You have probably heard the story of Tashonna Ward, the 25-year-old Milwaukee woman who recently spent hours in the emergency room due to shortness of breath and died after waiting too long. Ward was told that she would spend between two to six hours in wait time at the ER according to distressing posts on her Facebook page. Preliminary tests were performed on Ward and showed she had cardiomegaly, an enlarged heart, but she was never admitted despite having chest pains and tightness of breath.
After waiting 2 hours and 29 minutes in the ER, Tashonna Ward and her sister decided to go to urgent care. She never made it. She passed out en route and collapsed and died in the urgent care parking lot. The cause of death: hypertensive cardiovascular disease.
While many reports mentioned the emergency room wait times that led to Ward’s death, a few have reported that she developed cardiomegaly due to pregnancy complications from a miscarriage in March of 2019. In fact, the Milwaukee County Medical Examiner’s Report states that the “decedent did develop cardiomegaly during pregnancy.”
The United Nations has designated Sierra Leone as the most dangerous place to have a baby. In fact, it has the highest maternal mortality rate in the world at 1,360 deaths per 100,000 live births. On average, most women have at least six babies in Sierra Leone.
In a previous post I mentioned the Aminata Maternal Foundation that helps pregnant women in Sierra Leone. An Australian organization, it was started by a woman, Aminata Conteh-Biger, who became a sex slave during the Liberian Civil War. Now, she is giving back to expectant mothers after so many years away from her home country.
This video shows the work of the Aminata Maternal Foundation and how it oftentimes becomes difficult for young pregnant girls to receive permission from family and elders to deliver in a hospital or health center. It also shows the frustration of healthcare workers who try to teach entire villages about the importance of proper maternal healthcare.
One of the leading causes of maternal mortality in the United States is hemorrhaging. In fact, according to the CDC hemorrhaging accounts for 11.2% of pregnancy-related deaths. Based on these increasing numbers since 1986 the Joint Commission, the country’s leading accreditation organization for hospitals, has created 13 new standards for perinatal safety for hospitals to properly care for women who hemorrhage during or after delivery. These standards were designed specifically to prevent, recognize and treat, as well as evaluate patients for transfer to critical care for not only hemorrhage but also severe hypertension/preeclampsia.
As I have written many times before postpartum hemorrhage (PPH) or excessive uterine bleeding after childbirth is the leading cause of maternal mortality in low-and-middle income countries. The recommended drug to prevent PPH according to the World Health Organization (WHO) is oxytocin. When administered in its recommended dose it causes little to no side effects. Oxytocin, the WHO’s current gold standard therapy, however, must be refrigerated and administered by skilled health workers posing two obstacles to its wider use in low resource, tropical settings.
Some countries have approved misoprostol, an oral drug, to prevent PPH, but there are several concerns that its use can be misappropriated for abortions instead of used solely for PPH. The World Health Organization has listed misoprostol as an alternative to oxytocin if it is not available.
Now, another PPH preventative drug, carbetocin, has been added to the latest updated 2019 WHO Essential Medicines List. The announcement was made last week. Unlike oxytocin, even at high temperatures carbetocin remains effective. The recommendation is that carbetocin can be used when oxytocin is not available or if its quality is uncertain. Additionally, the cost must be comparable to oxytocin.
Maternal mortality continues to be a major problem the world over. The United States is the only developed country where maternal death rates are increasing especially for non-Hispanic black women. And in low-and-middle income countries, approximately 830 women die each day from pregnancy-related, preventable causes.
Maternal health organizations are working diligently to save more mothers’ lives, but one death is still too many especially when it is likely preventable. I like to list organizations that you can support with donations in order to help them keep more women and their children alive on the local level and make sure mothers are a part of their families’ lives.
This list highlights local organizations that help some of the most vulnerable communities in countries with some of the highest maternal mortality rates. And, in the cases of the United States and Australia, the organizations help the communities that experience the most maternal deaths. Each site allows direct donations that go directly to maternal care and/or advocacy.