December 28, 2011
It’s an obstetrician’s worst nightmare and it continues to happen on a daily basis. The story of Michal Lura Friedman brings tears to my eyes. After 7 years of trying, the 44 year old songwriter finally became pregnant –with twins. Her husband, Jay Snyder, a free-lance voice-over artist, describes the 9 months of Friedman’s pregnancy as pure bliss. However towards the end, her blood pressure became elevated so she was scheduled to have a C. Section the day after Thanksgiving.
Snyder accompanied his wife to the hospital and witnessed the birth of his babies. Then Friedman began to bleed. And bleed. And bleed. At 9:30 p.m., she became yet another U.S. maternal mortality statistic.
At least 2 women die from complications of childbirth in the US daily. Some celebrities such as Christy Turlington Burns have become a Maternal Health Advocate as a result of first-hand experience. She had a near-miss childbirth experience but lived to tell the story. Many women, including Friedman, don’t. The American Congress and College of Obstetrician-Gynecologists (ACOG), will have both Burns and Tonya Lewis Lee, the wife of renowned director, Spike Lee as spokeswomen on the topic of maternal mortality at the 2012 Annual Conference in San Diego. However, we need much more. There are obstetricians who have worked on the front-lines managing high-risk patients for years who can’t get a seat on ACOG’s policy committees and it is frustrating. Here are a few questions that should be asked at the hospital where Friedman expired:
- She had a short stature with a uterus stretched to the max with two babies. Was the possibility of hemorrhage considered?
- When her blood pressure became elevated, was it controlled prior to doing the C. Section knowing the risk of possible HELPP Syndrome that is associated with pre-eclampsia?
- Was there an OB Rapid Response Team?
- Was a Bakri balloon used once the bleeding couldn’t be controlled with uterine massage or meds?
- Was the prospect of a problem anticipated BEFORE it occurred or was there chaos trying to find appropriate meds and equipment as the tragedy unfolded?
Pregnancy is not a benign act contrary to what most people believe. Things can and do happen, most often when the hospital staff is unprepared and ill-equipped to handle an emergency. My heart bleeds for Jay Snyder. He is 41 years old, a new father and now a widow who must take care of two beautiful children, who will never know their mother. With all due respect ACOG, talk is cheap. More action must be taken to stop this.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do…
November 2, 2011
In a recent medical study, violent deaths of pregnant women outnumber traditional causes of maternal deaths such as post partum hemorrhage or pre-eclampsia . I am not surprised. In September 2010, I wrote an article entitled 7 Reasons Why Pregnancy Becomes a Deadly Affair after an 18 year old college student almost lost her life at the hands of her football-playing boyfriend because she became pregnant. Pregnancy is not a benign act and 50% of them are unplanned.
Dr. Christie Palladino, an ob-gyn physician at the Georgia Health Sciences University and main researcher of the study, looked at data from 17 states and found 94 pregnancy-related suicides and 139 homicides from 2003-2007. Approximately 45 % of suicides occur during pregnancy, often precipitated by a domestic dispute. Palladino addresses the problem by focusing on identification and treatment of pregnant women who have depression by obstetricians or women’s health providers. While it is a noble ideal it only scratches the surface. There is an association between the “depressed” pregnant woman and relationships that usually involves the father of the baby. It is not enough to put prescribe antidepressants and not provide professional counseling. Most obstetricians do not feel comfortable treating depression if the truth be told. It is neither their specialty nor area of expertise. And God help the patients who are on Medicaid. The challenge to find a psychiatrist that will accept them will be daunting. Palladino mentions more research for future studies. We don’t need more data. We don’t need another American Congress of Obstetrician-Gynecologist (ACOG) task force. We need action plans that include:
- Formal collaborations between mental health workers and obstetricians for proper referrals and treatments including case management meetings during the patient’s prenatal care
- Group therapy and individualized sessions conducted by licensed psychologists and social workers
- Collaboration of social work schools and public health departments or community health clinics that could provide psychotherapy for indigent or Medicaid pregnant patients. Social work students could perform counseling under the supervision of a licensed preceptor
- Home visits (through the use of Home Visit Grants) for at-risk-women by doulas or community health workers
I would also encourage pregnant women who are in abusive relationships to review the 7 warning signs of a potentially deadly affair.
Suicides and homicides are preventable. Let’s roll up our sleeves and get busy.