by Dr. Nicole Calloway Rankins
One night I received a call through the answering service from a patient I’ll call Michelle. Michelle had an uncomplicated delivery a few days earlier and was now at home. She was calling because she felt short of breath.
On the phone Michelle didn’t sound short of breath. I asked her several questions to try and get a sense for what may be going on, and nothing stood out as alarming in her responses. However, Michelle was persistent that she just didn’t feel right. I advised her that the safest thing to do was to come to the emergency department to be evaluated.
When Michelle got to the emergency department she was diagnosed with a pulmonary embolism - a blood clot in the lungs that can be life threatening. She got the treatment she needed and thankfully was fine.
I’m glad I listened to Michelle’s concerns that night. But to be clear, I’m not the hero of the story, Michelle is. She was persistent in voicing her concerns that something was wrong. Both on the phone with me and in the emergency department.
Why am I telling you this story? Because pregnancy related morbidity (health related conditions that have a negative effect on the woman’s well-being), and pregnancy related mortality (death related to pregnancy) are on the rise. Pregnancy related deaths have nearly doubled since 1990. In the United States for every 100,000 women who have a live birth, 18 will die. There are about 4 million births each year in the US so that translates into over 700 women dying from pregnancy related causes each year. It’s significantly worse for black women. The rate for us is 43.5 deaths per 100,000 live births.
It’s unlikely that you’ll have problems during your pregnancy or after birth. But you should be prepared just in case.
It’s unlikely that you’ll have problems during your pregnancy or after birth. But you should be prepared just in case. Read on to learn 5 tips to help you stay safe both during and after delivery.
1. Ask your doctor how the hospital is prepared to deal with emergencies, especially bleeding after birth.
The #1 cause of maternal mortality in the United States is postpartum bleeding. This is largely preventable with swift recognition and treatment. A recent New England Journal of Medicine editorial on how to quickly address maternal mortality recommended that all hospitals institute the Alliance For Innovation on Maternal Health (AIM) patient safety bundles. Obstetric hemorrhage is one of those bundles (you can see all 12 bundles here).
Key features of each bundle are readiness, recognition & prevention, response, and reporting/systems learning. In the case of postpartum bleeding, this includes having a hemorrhage cart with readily available supplies and medications to address bleeding, formally measuring the amount of bleeding, and having protocols in place to respond to bleeding including who to call and when care needs to be transferred to another facility. The full bundle can be found here.
I know it's hard to think about the possibility of something like this happening to you. But you’d much rather know ahead of time that the hospital is prepared than to find out otherwise when it's too late.
2. If you don’t feel right call no matter the time of day or night.
Most obstetric care providers have a way for you to reach someone 24/7. It may be a doctor, nurse, or nurse practitioner. You can reach that person by calling the regular office number, even if it’s after hours. There are a few practices that don’t have someone on call after hours. In that case you’ll likely hear a message that directs you to go to the Emergency Department if you have concerns.
3. When in doubt go in.
If you’re not feeling well and you’re concerned then by all means GO IN TO BE SEEN. Don’t let things linger. During office hours try and get into the office for an appointment. It’s ideal if your regular doctor can see you. If you can’t get into the office go to the emergency department. If you have to go to an emergency department, go to a hospital that has a labor and delivery unit. They’ll be more familiar with treating problems related to pregnancy.
4. Be persistent.
This is a big one. Keep voicing your concerns until your concerns are addressed. Don’t worry about being perceived as annoying. Don’t worry about hurting feelings. I’m not exaggerating when I say that this could be life or death.
Persistence is especially important if you’re a black woman.
Persistence is especially important if you’re a black woman. It’s an unfortunate truth that black women are more likely than other racial/ethnic groups to have their concerns dismissed or ignored by healthcare providers.
5. You’re not out of the woods after your baby is born.
Did you know that over 60% of maternal deaths occur AFTER delivery? About 45% are within the first 42 days after delivery. So you’re actually at the most risk of problems happening after birth.
To help you stay safe I’ve created a tipsheet of warning signs to look out for after birth. You can grab your copy below.
I wish you a safe and fulfilling pregnancy and birth!