Saving hoosier mothers from maternal mortality

I’m in my first semester of law school (!!!) If you’ve been around for awhile, you’ve likely noticed quite the transition from mommy blogger to political activist to non-fiction author and the story of how I find myself a law student is one for another day.

The Indianapolis Bar Association held a writing competition open to all Indiana law students on an area of maternal health that Indiana could improve upon. I happened to know a fair amount about this already from when I was writing chapter six of RAISING THE RESISTANCE: A Mother’s Guide to Practical Activism about American motherhood.

I adapted portions of my own experience and problems addressed in this book and proposed a three-point legislative plan to combat maternal mortality in the state and submitted to the competition. And booyah, your girl won. Quite a few people have asked for the submission itself, so here it is.

To reward you for reading and learning more about this absolute bummer topic, I’m including a fun fact at the end.


Combatting the Causes of Maternal Mortality Through Legislation

By enacting legislation that protects access to reproductive healthcare, mandating implicit bias training for healthcare workers, and proactively addressing the most common causes of maternal mortality, cases may be reduced and ultimately lives saved.

After the birth of my second child, I held her perfect, plump, warm body against my chest and sobbed—overwhelmed with relief, gratitude, and pure love. My husband and I spent the first hour of our new daughter’s life alone, basking in her perfection, inspecting her tiny toes, and gently caressing her chubby cheeks. Then he invited the anxious family in from the waiting room to meet their newest granddaughter and niece.

I proudly held my new baby in my arms taking in the “ahhhh”s and “oooooh”s until another overwhelming feeling came over me. No matter how hard I tried to hold on, I felt my grip around her body loosen. Then everything went black.

As I faded in and out of consciousness, I was able to see the doctor who delivered my baby at my bedside and my terrified husband clutching our newborn in the corner. I was unable to speak or move and felt unbearably cold. I couldn’t stop shaking. However, I was cognizant of my surroundings, which meant I could see my doctor desperately clenching an iPhone and say, “I’m not sure what’s happening… I’m going to Google it.”

I laid in the hospital bed, unable to speak or move, hoping I don’t die after childbirth because the Wi-Fi signal was too weak.

Fortunately, the Wi-Fi symbol must have been strong that day and the medical staff revived me from shock relatively quickly. I had a blood transfusion as I held my healthy, newborn daughter, and I lived to tell the tale of my brush with maternal mortality.

I had many worries during my pregnancies, but dying during childbirth wasn’t one of them. I thought a mother dying during childbirth was mostly a literary device used to provide depth to characters like Oliver Twist, not something that happens in of the most developed countries in the world.

After I recovered, I sought more information about maternal mortality and discovered it is a widespread problem in the United States. The United States spends more on healthcare than any other country, but we also have the highest rate of maternal mortality in the developed world. Even more disturbing, the maternal mortality rate continues to get worse with more women dying due to complications related to pregnancy every year.

In 1991, the rate was 10.3 per 100,000 live births. (Delbanco et al., 2019) Nearly 30 years later, the most recent data reports 20.1 deaths per 100,000 live births. To put that rate in perspective, 754 women died of maternal causes in the United States in 2019. (Hoyert, 2021)

Although the rate of maternal mortality in the United States overall is catastrophic, the severity of the problem varies from state to state. For example, in Indiana—where I gave birth and live—mothers die from maternal causes at 11 times the rate as mothers in California. Mothers in Iraq, the Gaza Strip, and Indiana have approximately the same maternal mortality rate.

Indiana experienced a dramatic increase in maternal mortality cases from 14.3 per 100,000 live births (slightly below the national average of ~22 per 100,000) to 51.3 per 100,000 between 2010 and 2011. The elected government began a rampage against women’s health and focused much of their ire on the non-profit providing reproductive services, Planned Parenthood. By the Spring of 2011, the State banned Planned Parenthood from providing any services through Medicaid. The services Planned Parenthood provides include providing contraception, sexually transmitted infection testing and treatment, breast exams, and pap tests, as well as abortion services. The law prohibiting Medicaid patients from utilizing their benefits at Planned Parenthood was deemed unconstitutional in the Fall of 2012. However, access to reproductive services continued to be limited through other legal means.

Government contracts to Planned Parenthood were cut from $3.3 million in 2005 to $1.9 million in 2014. The number of Planned Parenthood clinics decreased as well from 28 in 2011 to 18 in 2015. Currently, there are 14 throughout the state.

The first clinics in Indiana to close between 2011 and 2013 were in rural areas, which suffer an even higher rate of maternal mortality due to limited access to obstetric services. None of the rural clinics to close offered abortion services.

Causation may not prove the aftermath of the state’s government actions is to blame. However, there was an alarming rise in the number of maternal deaths during this state-sponsored campaign to close women’s health clinics and stigmatize reproductive healthcare. (Boulware, 2017)

One of the most heartbreaking and maddening elements about the issue of maternal mortality is that the causes are generally consistent. One of the most common causes is postpartum hemorrhage, as I experienced. Other causes include sepsis, embolism, and cardiovascular events. Only approximately six percent of maternal mortality cases have no known cause. Due to this predictability, 60 percent of maternal mortality cases are preventable. (CDC, 2019)

Women of color die from maternal causes at an even greater rate. Black, American Indian, and Alaska Native women are two to three times more likely to succumb to maternal mortality than white women. (CDC Newsroom, 2019) In Indiana, Black mothers have the highest maternal mortality rate. (Indiana Maternal Mortality Review Committee, 2021)

The issues contributing to Indiana’s catastrophic maternal mortality rate have been outlined. Potential legal solutions to combat this issue and ultimately save the lives of mothers in Indiana address these problems and instead provide alternatives. These solutions could best be implemented through state legislation as an antidote to the harmful legislation in place during the dramatic rise of maternal mortality cases.

A proposed bill to combat maternal mortality would include:

  1. Protecting access to women’s healthcare
    • This measure would provide the necessary funds to reproductive healthcare clinics ensuring women have access to the care they need. Special attention would be given to rural areas where patients do not have access to doctors and hospitals close to the areas where they live.
    • Approximately 40 percent of childbirths in the United States are covered by Medicaid and protecting this eligibility and access to services can lead to better outcomes. (Hostetter & Klein, 2019)
  2. Mandate implicit bias training for healthcare providers
    • Women of color experience higher rates of maternal mortality, as well as other troubling consequences. A decade-long study of healthcare providers’ implicit prejudice found that the providers’ implicit prejudice is associated with a lower quality patient-provider communication involving patients of marginalized groups.
    • By attacking the systemic causes of adverse outcomes for marginalized women, the expansion of implicit bias training may reduce the barriers to providing quality care. (Omeish & Kiernan)
  3. Enact proactive protocols to prevent the most common medical causes of maternal mortality
    • For example, measures such as the universal use of pneumatic compression devices for patients who underwent cesarean delivery and antihypertensive therapy are effective in preventing the most common causes of maternal mortality—embolism and hemorrhage.
    • These measures have been shown to successfully prevent death from maternal causes. (Brancazio, 2014)

Just as we can predict the causes of maternal mortality, we can predict how these proposed solutions could reduce maternal mortality and ultimately save mothers’ lives in Indiana.

I omitted the bibliography, but if you nerds really crave those sources, I can provide.

Promised Fun Fact: I expand more in the book about the defunding of reproductive healthcare spearheaded by then Lt. Gov. Mike Pence, which was followed by a SHARP increase in maternal mortality in the state. I won this contest as a representative of his alma-mater. I looked up his class pic in the library. What a goob.

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