Caring for expectant moms

by Debra Johnston, M.D.

Lately my teenager has been fascinated by medical dramas. Although my “doctor self” is usually rolling my eyes throughout the program, it’s often a good conversation starter.

One recent show featured a pregnant woman who experienced one medical crisis after another. Her kidneys, liver, and lungs failed in succession as the team raced to identify the underlying obstetrical problem and find a treatment. At the climax of the episode, her heart stopped. Of course, being television, the correct diagnosis was made, the experimental treatment worked, and the episode ended with a perfectly healthy mother at home, holding her perfectly healthy baby. 

For all the erroneous and outrageous details that transform bad fictional medicine into good TV, they did get something right. Pregnancy is a dangerous condition. In fact, in America, pregnancy complications account for approximately two percent of all deaths among women between the ages of 20 and 44. 

To put the two percent into perspective, consider that pregnancy complications can only happen in the months during and immediately following pregnancy. On average a woman in the United States will birth between one and two children. This means that between the ages of 20 and 44, the risk of pregnancy-related death isn’t spread across those 25 years as are the risks of cancer or car accidents. It is concentrated into the relatively few months during which she is pregnant. And for women younger than 20 and older than 44 the risk of pregnancy complications is even greater but, statistically speaking, women in those age groups simply don’t have enough babies to categorize pregnancy complications as a major cause of death. 

Consider also that death by violence is not counted as a pregnancy complication, even though pregnancy is a significant trigger for violence. 

What’s more, consider that these risks are not distributed equally between women. Socioeconomic status, education, physical location, and race all impact the likelihood of pregnancy complications, and death from those complications. 

Issues that affect pregnant people affect their whole family. In medical school, I was taught “nothing is worse for a fetus than a dead mother.” It’s hard to disagree. 

So, what can we do to make pregnancy safer? The answer to that question is multi-faceted. Access to quality obstetric care is one factor. However, we must also ensure women are as healthy as possible before they conceive. They need good nutrition and safe places to live and work. They need education to know what is normal, and what is not. They and their families need access to psychiatric care to address mental illness and addiction. 

It may not make for good TV, but in the real world, the starting place is as basic, and as difficult, as that. 

Debra Johnston, MD. is part of The Prairie Doc® team of physicians and currently practices as a Family Medicine Doctor at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at http://www.prairiedoc.org,