We’re proud to feature the voice of midwife and birth advocate Ina May Gaskin in our third and final post about maternal mortality. This week, Ina May discusses the connection between post-natal care and maternal mortality, and shares stories from her powerful Safe Motherhood Quilt Project.
Tell us a little bit about the Safe Motherhood Quilt Project.
The Safe Motherhood Quilt Project is made up of individually-designed squares, each representing a woman in the U.S. who has died of pregnancy-related causes. The Safe Motherhood Quilt is a voice honoring women who can no longer speak for themselves.
I have a quilt panel here that contains 20 different blocks, each honoring a woman who died from pregnancy-related causes in 2007. There were far more deaths in 2007 than the 20 blocks that I have — this is the tip of the iceberg.
There was a 36-year-old immigrant from Kenya. She had her twins in a Kansas City suburb while the father was back in Kenya. She had no other family members in the U.S. She likely delivered her twins prematurely by c-section, and was then sent home. Who was taking care of her when she was taking care of her twins post-cesarean? Well, her body was found three weeks after she had returned home from the hospital. One of her babies had died of starvation and the other was saved just in time. What a tragedy.
Melissa and Valerie were friends. They lived in the same small town in New Jersey, were teachers in the same school, and gave birth to their first babies by c-section within two weeks of each other. One died of immobility after her c-section, and I’m unsure why the other died — but the only reason it was recognized was because of the close ties they shared. This is not supposed to happen.
Galit was a mother of three. She had each of her babies vaginally, and was released from the hospital after her third birth to later have a late hemorrhage. She died in the arms of her husband in the driveway, as he was trying to get her to the hospital. Even a mom who has had babies before may not know that she’s in trouble until it’s too late. We must start getting women post-natal visits. If we don’t do that, it’s an appalling tragedy.
Can you speak to the crisis of maternal death in our country?
I was a midwife for almost 30 years before I knew we had a problem with maternal death in the U.S. Of course I knew we had problems in countries where poverty is great, but an industrialized country — the one I live in? I was invited to England quite a few times, and while there, the subject (of maternal mortality) came up. I found out they have a book available to mothers called “Why Mothers Die,” with the most recent version named “Saving Mothers’ Lives,” which is what this is really about. The idea is not to just be morbid, but to identify any mistakes that may have been made, or practices that you may not understand very well. To study up and learn from the deaths so they decrease. I came home and asked myself, ‘Where’s our version of this?’
We (Americans) don’t even get one full, printed page of reported maternal deaths each year. I’m insulted and angry. In 1998, little booklets (that are only 2 ½ pages long) were printed by the Centers for Disease Control, and stated that maternal mortality rates were based solely on vital statistics data, and are underestimates because of misclassification. It says that the number of deaths truly happening were estimated to be three times what we actually report. ‘How can that be,’ I ask?
How can the U.S. be so inaccurate in our maternal mortality statistics?
Neonatal deaths — there’s no mistaking them because a newborn is a newborn. They don’t look like a 1-year-old, they don’t look like an adult. With maternal deaths — women of childbearing age die from all kinds of causes. You actually have to investigate and have questions on the death certificate that cover the pregnancy status of women of childbearing age. And you have to then find out why they died and do an investigation — because we can’t rely on an honor system.
How can we prevent maternal mortality?
It’s bad enough if the death is unpreventable, and that’s going to be true in about 3 out of every 100,000 cases. That’s not very many. But most deaths are preventable. These usually have to do with too many c-sections, so I would say, ‘Let’s not start with an elective c-section.’ Then, we have doulas to lower the chance of a woman having an emergency c-section. Next, there’s the matter of the clock and the calendar. We’re inducing way too many women, and a lot of the inductions are done for convenience sake. Back when I began practicing midwifery, you didn’t do that — it was rare that induction was needed. Now, people say, ‘Im tired of being pregnant,’ and they don’t know that induction can be dangerous. So, there are lots of women who have a quilt block made for them simply because fear was present, simply because they were a day or two over 40 weeks pregnant. It used to be that everyone in medicine and midwifery knew that it was actually a due month, which is anytime between weeks 38 and 42 — and at any rate, the estimated due date is just a guess anyway.
Many of the women honored in the quilt panel you spoke of died post-childbirth. Why is this happening?
Those of us who attend home and birth center births make post-natal home visits. Why? Because things can arise in the days after birth that cannot be predicted. You can’t do a check-up over the phone. We have to look at the mom, probe her abdominal region, touch her, smell — examine her. Now women are being released from hospitals — discharged sometimes 24 hours after birth, and 48 hours after c-section (this is major abdominal surgery), with no follow-up visits planned. The shocking thing is that women who have a standard maternity care package usually don’t get home visits from any trained person after they’ve gone home, and women are dying because of it. It’s one of the most preventable kinds of maternal deaths that occur.
Ina May Gaskin, MA, CPM, is founder and director of the Farm Midwifery Center in Tennessee. The Farm is noted for its low rates of intervention, morbidity and mortality, despite the inclusion of many vaginally-delivered breeches, twin and grand multiparas (mothers who have had five or more births, increasing the risk of birth complications). Ina May has attended more than 1200 births, and is the author of “Spiritual Midwifery,” now in its fourth edition, and “Ina May’s Guide to Childbirth.” She has lectured all over the world at midwifery conferences and at medical schools, both to students and to faculty. Ina May was president of Midwives Alliance of North America from 1996 to 2002, and received both the ASPO/Lamaze Irwin Chabon Award and the Tennessee Perinatal Association Recognition Award in 1997.
This interview, originally video-taped for Mindful Mama, was transcribed and re-purposed with permission from Sarah Kraft, Mindful Mama’s founder.
Did you receive post-natal care? What were the benefits of having this additional support?
Mother’s Advocate wants to facilitate a safe and supportive community for birth advocates, educators, and expectant mothers. You’re welcome to share any thoughts about or experiences with maternal mortality.