The Conversation on Maternal Mortality Continued....

I wrote of Tori in a previous Substack post, but just this week Allyson Felix, a teammate of Tori, reported to Sean Gregory, a Time Magazine sports reporter, that her teammates and other famous Black women have had near death preeclampsia complications during pregnancy. She talks about how she and her friends were never told to be concerned if their feet became swollen. Swelling feet can be one of many signs of the development of preeclampsia. Allyson and her friends should have had access to prenatal care which encouraged them to check with their doctor about something as simple as swollen feet.

Preeclampsia is a pregnancy disease. The point of prenatal care is to look for signs of preeclampsia. In that process your doctor should tell you what to look for in order to stay out of trouble and your doctor should take what you report seriously. The doctor and you must then plan for managing the potential complications until your baby is old enough to survive birth.

One of the most meaningful signs to watch for during prenatal care is your blood pressure. A recent study has indicated that Black women do better if they can have a blood pressure cuff at home and check their pressure on a daily basis. I always asked my patients to check their pressures at home. That is the single best thing you can do to manage preeclampsia. With preeclampsia, blood pressure doesn’t just suddenly skyrocket. It generally starts to go up slowly. Checking blood pressure at home is safe, cheap, and very effective.  

I have delivered approximately 6000 babies and worked with over 1000 preeclamptic women and together we managed their symptoms well. I have had no maternal deaths in the patients I’ve delivered. I know from experience that preeclampsia can be managed well if it is recognized and treated in time. While delivery of the baby is the only recognized treatment for eclampsia, it’s often possible to manage preeclampsia well enough for the mother to carry her baby to 32 weeks, an age offering the baby a good chance of survival.

I created the video course “How to Avoid Losing Your Life in Childbirth” to give women an opportunity to learn what they needed to know to recognize the signs of preeclampsia and discuss management of the symptoms with their doctors. Women need access to the information that gives them the confidence to discuss their treatment preferences with their doctor. Women need to know that in cooperating with their physician, the woman decides what course of treatment she wants, even if her physician prefers a different approach. Informed consent is more than signing a bunch of papers shoved in front of you when you check into a clinic or hospital.
         Since making the video on how to make choices which support your safe pregnancy, I have offered information about safe pregnancies on podcasts and my website, LindemannMD.com. I feel strongly that women need access to information about the choices they make which can improve the safety of their pregnancies.

         No pregnant woman thinks she will become seriously or permanently injured, or worse yet, become one more needless maternal mortality statistic. Most women plan ahead by getting ready for the new baby with few thoughts as to the potential risks to their baby or themselves by being pregnant. There was a time when women saw their doctors on every prenatal visit and they could develop trust in their doctors. Those days are long gone, leaving many women without access to the care they need. Indeed, there are studies which claim women don’t need as many prenatal care visits than they currently get.
         These studies on how many prenatal visits are needed are done to try to reduce healthcare costs. They really have nothing to do with patient safety. The studies like this one look for the consequences of having fewer prenatal visits. They all come to the same conclusion. There is no evidence of harm to the group with fewer visits. These studies are at best useless and at worst dangerous. The hallmark of effective prenatal care is as many visits as needed with the same doctor who knows and cares about you. There is no magic number of prenatal visits to put in some sort of statistical box. Nothing can replace the opportunity to establish a good relationship with one committed provider, the key to needed access. When Olympic athletes like Tori Bowie and Allyson Felix, women we know are physically fit, wind up dead or seriously ill, there is something very wrong with their prenatal care.
         On August 4th, my book Pregnancy Your Way: How to Have a Safe and Happy Birth will be available on Amazon. I describe for mothers in a step-by-step fashion what is normal for pregnancy, what is not normal, and when you need to intervene to save your life. Our current healthcare system has failed miserably in providing women with good quality prenatal care. Change will come only when women begin advocating for the kind of prenatal care which provides them access to what they need to know to have a safe and happy pregnancy.