Democracy Dies in Darkness

Serena Williams shared a harrowing postpartum story. And she was one of the lucky ones.

ANALYSIS | It happens more often than any of us should be comfortable with

By
January 11, 2018 at 3:34 p.m. EST

Serena Williams’s inaugural interview as a mother appeared in Vogue this week, along with lush observations about her new life chapter and gorgeous shots of her cuddling with baby Alexis Olympia Ohanian Jr. But while it might seem like everything about the tennis star’s journey to this moment has been charmed, the harrowing details of what happened in the weeks after she gave birth are definitely not.

Williams revealed to the magazine that, while the pregnancy itself went off without a hitch, postpartum was where the problems began. She underwent an emergency C-section after her heart rate dropped dangerously low during labor and that surgery went smoothly.

And the next day, she began to feel a shortness of breath that quickly turned to gasping for air. Given her history of blood clots and the fact that she had been for the moment taken off her anticoagulant regimen, she immediately alerted the medical staff, requesting a CT scan which ultimately revealed blood clots in her lungs.

The intense coughing fits triggered by the pulmonary embolism caused her C-section incision to reopen, sending her back into surgery, where doctors found that a large hematoma had built up in her abdomen. To keep more clots from forming and reaching her lungs, surgeons inserted a filter into a major vein. Williams left the hospital a week later, and was confined to bed for more than a month after giving birth.

She is one of the lucky ones. At a time where maternal mortality rates are disturbingly high among American women — especially women of color — someone with her same symptoms might have slipped through the cracks. Even women who have every advantage are still susceptible to the screw-ups and missed signals that turn the happiest moment in someone’s life into a nightmare. And it happens more often than any of us should be comfortable with.

For evidence, look no further than the deep dive done by NPR and ProPublica into maternal health last year, including all the reasons that at a time when it seems like we should be more able to save lives than at any other point in history, we’re losing them instead. The first piece, published around Mother’s Day, told the story of Lauren Bloomstein: a 33-year-old nurse, married to an OB-GYN, who was set to deliver at the hospital where she herself worked. Her pregnancy went smoothly, with her husband monitoring her blood pressure at home daily; though it seemed at first like she might need to have a C-section, the baby, a healthy girl, was born naturally 23 hours after Bloomstein checked into the hospital. Hours later, she told her husband she felt poorly. Bloomstein was treated for acid reflux and given morphine for her pain, but the details of what happened next are complicated and heartbreaking. Late into the night, she ultimately received a diagnosis of HELLP syndrome: the most serious form of preeclampsia. Within a day, she died.

Another NPR and ProPublica investigation was equally wrenching. Shalon MauRene Irving served as a lieutenant commander in the uniformed ranks of the U.S. Public Health Service, and worked as an epidemiologist at the Centers for Disease Control and Prevention. The highly educated daughter of Dartmouth graduates who had a tightly knit network of support, her pregnancy was at risk from the start: Uterine fibroid surgery left her doctor fearful that her uterus could rupture, so a C-section was scheduled for 37 weeks. The day her daughter was born, MauRene Irving was surrounded by family; when mother and child came home from the hospital, MauRene Irving’s own mother moved into to help out.

But in the weeks that followed, MauRene Irving experienced a series of escalating symptoms that were ultimately not treated with the interventions it would have required to save her life. Three weeks after giving birth, following multiple appointments with physicians, she collapsed in her bedroom. Her death was ultimately attributed to complications attributed to high blood pressure — a condition that medical staff had missed in the weeks after she gave birth, despite her risk factors and health history.

The painful lesson from both Bloomstein and MauRene Irving’s stories is that even women with every seeming advantage are not immune. Healthy women, young women, women with advocates in the room, with good, dedicated doctors, and medical backgrounds themselves are all at risk. The statistics they are up against are worrisome — American women are three times more likely to die during childbirth than Canadian women, six times as likely as Scandinavian women — and the rate of maternal mortality has only climbed in recent years. As the NPR and ProPublica reportage pointed out, more than half of those deaths were preventable.

For every story like these that makes it into the headlines, there are countless others that do not. Mothers die because their self-evaluation that “something is not right” goes unheeded by physicians, and because their pain is not taken seriously. They die because, while medical interventions for high-risk infants have advanced, attention to maternal health innovation has stagnated.

They die because of honest oversights and egregious ones; because of racism, sexism, and lack of access to prenatal and postnatal care. They die because they happened to deliver on a weekend, when data shows that the risk of maternal mortality shoots up almost 50 percent. They die because of complications attributed to pregnancy at advanced maternal age, because of lack of communication between different doctors, because of a broken healthcare system. They die because someone wasn’t paying close enough attention.

The truth is that Serena Williams was fortunate to have had advocates in her hospital room, as well as knowledge to ask for a CT and the power to for that request to be taken seriously. For a different woman, in a different hospital, with a different medical team or status to leverage, that same condition could potentially turn fatal without adequate intervention.

When Williams shared her story, she also helped raise awareness for the fact that no amount of wealth or fame can insulate a woman from risk during a major medical event. She is doing women — mothers — everywhere a favor, because it is a subject that sorely needs our attention.