’re not alone. It’s clear that women are not receiving critical support and care that they need to have healthy pregnancies and safely welcome their babies into the world. However, according to the National Institute of health, 80% of maternal deaths are preventable. You can dramatically reduce your and your baby’s risks during pregnancy and birth by building a supportive and comprehensive care team, paying close attention to your health in every trimester of pregnancy, and learning how to advocate for yourself and your growing baby.
What’s behind the U.S. maternal health crisis?
Racism and inequality in our healthcare system is a major cause of increasing maternal mortality rates. In fact, black women are three to four times more likely to die from pregnancy complications than white women, largely due to less access to resources and quality healthcare in communities of color. Maternal care deserts, which are communities that lack important resources like obstetrician units in hospitals, are more likely to be located in black and brown communities. These communities are under-equipped to safely support birthing parents and intervene in the case of a problem, mainly due to a lack of funding. However, while the maternal health crisis is disproportionately impacting women of color, maternal mortality rates for white Americans are still five to seven times higher than they are in most other high-income countries. The broken U.S. healthcare system effects all Americans with its skyrocketing insurance premiums and nearly complete lack of preventative care. High healthcare costs in general leave many women lacking necessary prenatal care regardless of race. Roughly half of pregnant Americans are skipping some or all of the prenatal care and monitoring that’s needed to prevent health problems for mom and baby. We know that frequent monitoring during pregnancy is the first step in identifying potential risks and treating them before they become full-blown health concerns. And Americans are sicker than ever with conditions that increase prenatal risks, such as obesity, high blood pressure, and metabolic syndrome. Poor health status plus reduced access to health care is a recipe for disaster when it comes to pregnancy. Perinatal mood disorders are also on the rise in the United States. More mothers-to-be are experiencing increasing anxiety and depression, and the extreme lack of support for birthing people during pregnancy and after birth leaves especially vulnerable people nowhere to turn. The COVID pandemic limited the resources available to pregnant women and mothers. However, pre-pandemic support systems in the U.S. weren’t exactly robust. Having a baby should be a joyful event, but without that promised village to help with care and resources, and with the constant pressures and expenses of everyday life, more mothers-to-be are feeling overwhelmed and alone than ever before
The main causes of maternal mortality in the United States
Cardiovascular disease is the leading cause of maternal mortality worldwide and in the U.S., accounting for over a third of a maternal deaths. Cardiovascular disease encompasses a wide range of health problems including congenital heart disease, cardiomyopathy, and high blood pressure which can lead to preeclampsia and eclampsia. During pregnancy there is significantly more strain on the heart due to increased blood volume, heart rate, and cardiac output. For some pregnant women, a heart condition that was previously benign worsens during pregnancy, and for others, a new condition arises during pregnancy. Big risk factors for cardiovascular disease during pregnancy include obesity, high blood pressure, and being over age 40. Women with any of these risk factors, or with known congenital heart disease, should work closely with their doctors before and during pregnancy to identify and manage risks.
Additionally, adopting healthy lifestyle changes including maintaining regular exercise, achieving a healthy weight prior to pregnancy and monitoring pregnancy weight gain, improving metabolic health through proper nutrition, and managing stress can significantly reduce cardiovascular disease risks during pregnancy. Postpartum hemorrhage is responsible for roughly 11% of American maternal deaths, a number that’s doubled in the last 20 years. Many pregnancy risk factors, including gestational diabetes and preeclampsia, increase the risk for postpartum hemorrhage, so it’s especially important to intervene early when these conditions are detected. Additionally, advanced maternal age, c-section birth, labor induction, prolonged labor, and placenta previa all increase risk for postpartum hemorrhage. Another common risk factor is iron deficiency anemia, possibly because it increases the chances of developing the aforementioned risk factors. Iron deficiency effects 38% of pregnant women worldwide and is the most common nutrient deficiency during pregnancy. Like many other risk factors, iron deficiency anemia is preventable with regular prenatal care screenings and early interventions. Postpartum infections are the third leading cause of maternal mortality in the U.S. and most commonly result from obstetric infections after c-section births. The United States has significantly higher c-section rates, with just over 32% of births being c-sections in 2021 compared to about 21% for other developed nations. Top factors behind America’s high c-section rates include increased rates of medical interventions during labor, the popularity of obstetricians, who are trained surgeons, performing births over midwives, and hospital policies. Many U.S. women and families mistakenly believe c-section births are safer. However, since c-section births have become more popular neonatal outcomes have not improved and maternal outcomes have actually worsened. Other factors including frequent cervical checks, premature rupture of membranes or “breaking the water,” and poor health status going into birth all increase postpartum infection risk.
Preconception care and preventing risks
Having a healthy pregnancy starts long before conception. However, most women only seek care upon getting that positive pregnancy test. This is related to the lack of preventative healthcare in the United States: Our medical system is set up to diagnose and treat existing conditions, not to prevent health conditions from happening in the first place. This is an ineffective healthcare model because it’s significantly easier and less expensive to keep a healthy person well than it is to return a sick person to a state of health. Beginning your pregnancy in a state of optimal health dramatically reduces your risk for developing the complications that are leading causes of maternal death. The goal is to lay the groundwork for a healthy pregnancy before you get pregnant so that you have a better chance of maintaining a state of health throughout your pregnancy and birth.
As a functional fertility and pregnancy coach, I advise clients to begin optimizing their health at least one year prior to trying to conceive. Pay special attention to factors that contribute to the top maternal health risks, including diabetes and insulin resistance, high blood pressure, high cholesterol, poor cardiovascular health, and micronutrient deficiencies. If you don’t have a year to wait, any amount of time spent improving your health habits prior to getting pregnant will help reduce your and your baby’s risks. If you’re already pregnant it’s even more important to address any known risk factors or conditions as early as possible, and to build the support you need to cultivate and keep up with healthy habits throughout your pregnancy.
The importance of prenatal care
Once you’re pregnant, your regular doctor’s or midwife’s visits become critically important in monitoring your health and addressing concerns before they become full-blown problems.
Attending your scheduled prenatal visits ensures that you’re being screened for common pregnancy complications throughout your pregnancy, and catching complications early mean that you and your care team have a better chance of managing them so that they don’t become serious problems. Additionally, your doctor or midwife will check on your growing baby at regular intervals and be able to identify possible concerns that may need specialized medical attention before or shortly after birth. Regular prenatal care significantly reduces mom’s and baby’s risks: Women who do not receive prenatal care are five times more likely to die during pregnancy and childbirth than women who do receive care, and their babies are three times more likely to to have a low birth weight. Contrary to what many people think, prenatal care is not always cost-prohibitive! Pregnant women without health insurance normally qualify for free or low-cost prenatal care through their state or through lower-cost clinics like Planned Parenthood and community health centers. Women who are pregnant are also often fast-tracked to gain access to free or low-cost health insurance through their local government. Be sure to choose a care provider you feel comfortable with. You’ll be seeing your prenatal care provider regularly and she or he will eventually help you birth your baby. You’ll spend time with your care provider at least monthly throughout your pregnancy and should be able to talk with him or her about physical symptoms, mental struggles, and any concerns you have and get fast, supportive responses between visits. You don’t have to stick with the first provider you meet. If you aren’t feeling respected and validated you absolutely should look into other prenatal care providers in your area or consider adding additional support like a doula or a pregnancy coach to your prenatal care team. These providers often have more time to spend with pregnant women than an obstetrician or midwife, they welcome your questions and help you mentally and physically prepare for birth and motherhood, and they’re keen to provide the emotional support that pregnant women may be lacking.
Taking charge of your prenatal health
Four out of five maternal deaths in the United States are preventable, which means we all have incredible power to improve our health and reduce our risks during pregnancy. The most impactful step a woman can take is to improve her overall health before getting pregnant, and if that’s not possible, to work with a professional to improve health and manage risks throughout her pregnancy. In addition to receiving regular prenatal care, women need to become their own advocates during pregnancy and raise concerns with their care team early and often. And while prenatal care is crucial, it may not be enough to provide the physical, mental, and emotional support women need to take charge of their prenatal health. A prenatal nutritionist or pregnancy coach offers the nutrition and lifestyle support many pregnant women are lacking to address risk factors at their roots and reverse them before they become full-blown health conditions.
As a functional pregnancy health coach, I’ve worked with over 600 women in the last eight years to lay the groundwork for a healthy pregnancy, reduce risks for mom and baby, and provide the education and support mom needs to feel empowered and confident throughout pregnancy. You can schedule a pregnancy health consult here to talk about your unique health concerns and get expert support in achieving your pregnancy wellness goals.
Danielle DeSimone, Executive Contributor Brainz Magazine
Danielle DeSimone is a functional fertility, prenatal, and postpartum health coach who has spent nearly a decade empowering women as they step into motherhood. Danielle has spent time in both traditional fertility medicine at the Sher Institute for Reproductive Medicine in Manhattan and in functional medicine at Parsley Health. She is the founder of Shine Total Wellness, a US based women's wellness practice that offers one on one health coaching worldwide via telehealth. Danielle's mission is to empower women to achieve vibrant fertility health and feel supported and confident throughout pregnancy and postpartum.
References:
1. National Women’s Health Network, 6 Underlying Causes of the maternal Health Crisis in the U.S., <https://nwhn.org/6-underlying-causes-maternal-health-crisis/gclid=Cj0KCQjwrfymBhCTARIsADXTabm1yomQ8ZAXqZCmP2rIK8BsoPsbB7Ntv9n_UeYUxO3 mARJWKqexJ2EaAt_UEALw_wcB>
2. Centers for Disease Control and Prevention, Four in five pregnancy related deaths in the US are preventable, <https://www.cdc.gov/media/releases/2022/p0919-pregnancy-related-deaths.html#:~:text=The%20leading%20underlying%20causes%20of,to%20the%20heart)%20(13%25)>
3. U.S. Department of Health &Human Services Office on Women’s Health, Prenatal Care,
<https://www.womenshealth.gov/a-z-topics/prenatal-care#:~:text=Prenatal%20care%20can%20help%20keep,when%20they%20see%20mothers
%20regularly.>
4. Summer, Lakota. (2023, July 5). “When Racism Blinds The Issue.”Brainz Magazine.
