Motherhood and Mortality

I do respect those individuals who elect (at this time they still can sorta) to become Mothers. Many I think believe or feel that they can be good Mothers, whatever that means. Many Women do not certainly elect Motherhood I hope thinking it will be fine, they will fake it till they make it nonsense. I want to believe that Women are aware you cannot have it all. You cannot. You have to make a huge sacrifice the minute you decide to pursue Motherhood. That means your personal happiness, your own health, your financial security can be at risk and your own Marriage may also collapse with the weight of Parenthood. It is not for the faint of heart.

The United States has an appalling mortality rate regarding lives of both Mothers and Children. This also depends on where you live in the United States, your access to Health Care and Health Insurance. According to the March of Dimes that In the United States, about 6.9 million women have little or no access to maternal health care. And again the most single contributing factor is Race.

The CDC breaks down infant mortality and its causes to Five Factors. The NIH explains it as such here. And the current stats are not good as we enter year three of Covid.

This according to the CDC:

The number of women who died of maternal causes in the United States rose to 1,205 in 2021, according to a report from the National Center for Health Statistics, released Thursday by the US Centers for Disease Control and Prevention. That’s a sharp increase from years earlier: 658 in 2018, 754 in 2019 and 861 in 2020.

That means the US maternal death rate for 2021 – the year for which the most recent data is available – was 32.9 deaths per 100,000 live births, compared with rates of 20.1 in 2019 and 23.8 in 2020.

The new report also notes significant racial disparities in the nation’s maternal death rate. In 2021, the rate for Black women was 69.9 deaths per 100,000 live births, which is 2.6 times the rate for White women, at 26.6 per 100,000.

The number is rising and it is not good, particularly for Women of Color. But it is overall not good for any Woman.

According to the Commonwealth Fund, as well as the World Health Organization, The US has the highest maternal death rate of any developed nation. While maternal death rates have been either stable or rising across the United States, they are declining in most countries.

“A high rate of cesarean sections, inadequate prenatal care, and elevated rates of chronic illnesses like obesity, diabetes, and heart disease may be factors contributing to the high U.S. maternal mortality rate. Many maternal deaths result from missed or delayed opportunities for treatment,” researchers from the Commonwealth Fund wrote in a report last year.

The Covid-19 pandemic also may have exacerbated existing racial disparities in the maternal death rate among Black women compared with White women, said Dr. Chasity Jennings-Nuñez, a California-based site director with Ob Hospitalist Group and chair of the perinatal/gynecology department at Adventist Health-Glendale, who was not involved in the new report.

“In terms of maternal mortality, it continues to highlight those structural and systemic problems that we saw so clearly during the Covid-19 pandemic,” Jennings-Nuñez said.

“So in terms of issues of racial health inequities, of structural racism and bias, of access to health care, all of those factors that we know have played a role in terms of maternal mortality in the past continue to play a role in maternal mortality,” she said. “Until we begin to address those issues, even without a pandemic, we’re going to continue to see numbers go in the wrong direction.”

So the reality is that we have a rising tide no boats just Moby crashing his tail against the water to insure the waves drown us as we thrash along in the water. And here we are about to make it harder for Women to manage their own reproductive choices. Good idea says the White Man in the Judicial Robe.

I have been noting the deterioration of mental health particularly among children as they come of out the Pandemic. This generation born during the time it began in 2020 and those who were still in K-12 schools are the new generation and they are really fucked up. Do I think it matters if schools were open or closed? No it is larger than that. You cannot Teach and cannot learn in a world and an environment that surrounds you which is in chaos. Sorry you cannot put yourself in a bubble or Island to prevent the world that is outside waiting for you to emerge. Going to school everyday I believe did no more or less than those who remained online. You are kidding yourself if you believe otherwise.

I truly believe any Woman who CHOSE to become pregnant during Covid lockdowns was either incredibly selfish, bored or utterly oblivious. Denial perhaps but there is a type of arrogance that ignorance allows those so unaware of what was happening in hospitals and in medicine overall that I have little or no respect of. Your kids like you Lady are fucked up. Again I point to 946 as my Karen in that room. She is batshit crazy and that is contagious.

I reprint this from the New York Times to understand how serious this issue is. I know I am harsh but I have that luxury and I never wanted Children so that has to be taken into account. I knew early on it was not for me. Not one regret there. But I do support Women’s Reproductive Rights and with that the choice to have a child. I support public health care, public education and tax credits for children and families as well as better wages and work environments for those who care for children, but I do not support stupidity. And those are the Women who think that it is not a massive sacrifice for at least two decades worth of life. Get over yourself you are not special. I am talking to you Karen.

Covid Worsened a Health Crisis Among Pregnant Women

In 2021, deaths of pregnant women soared by 40 percent in the United States, according to new government figures. Here’s how one family coped after the virus threatened a pregnant mother.

By Roni Caryn Rabin The New York Times March 16, 2023

KOKOMO, Ind. — Tammy Cunningham doesn’t remember the birth of her son. She was not quite seven months pregnant when she became acutely ill with Covid-19 in May 2021. By the time she was taken by helicopter to an Indianapolis hospital, she was coughing and gasping for breath.

The baby was not due for another 11 weeks, but Ms. Cunningham’s lungs were failing. The medical team, worried that neither she nor the fetus would survive so long as she was pregnant, asked her fiancé to authorize an emergency C-section.

“I asked, ‘Are they both going to make it?’” recalled Matt Cunningham. “And they said they couldn’t answer that.”

New government data suggest that scenes like this played out with shocking frequency in 2021, the second year of the pandemic.

The National Center for Health Statistics reported on Thursday that 1,205 pregnant women died in 2021, representing a 40 percent increase in maternal deaths compared with 2020, when there were 861 deaths, and a 60 percent increase compared with 2019, when there were 754.

The count includes deaths of women who were pregnant or had been pregnant within the last 42 days, from any cause related to or aggravated by the pregnancy. A separate report by the Government Accountability Office has cited Covid as a contributing factor in at least 400 maternal deaths in 2021, accounting for much of the increase.

Even before the pandemic, the United States had the highest maternal mortality rate of any industrialized nation. The coronavirus worsened an already dire situation, pushing the rate to 32.9 per 100,000 births in 2021 from 20.1 per 100,000 live births in 2019.

The racial disparities have been particularly acute. The maternal mortality rate among Black women rose to 69.9 deaths per 100,000 live births in 2021, 2.6 times the rate among white women. From 2020 to 2021, mortality rates doubled among Native American and Alaska Native women who were pregnant or had given birth within the previous year, according to a study published on Thursday in Obstetrics & Gynecology.

The deaths tell only part of the story. For each woman who died of a pregnancy-related complication, there were many others, like Ms. Cunningham, who experienced the kind of severe illness that leads to premature birth and can compromise the long-term health of both mother and child. Lost wages, medical bills and psychological trauma add to the strain.

Pregnancy leaves women uniquely vulnerable to infectious diseases like Covid. The heart, lungs and kidneys are all working harder during pregnancy. The immune system, while not exactly depressed, is retuned to accommodate the fetus.

Abdominal pressure reduces excess lung capacity. Blood clots more easily, a tendency amplified by Covid, raising the risk of dangerous blockages. The infection also appears to damage the placenta, which delivers oxygen and nutrients to the fetus, and may increase the risk of a dangerous complication of pregnancy called pre-eclampsia.

Pregnant women with Covid face a sevenfold risk of dying compared with uninfected pregnant women, according to one large meta-analysis tracking unvaccinated people. The infection also makes it more likely that a woman will give birth prematurely and that the baby will require neonatal intensive care.

Fortunately, the current Omicron variant appears to be less virulent than the Delta variant, which surfaced in the summer of 2021, and more people have acquired immunity to the coronavirus by now. Preliminary figures suggest maternal deaths dropped to roughly prepandemic levels in 2022.

But pregnancy continues to be a factor that makes even young women uniquely vulnerable to severe illness. Ms. Cunningham, now 39, who was slightly overweight when she became pregnant, had just been diagnosed with gestational diabetes when she got sick.

“It’s something I talk to all my patients about,” said Dr. Torri Metz, a maternal fetal medicine specialist at the University of Utah. “If they have some of these underlying medical conditions and they’re pregnant, both of which are high-risk categories, they have to be especially careful about putting themselves at risk of exposure to any kind of respiratory virus, because we know that pregnant people get sicker from those viruses.”

Lagging Vaccination

In the summer of 2021, scientists were somewhat unsure of the safety of mRNA vaccines during pregnancy; pregnant women had been excluded from the clinical trials, as they often are. It was not until August 2021 that the Centers for Disease Control and Prevention came out with unambiguous guidance supporting vaccination for pregnant women.

Most of the pregnant women who died of Covid had not been vaccinated. These days, more than 70 percent of pregnant women have gotten Covid vaccines, but only about 20 percent have received the bivalent boosters.

“We know definitively that vaccination prevents severe disease and hospitalization and prevents poor maternal and infant outcomes,” said Dr. Dana Meaney-Delman, chief of the C.D.C.’s infant outcomes monitoring, research and prevention branch. “We have to keep emphasizing that point.”

Ms. Cunningham’s obstetrician had encouraged her to get the shots, but she vacillated. She was “almost there” when she suddenly started having unusually heavy nosebleeds that produced blood clots “the size of golf balls,” she said.

Ms. Cunningham was also feeling short of breath, but she ascribed that to the advancing pregnancy. (Many Covid symptoms can be missed because they resemble those normally occurring in pregnancy.)

A Covid test came back negative, and Ms. Cunningham was happy to return to her job. She had already lost wages after earlier pandemic furloughs at the auto parts plant where she worked. On May 3, 2021, shortly after clocking in, she turned to a friend at the plant and said, “I can’t breathe.”

By the time she arrived at IU Health Methodist Hospital in Indianapolis, she was in acute respiratory distress. Doctors diagnosed pneumonia and found patchy shadows in her lungs.

Her oxygen levels continued falling even after she was put on undiluted oxygen, and even after the baby was delivered.

“It was clear her lungs were extremely damaged and unable to work on their own,” said Dr. Omar Rahman, a critical care physician who treated Ms. Cunningham. Already on a ventilator, Ms. Cunningham was connected to a specialized heart-lung bypass machine.

Jennifer McGregor, a friend who visited Ms. Cunningham in the hospital, was shocked at how quickly her condition had deteriorated. “I can’t tell you how many bags were hanging there, and how many tubes were going into her body,” she said.

But over the next 10 days, Ms. Cunningham started to recover. Once she was weaned off the heart-lung machine, she discovered she had missed a major life event while under sedation: She had a son.

He was born 29 weeks and two days into the pregnancy, weighing three pounds.

Premature births declined slightly during the first year of the pandemic. But they rose sharply in 2021, the year of the Delta surge, reaching the highest rate since 2007.

Some 10.5 percent of all births were preterm that year, up from 10.1 percent in 2020, and from 10.2 percent in 2019, the year before the pandemic.

Though the Cunninghams’ baby, Calum, never tested positive for Covid, he was hospitalized in the neonatal intensive care unit at Riley Hospital for Children in Indianapolis. He was on a breathing tube, and occasionally stopped breathing for seconds at a time.

Doctors worried that he was not gaining weight quickly enough — “failure to thrive,” they wrote in his chart. They worried about possible vision and hearing loss.

But after 66 days in the NICU, the Cunninghams were able to take Calum home. They learned how to use his feeding tube by practicing on a mannequin, and they prepared for the worst.

“From everything they told us, he was going to have developmental delays and be really behind,” Mr. Cunningham said.

After her discharge from the hospital, Ms. Cunningham was under strict orders to have a caretaker with her at all times and to rest. She didn’t return to work for seven months, after she finally secured her doctors’ approval.

Ms. Cunningham has three teenage daughters, and Mr. Cunningham has another daughter from a previous relationship. Money was tight. Friends dropped off groceries, and the landlord accepted late payments. But the Cunninghams received no government aid: They were even turned down for food stamps.

“We had never asked for assistance in our lives,” Ms. Cunningham said. “We were workers. We used to work seven days a week, eight-hour days, sometimes 12. But when the whole world shut down in 2020, we used up a lot of our savings, and then I got sick. We never got caught up.”

Though she is back to work at the plant, Ms. Cunningham has lingering symptoms, including migraines and short-term memory problems. She forgets doctor’s appointments and what she went to the store for. Recently she left her card in an A.T.M.

Many patients are so traumatized by their stays in intensive care units that they develop so-called post-intensive care syndrome. Ms. Cunningham has flashbacks and nightmares about being back in the hospital.

“I wake up feeling like I’m being smothered at the hospital, or that they’re killing my whole family,” she said. Recently she was diagnosed with post-traumatic stress disorder.

Calum, however, has surprised everyone. Within months of coming home from the hospital, he was reaching developmental milestones on time. He started walking soon after his first birthday, and likes to chime in with “What’s up?” and “Uh-oh!”

He has been back to the hospital for viral infections, but his vocabulary and comprehension are superb, his father said. “If you ask if he wants a bath, he’ll take off all his clothes and meet you at the bath,” he said.

Louann Gross, who owns the day care that Calum attends, said he has a hearty appetite — often asking for “thirds” — and more than keeps up with his peers. She added, “I nicknamed him our ‘Superbaby.’”