It was her second time lying numb in a hospital bed in North Bergen, New Jersey, with blood streaming down her legs and fear creeping into her heart.
At that moment, Timoria McQueen Saba thought to herself, "there's no way in the world that I'm the only woman who had this happen," she said.
In 2010, after giving birth vaginally to her oldest daughter, Gigi, one late afternoon in April, postpartum hemorrhage or excessive bleeding -- the
leading cause of maternal death worldwide -- nearly killed her.
Then, about a year later, she started bleeding profusely in the small bathroom of a frozen yogurt shop. The blood was from a miscarriage, which left her feeling helpless in that hospital bed. She didn't know she was pregnant.
"I was all the way back to where I was the year before, and I realized ... I hadn't healed from the near-fatal traumatic experience the year before," said Saba, now the 39-year-old mother of two girls.
The former celebrity makeup artist, who saw clients such as novelists
Candace Bushnell and
Kyra Davis, decided to become a maternal health advocate, speaking on behalf of the
830 women who die from pregnancy- or childbirth-related complications every day around the world. That's about 303,000 a year.
Each year in the United States,
about 700 to
1,200 women die from pregnancy or childbirth complications, and
black women like Saba are about three to four times more likely to die of pregnancy or delivery complications than white women.The quick-witted, savvy Saba said the data shocked her.
"It really took me a while to digest it," she said -- she survived something that many others around the world haven't."What was different about me? Why didn't I die? What were the reasons for that?" she asked. "I felt like I have a duty to tell this story, to represent my race in a way that not many people can, because I lived through it."
'We've known for a number of years'Women in the United States are more likely to die from childbirth- or pregnancy-related causes than other women in the developed world, and
half of those deaths may be preventable, according to the Centers for Disease Control and Prevention.
The CDC's
pregnancy mortality surveillance system was implemented in 1986 to track maternal deaths. Since then, the number of reported pregnancy-related deaths nationwide steadily increased from 7.2 deaths per 100,000 live births in 1987 to 17.8 per 100,000 in 2009 and 2011.
Why the increase? Some researchers argue that
health officials simply have improved counting deaths over time by
using new classification codes and introducing a
pregnancy status box on death certificates in 2003, which could make it appear that there's an increase.
Others argue that
higher rates of obesity,
women having children at older ages, and other social changes and trends in public health could drive an apparent increase. Yet it remains complicated to answer why there has been a rise in deaths and why black women are more affected than women of other races, said Dr. Michael Lindsay, associate professor at the
Emory University School of Medicine and chief of service for gynecology and obstetrics at Grady Memorial Hospital in Atlanta.
The
racial divide in maternal deaths has been persistent for decades, Lindsay said, "so the rate is not something new. It's something we've known for a number of years."
Though maternal deaths are rare in the United States, many doctors and researchers have varying ideas about what factors could be driving this longstanding racial disparity in death rates.
Some point to the differences in overall health and chronic illnesses among black and white women as a driving factor for the disparity. For instance,
rates of obesity and high blood pressure (or hypertension) -- risk factors for pregnancy complications -- tend to be higher among black women.Others point to differences in socioeconomic status, access to health care, education, insurance coverage, housing, levels of stress and community health among black and white women, including even implicit bias and variations in the ways in which health care is delivered to black versus white women. Historically, black women in low-income communities haven't had the same access to quality care as white women in high-income communities.
Those same factors shed light on disparities not only in maternal mortality but in obesity, hypertension,
heart disease and overall health, said Dr. Elizabeth Howell, an obstetrician-gynecologist and professor at the Icahn School of Medicine at Mount Sinai.
"There are economics, social, environmental, biologic, genetic, behavioral and health care factors that all contribute to disparities in this country," Howell said. "It's a complex web of these kinds of factors, and I think people are looking at and trying to figure out how these different factors actually all contribute to disparities," she said, adding that her research has focused on the factor of quality care.
For instance, Howell and her colleagues found that black women in New York City were more likely than white women to give birth in hospitals that already have a high rate of
severe maternal morbidity or complications, according to a study published in the
American Journal of Obstetrics and Gynecology last year.
The researchers found that 63% of white patients versus 23% of black patients gave birth in the safest hospitals in the study.
Solving a deadly problemTo examine differences in hospitals' quality of care, and to assess differences in how many black and white patients those hospitals cared for, the researchers analyzed hospital discharge and birth certificate data in New York City between 2011 and 2013, which was about 353,773 births.
"If we could narrow variation in outcomes and improve quality of care for pregnant women, we would reduce disparities," Howell said.
There have been efforts to establish standardized protocols, called
patient safety bundles, across all hospitals -- whether they serve mostly white or black patients -- to appropriately assess and address childbirth complications,
such aspostpartum hemorrhage, with an equal quality of care, she said.
Health officials, doctors and advocates
gathered Tuesday at the CDC in Atlanta to discuss efforts to measure and prevent maternal deaths and the racial disparities that persist. The public meeting included discussions of the effects that maternal deaths have on families and communities, as well as efforts to prevent deaths, such as those patient safety bundles.
As for establishing uniform bundles, "it addresses unequal treatment," said Dr. William Callaghan, chief of the CDC's Maternal and Infant Health Branch, who spoke at Tuesday's meeting.
"It's not a state-by-state solution to solving the problem of disparities. This is a national problem, and we all know it. It's always the elephant in the room in the United States that things are different," he said. "You'll find this across every health outcome."
Saba, who did not attend the meeting, was happy to hear that it was scheduled to take place, but she said she wished that actual patients had more of a presence on the agenda and more of a voice in the room.
"There are many advocates like myself. We have been sharing our stories for years or trying to. Yet we continue to be left out of most of these conversations," Saba said.
"There needs to be a better balance of speakers who can bring to light the full picture from legislation, research and statistics to real patients who survived a birth trauma or the families of those that didn't," she said.
Saba added that she has long been a proponent of the
Preventing Maternal Deaths Act of 2017. The
bipartisan bill was introduced in Congress in March to support state efforts to prevent maternal deaths, eliminate disparities in maternal health outcomes and identify solutions to improve health care quality for mothers.
It has not passed in the House or Senate.
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here.
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