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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