On Maternal & Fetal Health
TW: Please be aware this post discusses infertility, abortion, miscarriage, still-birth, maternal morbidity, maternal mortality, and mental health. If you or anyone you know is struggling with any of the aforementioned topics please seek professional help.
I am all too aware that this is an incredibly emotional and challenging topic for so many woman, couples and families around the world, and therefore I have tried my very best to cover this in a sympathetic and respectful way. However, I fully believe the way that we make strides towards a better future for all of us is to talk openly about the topics of infertility, miscarriage, still-birth, maternal morbidity and maternal mortality. We need to share the sometimes startling statistics around these issues and we need to start demanding a change in our healthcare system that prioritizes these issues.
Before I get too deep into this, I want to make a few things abundantly clear. By no means are any of the following criticisms directed at individual doctors, nurses, midwives, researchers, doulas or maternal support staff but rather at the overall medical institutions that have now failed to prioritize female health for generations. I strongly believe in a woman's right to choose about how to handle their own health and to do whatever is best for them and their families. I will never place blame on or judge any woman for any health struggles they have endured or any choices they have made. Finally, for the purposes of this I have looked at U.S. statistics and research only as it is the country where Meghan currently resides.
Meghans recent revelation about the miscarriage she suffered this summer is, unfortunately, an all too common story. Most everyone knows someone personally or knows of someone who has gone through struggles to do with infertility, miscarriage, stillbirth, maternal morbidity or sudden infant death syndrome. For such a common and devastating problem, it simply does not get the attention or support it deserves.
October is Pregnancy & Infant Loss Awareness month, yet the fundraising and reach of this important medical issue doesn't get nearly the same amount of attention as other medical problems. This follows a similar trend that is seen throughout the medical community that women are treated entirely differently from men but not due to any physical or chemical differences between males and females.
A 2000 study published in the New England Journal of Medicine found that women are 7 times more likely than men to be misdiagnosed and discharged in the middle of having a heart attack. Women wait, on average, 16 minutes longer before receiving an analgesic for acute abdominal pain in the ER in the United States and they are only half as likely to be prescribed painkillers as men after coronary bypass surgery.
This disparity isn't to do with how qualified doctors are or how good medical professionals are at their job. The problem stems from the fact that most diseases are based on our understandings of male physiology because, historically, most medical research has been conducted on men. Therefore, the symptoms we commonly associate with something like a heart attack are specific only to men and women typically have entirely different symptoms during heart attacks. Women's symptoms are not taught as widely or recognized as easily.
Women have been historically underrepresented in the medical community and in medical research and maternal and fetal health have suffered because of it. The first official CDC survey on family planning for women of reproductive age was not even conducted until 1967. There have been huge strides made since the CDC began reproductive health work in the late 1960's. The infant mortality rate and the teen pregnancy rate have both fallen dramatically in the United States. However, the U.S. is still behind most other developed countries in maternal and fetal health.
To better understand some of the statistics from the U.S. here is a brief definition of the main problems facing women of reproductive age when trying to start or grow their family.
Infertility: The inability to conceive after one year (or longer) of unprotected sex.
Miscarriage: When an embryo or fetus dies before the 20th week of pregnancy. It is not always known what causes a miscarriage but risk factors include diabetes, infection, major injury, history of miscarriage or when the fertilized egg has an abnormal number of chromosomes.
Stillbirth: The death or loss of a baby before or during labor. Typically counted as pregnancy loss after 20 weeks of pregnancy.
Pregnancy Loss: Either a miscarriage or stillbirth describe pregnancy loss but they differ as to when the loss occurred.
Sudden Infant Death Syndrome (SIDS): Used to describe the sudden and unexpected death of a baby less than 1 year old in which the cause was not obvious before investigation. These deaths often happen during sleep or in the baby’s sleep area.
Severe Maternal Morbidity: Includes unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health.
Maternal Mortality: The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes
It is estimated that 1 in 4 known pregnancies end in miscarriage or stillbirth. Despite this the United States spent only $1.8 billion of their total $4.79 Trillion budget (which is less than 0.0004%) to support Maternal & Child Health both domestically and globally.
While the U.S. has slightly increased research and resources on maternal and fetal health over the last decade, infertility and severe maternal morbidity have both increased. Additionally, while rates of stillbirth and sudden infant death syndrome have steadily declined throughout the 1990's, they have held steady over the last twenty years, rather than continuing the downward trend. The United States ranks 55th in maternal mortality, just in front of Russia and behind the Ukraine.
Not only does maternal and fetal health impact millions of women, couples and families each year but the economic cost of it is staggering, especially in the United States. Since there is no universal healthcare, many people have to pay for necessary medical procedures, medication and hospital visits out of pocket. For those with insurance, the cost of pregnancy can still hurt as most insurance don't cover prolonged hospital stays or frequent doctors appointments.
One woman wrote about how her miscarriage cost her nearly $5,000 of which her insurance only covered a fraction and the rest went to her deductible. For women struggling with infertility, the American Society for Reproductive Medicine estimated that the average IVF (in vitro fertilization) costs $12,400 and it is not guaranteed to be effective. It varies greatly to how much insurance covers of IVF, with some plans covering the IVF but not the accompanying injections while others cover nothing. If a woman is fortunate enough to get pregnant on her own and carry to term without complications, it on average costs $10,808. However, it can increase to nearly $30,000 when factoring in care during pregnancy and post-partum.
When considering the economic burden of these problems on women, couples and families, it would seem prudent to invest more money in research that could lead to answers about why this happens and more importantly, how to prevent it. There is a notion in our society that infertility, pregnancy loss or maternal morbidity is an unavoidable fact of life in some cases. While there have been dramatic improvements in the last century, it is vital that we as a society do not simply accept these major health concerns as part of life but rather encourage more funding for maternal and fetal research and demand that women's health finally be prioritized in ways that it has not for generations.
This isn't to say that we will be able to completely avoid these tragedies but we can and must do better. While so many women, couples and families suffer these losses and struggle through the heartbreak of these situations, we should offer more than our thoughts and prayers. We should insist that we do everything we can as a society to move forward with maternal and fetal health as a much larger part of our healthcare systems and medical research. We should make resources to support those going through it more readily available and teach the next generation what we have learned in order to hopefully lower some of these statistics.
My thoughts and prayers are certainly with Harry & Meghan and I sincerely hope they will have their rainbow baby as soon as they are ready. While I hope Meghan's essay makes those going through similar situations feel less alone, it should be also be a wake up call to many about prioritizing fetal and mental health and research. We should not accept that this is something that simply happens that we must accept and move on from. Rather we should insist on discovering the cause and work to find the solutions so that it becomes a rarity rather than a startling norm. xx