When reporting on maternal death in America, leave time for tears

I've become used to those heartbreaking pauses in conversation when someone needs to wipe a tear, swallow a whimper or simply silently sob. In those moments, sitting across the coffee table from a sister or on the other end of a phone call with a mother, resides the real story of maternal mortality. 

Maternal mortality or maternal death can happen during pregnancy, at delivery or during the postpartum period, even up to a year after childbirth, with leading causes being heart disease or stroke, infections and severe bleeding or hemorrhage. 

In my career as a journalist, this issue often emerged as a global one — with statistics showing the regions of sub-Saharan Africa and southern Asia accounting for about 86% of the estimated global maternal deaths in 2017.

At the same time there has always been hope — between 2000 and 2017, southern Asia saw a nearly 60% decline in maternal mortality rates and sub-Saharan Africa achieved a substantial 40% reduction in maternal mortality rates, according to the World Health Organization. WHO has noted that the high maternal death rates in those regions of the world and others reflect inequalities in access to quality health services, underscoring disparities between rich and poor.

Yet around that same time, the United States — among the wealthiest nations in the world — saw its maternal mortality rate rise. 

The ratio of pregnancy-related deaths in the United States actually rose from about 15 maternal deaths per 100,000 live births in 2001 to about 17 maternal deaths per 100,000 live births in the United States as of 2018.  

According to WHO and other health groups, Bahrain, Japan, Kuwait, Portugal, Qatar, South Korea, Saudi Arabia, Turkey and Uruguay were estimated to have lower maternal death rates than the United States in 2017, the year with the most recent global data available.

That was the catalyst for my 2019 National Fellowship project for the USC Center for Health Journalism: “The US has the highest maternal death rate of any developed nation. California is trying to do something about that.”

I first learned about this issue in 2017, when CNN partnered with Every Mother Counts, a nonprofit that seeks to raise the profile and issues of maternal health, to host its documentary series “Giving Birth in America.” I joined the team involved in that partnership, writing articles to accompany each episode in the series.

My first piece focused on how non-Hispanic black women in the United States are about three to four times more likely to die of pregnancy or childbirth complications than white women. That racial divide in maternal deaths had been persistent for years across the country, and is well known within medicine.

Physicians I interviewed spoke matter-of-factly about the disparity, referencing implicit bias and variations in how health care is delivered to black versus white women as some of the factors accounting for this health disparity, among others.

My second piece focused on how, similar to black women, Native American women are also about three times as likely to die of pregnancy or childbirth complications as white women in the United States. To help reduce the racial gap, some maternal health and advocacy groups suggest that the personalized care services from midwives or labor assistants, sometimes referred to as doulas, could be a solution.

Yet getting that additional support can come with an additional cost that many women might not be able to afford. For instance, I learned in my reporting that the out-of-pocket costs for a midwife can range from about $2,800 to up to $12,000.

Since reporting on those previous stories, I made it my mission to continue covering this topic, exploring ways in which Medicaid expansion might be associated with fewer maternal deaths and hearing the stories of fathers who lost their beloved partners, and sometimes even their newborns, to maternal mortality.

While sharing their stories of grief, some of those men — from different backgrounds, regions and races — fought back angry tears. Others let the tears fall, seemingly with no more fight to give. They all had the same desire to let other men in similar situations know they are not alone.

During those interviews, I learned to be still and listen. I put aside my reporter instinct to ask questions and embraced those heartbreaking pauses. The pauses silently cried out just how loved each woman was who lost her life.

That’s when I realized there has to be a larger story told. Not a story of the injustice, heartbreak, grief and despair — but a story of answers and solutions.

The 2019 National Fellowship was pivotal in my quest to find the people who are working to end the maternal mortality crisis and the places where this work was not just being discussed but happening. In approaching my fellowship project, I first gathered statistics from various sources — including the CDC and the United Health Foundation — on state-by-state differences in maternal mortality rates.

That quest took me to Los Angeles.

In analyzing the numbers, I found that the California Department of Public Health actually reported a decline in maternal mortality rates. The rate fell to 7.3 deaths per 100,000 live births in 2013, nearly half of what the rate was five years prior — whereas other states in the country continued to see rises in maternal death rates. Despite those declines, however, racial disparities in the data remained.

Once I had the data, I then sought the stories and the lives behind the numbers. I found officials who initiated tracking data on maternal deaths, doctors who started training for birth emergencies and women who turned their pain into advocacy.

There were still sorrowful tears and exasperated stories of disparities — such as a mother who said that her pregnant daughter’s health concerns were not taken seriously before she died in childbirth.

Yet at the same time, there were stories of hope, of physicians recognizing and calling for change, of efforts to bring midwifery services and doula care to underserved communities, of legislation requiring implicit bias training in hospitals.

My quest to find hope started with a little bit of self-doubt and hesitation. I wasn’t sure if there was hope out there. I worried I might be grasping for weak threads, but there were people making progress year by year, woman by woman.

Health officials acknowledged California’s deep-rooted disparities in maternal mortality and recent actions to address the issue. One said, “I don’t think anyone can be too enthusiastic about what gains we’ve made.”

One mother became a doula to prevent maternal deaths from touching other families after her daughter gave birth to her granddaughter and both passed away during the birth.

Medical workers in Santa Monica and San Francisco admitted there was work to be done to address bias and prepare for childbirth emergencies. An Olympic athlete in Los Angeles who survived life-threatening childbirth complications testified before lawmakers.

In speaking with experts and families across the Golden State, I found that there is hope. The hope was in those pauses between the tears.