Risks in the fourth trimester or postpartum

Sherry Willis-Prater’s baby was two months old and she was about to return to work in a Chicago school cafeteria. But one night as she walked up the small stairs to the kitchen, she gasped and nearly collapsed.

At the hospital, Willis-Prater, 42 at the time, was connected to a ventilator that pumped air into her lungs. Doctors said his heart was working at less than 20 percent of its capacity. She developed a rare type of heart failure that occurs after pregnancy.

That diagnosis was the last he expected to hear. After giving birth, Willis-Prater thought she had „crossed the finish line,” she recalled in an interview. „I don’t have to worry about anything anymore.”

Most people believe that labor and delivery are the most difficult parts of pregnancy, but recent scientific research challenges this belief and finds that there is still considerable risk in the year after birth. In fact, the most dangerous period for the mother is after the birth of the child.

For every woman who dies, about 50 to 100 women develop serious complications that can cause lifelong health problems. This number is increasing as more American women are overweight and suffer from high blood pressure and diabetes.

Additionally, more women are postponing childbearing until later in life, making them more likely to enter pregnancy with chronic health conditions that can lead to complications.

The new figures come amid an alarming rise in deaths among pregnant women and new mothers in the US, which has the highest maternal mortality rate of any industrialized country. This number has risen during the pandemic, from 20.1 deaths per 100,000 live births in 2019 to 32.9 deaths per 100,000 in 2021. Deaths are two to three times higher among black and Native American women than among white women.

But those numbers correspond to the traditional definition of maternal mortality: deaths that occur during pregnancy or up to six weeks after delivery.

A more complete picture came to light in September when the Centers for Disease Control and Prevention (CDC) looked at maternal deaths throughout the year after childbirth, including deaths from mental health disorders.

Based on data from 36 states 1,018 pregnancy-related deaths from 2017 to 2019, the CDC concluded that one-third of these occurred during pregnancy or around the time of delivery, and one-third occurred before the child was six months old. About 30 percent occurred between then and the first year of the child’s life, a period in which research on maternal mortality has not focused.

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These data have led to calls for more comprehensive aftercare and support for new mothers during the so-called 'fourth trimester’, as well as special attention to vulnerable women.

„Our approach to birth is that the baby is candy and the mom is a wrapper, and as soon as the baby is out of the wrapper, we push her away,” said Alison Stoop, a professor of obstetrics and gynecology at the university. North Carolina Medical School. „We need to recognize that the envelope is a person and that moms can get very sick and die.”

Mental disorders are the leading causes of maternal death among white and Latino women, leading to suicides and fatal drug overdoses. Bleeding is the leading cause of death in Asian women.

Among black women, such as Willis-Prater, Heart disease was the leading cause of death. High blood pressure, a predisposing factor, is more common among black women, who often lack access to health care due to both poverty and racism.

The risk of maternal death six months to one year after delivery is 3.5 times greater for black women compared to white women.

The practice of medicine is often slow to change, but these numbers are accelerating changes to Medicaid, the health care program that covers more than 40 percent of pregnant women in the U.S. for low-income Americans.

Health insurance for new mothers has been extended According to the Kaiser Family Foundation (KFF), 33 states and Washington, DC cover women recovering from pregnancy after a full year.

According to KFF, three states, including Texas, extend only limited coverage, and six more — including Arkansas. One of the highest maternal mortality rates in the country– No plans to expand Medicaid.

Other initiatives include a new law in New Jersey that requires emergency room doctors to ask women of childbearing age about their pregnancy history. Some of the illnesses that bring women to the hospital can be diagnosed more quickly if doctors know they have recently given birth.

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In North Carolina, health care providers receive a $150 bonus for a patient’s postpartum visit. Historically, nearly half of new mothers do not attend their postpartum checkups.

Instead of testing mothers six weeks after delivery, doctors are now advised to test mothers within three weeks of delivery, which was the norm.

„Now it’s like: 'See you in two weeks, okay? Yeah, it’s definitely coming,'” said writer Tamika Auguste with Stoopy. New guidelines for postpartum care American College of Obstetricians and Gynecologists.

According to Auguste, new mothers with medical conditions like high blood pressure should go for a check-up beforehand.

However, it is critical that doctors and other health professionals listen when women express concerns and pay special attention when Black and Native American women say something is not right.

„No more 'you’re fine honey, no problem,'” Auguste said. „Nothing like that. Rather: 'Let’s see if we can review you today or tomorrow.’

Many doctors refer to pregnancy as „nature’s heart stress test.” This condition puts a strain on a woman’s heart and circulatory system: blood volume increases by up to 50 percent, the heart works harder and the heart rate increases.

An increase in blood pressure can affect other vital organs and increase a woman’s risk of heart disease during pregnancy or even decades later, said Rachel Bond, a cardiologist and system director of the Women’s Heart Health Program at the center. , Arizona

„We tell women, 'You’ve taken your first stress test, you either pass or fail,'” Bond said. „Failure doesn’t mean you have heart disease, but it does mean we as doctors need to treat you more aggressively.”

After the baby is born, the uterus shrinks and the blood pressure rises and stroke occurs.

New mothers are more likely to experience life-threatening blood clots and infections. At the same time, hormonal changes can cause mood swings. Some of these are transient, but more severe and long-lasting postpartum depression can also develop.

Although most women survive pregnancy-related complications after delivery, it is very important that they seek medical attention immediately.

Deidre Vinci, a 28-year-old physician assistant from New Orleans, already had high blood pressure when she was pregnant with her third child. Doctors gave her a blood pressure monitor to use at home with the BabyScripts app, a remote monitoring system that sends readings to her obstetrician.

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She went into labor two-and-a-half weeks early after being diagnosed with preeclampsia, a highly dangerous form of high blood pressure. But three weeks after the baby was born, Vinci woke up in the middle of the night, dizzy and faint, and, reeling, called a friend for help.

Paramedics thought she was having a panic attack and didn’t want to take her to the hospital at first, but she was actually having a stroke. „I got there just in time,” Vinci recalled. „If I hadn’t made it, I might have been paralyzed for the rest of my life.”

Now Vinci has problems with short-term memory loss and weakness, but she can work. However, as a single mother of three, she never stopped worrying.

„My worst fear is missing my kids,” Vinci insisted. “What if I have another stroke and it permanently disables or kills me? I’m afraid”.

Among white women, mental health conditions account for 35 percent of pregnancy-related deaths, according to CDC data. Among Hispanic women, the figure is 24 percent. Pre-existing anxiety or depression can predispose women to postpartum depression, such as having a difficult pregnancy or having a sick baby.

Parental stress can trigger a relapse in someone recovering from a substance use disorder, said psychologist and group leader Dr. Postnatal Support International.

Karen Bullock, 39, who lives outside Peoria, Illinois, had a difficult pregnancy and a traumatic preterm birth and problems breastfeeding.

“Nothing comes naturally. “When the baby was born I was not happy, I was scared. Every time I saw him, I thought, 'I don’t know what to do with you.’ Bullock was diagnosed with postpartum depression and began taking medication.

Complications can surprise even women whose pregnancies are uneventful. Arianna Jacobs, a 34-year-old health technology analyst living in Washington, DC, was told her blood pressure fluctuated after a C-section. Jacobs tested it with a home blood pressure monitor because high blood pressure runs in her family. In a few days, the reading reached 170/110.

They took her to the hospital and treated her for preeclampsia, which always develops during pregnancy, not after.

„I want all mothers to be sent home with a box of chocolates and a blood pressure monitor, stressing that being a mother doesn’t stop you from being patient. Her body is recovering from something very strong,” Jacobs said.


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