From May 2017

Misogyny is at the Heart of Our High Maternal Death Rate

A recent story by ProPublica and NPR outlines the tragic and preventable death of NICU nurse Lauren Bloomstein only 20 hours after giving birth to her first child. Despite warning signs and her physician husband voicing alarm and questioning her plan of care, Lauren died of hemorrhagic strokes resulting from untreated HELLP syndrome. HELLP syndrome is an obstetrical emergency related to very high blood pressure that accounts for nearly 8% of pregnancy and postpartum related deaths. The most ominous sign is a rapidly rising blood pressure accompanied by, epigastric pain, intense headache, and anxiety.

I have a lot of feelings when I think about this story. First I recall my experiences with preeclampsia and HELLP syndrome as a doula. In what I retrospectively call the Year of Preeclampsia, I saw first-hand how swiftly preeclampsia and HELLP syndrome can develop and progress. It was a terrible coincidence that I attended several labors in succession that were one case study after another about hypertension, preeclampsia, and actual eclampsia. Eclampsia results when untreated preeclampsia results in blood pressures so high that the woman experiences seizures. Mercifully all the mothers and babies survived, and I left these experiences with a healthy respect for clinical expertise and vigilance while also holding space for the everyday normalcy of childbirth.

A 2013 meta-analysis of data on professional labor support by the Cochrane Review concludes that all women should have access to continuous labor support because of the significant benefits to maternal health. A doula is a professional labor support person who provides, physical, emotional, and educational support to women and their families during birth. This is a non-clinical role that has grown in popularity since the release of The Business of Being Born in 2008.

As a new nurse, I read the story of the needless death of a mother with my heart in my throat. Her blood pressure was unchecked for many hours despite very high readings relative to her baseline blood pressures. As a nurse on any hospital floor, I stand between patients and peril with my blood pressure cuff; I assess and document, I reassess and document. When I get a blood pressure that seems too high or too low, I look at the patient to see if they are symptomatic; I check my equipment; I reassess how I am taking the reading; and I look at the patient’s chart to see what the trend is for this specific patient. This is standard nursing practice on every hospital floor the whole world over. It is hard to understand how such a standard assessment fell off the schedule when this woman had every alarming marker of HELLP syndrome. Yet hospitals are systems for which a tragic death cannot be blamed on one nurse or MD. Tired staff, burned-out staff, high patient to nurse ratios, experience levels, and days worked in a row are boring problems that add up to senseless errors and tragedy when good protocols and ratios are either not in place or not being followed.

As a woman, I read this story and I see a broad systemic failure that is so much bigger than a hospital, labor and delivery unit, physicians, and nurses. My mind races as I think of all the horrifying attitudes and actions by our lawmakers and leaders that openly degrade women. I think of the multitude of ways the government is stripping away health care choices for women and mothers. We are presently between Thailand and Chad in the race to have the highest increase in maternal deaths. Not only are mothers dying in our modern health care system, more of them are dying each year.

Iran, Mexico, Congo, Chad all have between 12-14 weeks of paid maternity leave in contrast to the ZERO weeks provided by the United States. We are asking women to give birth without giving them adequate postpartum support for their health or their new motherhood. The vast majority of women in the US return to work within 6 weeks of giving birth despite evidence that this is not good for women, babies, or society as a whole.

The most depressing element of this is our cultural lip service we pay to mothers, which directly influences the laws we make that can help or harm women. We elevate motherhood as the highest achievement that a woman can attain. American culture is steeped in its own variation of the Virgin/Whore dichotomy as Mother/Nothing. If you are a mother, we will give you a holiday, we will market to you, we will speak of your importance to society while we do to little to protect your life and health care as a mother, while also openly judging your post-baby body. If you have the audacity to be an adult woman and not a mother, then we will treat you as a strange other who is probably selfish, likely defective and sad given your lack of motherhood, a man-hating feminist, or too stupid to understand the beauty of motherhood.

In America, a good woman is a mother, and a mother will sacrifice even her life for her baby. The shameful thing is that this isn’t hyperbole and yet somehow it is still is a shocking surprise to us all.

Sarah Thayer lives in Simsbury, CT with her two kids, aged 11 and 13, husband Joshua, and rescue pitbull. She is a licensed massage therapist and retired birth doula. She has a degree in sociology from Central Connecticut State University and is a new graduate nurse from Capital Community College in Hartford, CT. She teaches Comfort Measures for Labor to expectant families for Hartford Hospital and plans to pursue a degree in nurse midwifery.  In her free time, she enjoys knitting, hiking with her dog, playing piano, and spending time with her friends and family. Her twitter handle @LMTDoulaSarah.



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The Blame and the Shame of Miscarriages

I had my first miscarriage when I was 37. When I found out I was pregnant, I felt so intensely special. I was proud of myself for getting pregnant  so easily after 35. Less than two months into the pregnancy, I started spotting, and when I went to get my HCG levels tested for a second time, I learned that I was miscarrying.

That weekend, I was supposed to travel a few hours east to my hometown to celebrate my mom’s birthday. My mom, who developed a degenerative brain disease at 60, was turning 64.  I felt too fragile to go. I couldn’t imagine hiding my sadness and it didn’t occur to me that I could tell people. I had internalized the commandments of womanhood: you shall not divulge that you are pregnant before you and your fetus have made it through the first three months. I’ve never been good at hiding my emotions, so I made up an excuse and skipped my mom’s birthday party.

In a recent interview on this site, a 57-year-old woman describes her miscarriage to her daughter. When her daughter, a millennial, curious about her mother’s reproductive history, asks her what she thinks caused the miscarriage, she responds, “It was not my fault.” When we were ready to publish the interview, this mom of two successful daughters asked that we use a pseudonym.

Why did this mom feel the need, twenty years later, to say that her miscarriage wasn’t her fault? Why did she insist we use a pseudonym? Why did I feel like I couldn’t just call my family and say, “I had a miscarriage. I’m sad. I’m coming to mom’s party.”

Here are some synonyms of the word miscarriage: failure, foundering, ruin, ruination, collapse, breakdown, thwarting.

She miscarried; she carried it wrong. She lost the baby. How reckless.

I guess it’s pretty easy to see why she felt she needed to explain, twenty years later, that it wasn’t her fault. I guess it’s pretty clear why I hid out after my miscarriage. Paula Knight, a graphic illustrator and writer, captures all the shame and blame associated with miscarriage in her powerful comics and drawings, which explore miscarriage and childlessness:

“Failed” by Paula Knight, 2012

What if men had miscarriages? Would they be called miscarriages? My guess is that the word for miscarriage would imply less blame. The fetus died? Spontaneous abortion?

We are taught from a young age to whisper and hide: we whisper about our first periods; we hide our tampons, shoving them in a pocket as we walk to the bathroom. I remember a salesperson at CVS being appalled when I didn’t want a bag to carry my tampon box out of the store. I was a twenty-something-year-old woman. Yes, I menstruated. Why should I hide it?

Maybe it shouldn’t be the woman who is pregnant and then not pregnant who is so responsible for everything, for the secrecy, for the carrying the burden of a loss, etc. Maybe others can learn how to respond to the loss of a fetus. Maybe people could just agree not to grill pregnant women or women who are in their childbearing years, not  to ask so many questions, and if someone has a miscarriage they can tell you or not tell you, and you can respond by saying, “I’m sorry. How are you feeling?”

It wasn’t until I had a miscarriage that the miscarriage narratives came pouring in. Hearing about others’ miscarriages made me feel less doomed, less broken, less of a failure. This is why it’s so important that 57-year-old mom shared her experiences with her daughter, even if she was not comfortable associating herself publicly with miscarriage. By sharing her miscarriage narrative, she normalized miscarriage for her daughter. Hearing others’ stories and knowing that miscarriage is fairly common (as many as 50% of all pregnancies) does not eliminate the pain that accompanies miscarriages, especially for women who’ve undergone multiple, but it does  go a long way in helping women feel less isolated, less ashamed, and less guilty.

The miserable feelings that accompanied my first miscarriage were compounded by my age at the time (37), by my childlessness, and by the fact that I didn’t know miscarriages were extremely common. What a relief it would’ve been for me to hear the miscarriage narratives before I miscarried. Maybe I would’ve been able to go to my mom’s birthday party.

Have a miscarriage narrative? A better term for miscarriage?  Share with us in the comments, write an essay, or be interviewed.

Read previous MotherShould? essays about miscarriage here.

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