Preventable Complications Having Severe Consequences For Women During Childbirth

In the realm of medical malpractice, emphasis is often placed on birth injuries that have consequences for the newborn. However, mothers have always faced dangers associated with giving birth as well. There are roughly four million births in the U.S. annually, most of which have no complications; however, the Centers for Disease Control & Prevention (CDC), indicates that 50,000 mothers each year face problems with delivery. 

According to a report by ProPublica and NPR, the problem of maternal mortality in the U.S ranks near the top among industrialized countries. For every one woman who dies during childbirth, nearly 70 endure significant problems including hemorrhaging, organ failures and others.

Kristen Terlizzi, of the National Accreta Foundation, says public perceptions exist that mothers face minimal risks for complications impacting their health. Terlizzi had her uterus and a section of her bladder extracted in efforts to save her life in 2014. A 2016 study at Cedars-Sinai Medical in Los Angeles determined there was a need for “improvements in care” in roughly 44% of pregnancies and births. Incidents of maternal morbidity have continued to rise compared to maternal mortality. One source of problems has been the spike in the volume of blood transfusions. In addition, there has been a 60% increase in emergency hysterectomy procedures in response to infection or bleeding.

The United Kingdom has improved their system by creating uniformity in maternity-related care. They conduct reviews of all instances of maternal death to better assess how mistakes are occurring. Across the U.S., some states have recognized the failures in investigating cases where death occurs to mothers. Over 30 states have a formal means of reviewing maternal fatalities, yet few review cases with serious complications. The Joint Commission, which provides medical oversight, now requires that cases of severe morbidity be analyzed.

Some of the common complications include:

• Prolonged labor: Labor that lasts too long is common for mothers giving birth for the first-time, which leads to heightened risks for problems including infections.
• Fetal positioning (presentation): Often the fetus is abnormally positioned for delivery. This commonly occurs when the body is buttocks down, rather than head down.
• Umbilical cord problems: The umbilical cord, which transports nutrients to the fetus, may create complications. One common problem occurs when the cord precedes the fetus in delivery, restricting blood flow. The baby may also be at risk if the cord becomes twisted around the body and compresses.

The Alliance for Innovation on Maternal Health (AIM), reviewed births in four states and found morbidity occurred in approximately 2% of cases—equivalent to about 80,000. The CDC agrees that many outcomes are underreported. Typical examples of problems may include hemorrhaging, respiratory or kidney failures, blood clots and more. 

Cases where complications occur involving the mother leading to readmission to the hospital are rarely factored into reporting data. Eugene Declercq, of the Boston University School of Public Health, explained the data reporting is too frequently limited to the period where the mother is still pregnant, leading to post-birth complications going unreported.