WEBVTT - America’s Maternal Mortality Crisis, Part 1 0:00:00.640 --> 0:00:04.200 Hi everyone, I'm Katie Current and welcome to next question. 0:00:07.480 --> 0:00:11.639 And that same set of double doors opened, and those 0:00:11.680 --> 0:00:14.520 same two residents came through that set of double doors 0:00:15.280 --> 0:00:18.279 along with another doctor that I had never laid eyes on, 0:00:19.640 --> 0:00:26.040 and they told me that um, she passed and there 0:00:26.079 --> 0:00:29.120 was nothing else that they could do to Saber. I 0:00:29.240 --> 0:00:34.440 just remember the scream that my mother in law at all. 0:00:34.800 --> 0:00:39.159 I remember, you know, her aunt falling to the floor. 0:00:39.200 --> 0:00:42.240 I remember her brother just yelling, and I just remember 0:00:42.240 --> 0:00:44.080 I'm just looking around at all these people that I 0:00:44.159 --> 0:00:46.839 love so much and that love cure so much and 0:00:47.040 --> 0:00:49.360 so much pain, and I'm just standing there in shock. 0:00:50.400 --> 0:00:53.360 It's like no, no, no, no, and just insisting that 0:00:53.440 --> 0:00:58.840 they something didn't happen, because literally twelve hours earlier we 0:00:58.960 --> 0:01:00.920 walked into this hospit but with a woman that and 0:01:01.080 --> 0:01:03.280 only was in good health, it was an exceptional health. 0:01:04.760 --> 0:01:07.520 Not only that, I was just talking to her when 0:01:07.560 --> 0:01:09.160 she walked away from me, I was holding her hand, 0:01:09.200 --> 0:01:14.200 I was talking to her. How did this happen? On 0:01:14.319 --> 0:01:18.640 April two thousand sixteen, Charles Johnson and his wife Kia 0:01:19.040 --> 0:01:23.640 became a part of a shameful statistic America's maternal mortality 0:01:23.760 --> 0:01:27.840 rate in the US and estimated two women die every 0:01:27.959 --> 0:01:33.080 day from pregnancy and childbirth related causes, and six of 0:01:33.120 --> 0:01:37.640 those deaths could have been prevented. What's scary now is 0:01:37.720 --> 0:01:41.920 that those numbers don't take the coronavirus into consideration and 0:01:42.000 --> 0:01:45.720 the effect a pandemic could have on an already fragile 0:01:45.840 --> 0:01:50.160 maternal health system. The fact is the situation was bleak 0:01:50.280 --> 0:01:55.840 long before COVID nineteen hit the US in early Over 0:01:55.880 --> 0:01:59.120 the past three decades, while the world has drastically reduced 0:01:59.120 --> 0:02:02.240 its maternal more vality rate, the U s is the 0:02:02.280 --> 0:02:06.440 only developed nation to see its rate go up, and 0:02:06.640 --> 0:02:10.200 go up significantly. The US now has one of the 0:02:10.280 --> 0:02:13.520 highest mortality rates in the developed world, a fact that 0:02:13.639 --> 0:02:17.400 was so shocking to me, that seems so incongruous, that 0:02:17.480 --> 0:02:20.200 I set out to understand how this could be possible. 0:02:20.680 --> 0:02:23.600 And so today part one of our look into America's 0:02:23.639 --> 0:02:28.320 maternal mortality crisis and my next question, what's behind this 0:02:28.400 --> 0:02:36.080 devastating trend. To answer that question, we have to go 0:02:36.160 --> 0:02:42.480 back to cure a story. We were just over the moon, 0:02:42.600 --> 0:02:45.720 ecstatic to welcome our first son, Charles. It was just 0:02:45.760 --> 0:02:50.160 such a tremendous blessing We've always talked about having back 0:02:50.200 --> 0:02:52.280 to back boys. You know. The first time around, we 0:02:52.400 --> 0:02:55.919 talked about all the politically correct stuff. We're not really 0:02:55.919 --> 0:02:59.360 worried about what jenitors. As long as it's a healthy baby, 0:02:59.400 --> 0:03:01.760 we don't care. But by the time the second one 0:03:01.800 --> 0:03:04.200 came around, Kira had her mind made up. She was like, 0:03:04.240 --> 0:03:07.280 I'm a boy's mom. This is where I get in, 0:03:07.280 --> 0:03:10.080 where I fit in. Kira and Charles were married in 0:03:10.280 --> 0:03:13.600 two thousand and twelve. Two years later, they welcomed their 0:03:13.639 --> 0:03:17.840 first son, Charles the fifth, via C section in Atlanta, 0:03:17.960 --> 0:03:20.600 and two thousand and fifteen, a job opportunity moved the 0:03:20.639 --> 0:03:23.840 young family out to Los Angeles, where they were preparing 0:03:23.880 --> 0:03:26.880 for the birth of their second son, who they decided 0:03:27.000 --> 0:03:30.920 to call Langston. We interviewed about I think about three 0:03:31.040 --> 0:03:33.760 or four different O. B. G Yan's, and we had 0:03:33.800 --> 0:03:36.720 also made the decision very early on that we wanted 0:03:36.760 --> 0:03:40.680 to deliver at Cedar Sinai Hospital. It was our understanding 0:03:41.000 --> 0:03:43.440 that Cedar sign I was supposed to be, you know, 0:03:43.600 --> 0:03:45.800 one of the best places, certainly in the state of California, 0:03:46.240 --> 0:03:48.480 and it had a reputation of being, you know, one 0:03:48.520 --> 0:03:50.720 of the best places in the country. Particularly in the 0:03:50.760 --> 0:03:54.640 area of eccentrics and delivery. Beyond a little bit of 0:03:54.720 --> 0:03:59.720 nausea early on, Kira's second pregnancy passes without incident. She's thirty, 0:04:00.280 --> 0:04:03.920 she's fit, she's healthy, and she has the resources to 0:04:04.040 --> 0:04:07.360 choose her care. Because Kira had a C section with 0:04:07.400 --> 0:04:10.560 her first delivery, her doctor recommends they do the same 0:04:10.640 --> 0:04:14.160 for the second. She's scheduled for a routine C section 0:04:14.480 --> 0:04:18.400 on April twelve, two thousand and sixteen, at Cedars Sinai 0:04:18.480 --> 0:04:22.799 Hospital in l A. So we walked in for Lengthson's 0:04:22.839 --> 0:04:27.400 delivery for the scheduled C section at two o'clock, and 0:04:27.440 --> 0:04:31.800 so Lengthon is born, perfectly healthy, tin fingers, tin toes, 0:04:32.560 --> 0:04:35.080 you know, super super handsome, looking just like me. And 0:04:35.120 --> 0:04:39.120 it's just we're just overwhelmed with all this, just joy 0:04:39.160 --> 0:04:42.719 and pride of just welcoming this precious gift into our lives. 0:04:42.800 --> 0:04:48.240 And so shortly after the delivery, they take us back 0:04:48.279 --> 0:04:52.960 to recovery. You're sitting in the bed resting, and Lengthon 0:04:53.080 --> 0:04:56.520 is there and the little incubator toaster thingy. And as 0:04:56.560 --> 0:05:01.279 I'm sitting there, I looked down here's bedside, and I 0:05:01.320 --> 0:05:03.640 begin to see the calf that are the fully catheter 0:05:04.080 --> 0:05:06.640 coming from her bedside begin to turn pink with blood. 0:05:09.160 --> 0:05:11.560 And so this was around four o'clock in the afternoon, 0:05:12.279 --> 0:05:14.839 and I brought it to the attention to the doctors 0:05:14.839 --> 0:05:18.120 and the nurses and cedars, and they come in, they 0:05:18.160 --> 0:05:21.440 examine cure, They examine her physically and take her vitals. 0:05:22.160 --> 0:05:25.320 They do an art sound, but very importantly, they order 0:05:25.400 --> 0:05:30.760 a CT scan to be performed stat When the results 0:05:30.800 --> 0:05:34.520 from those initial tests come back, they're not good. Kira's 0:05:34.560 --> 0:05:38.799 blood levels are abnormal and the ultrasound shows fluid filling 0:05:38.839 --> 0:05:42.560 her abdomen, but there's no action from the staff. As 0:05:42.640 --> 0:05:46.680 CIA's condition continues to deteriorate, she's forced to wait for 0:05:46.720 --> 0:05:53.440 the next step. The CT scan. Six o'clock comes, no 0:05:53.640 --> 0:05:58.440 CT scan. Seven o'clock, no CT scan, eight o'clock, Still 0:05:58.480 --> 0:06:01.400 no CT scans, Still haven't take her back to surgery. 0:06:01.680 --> 0:06:07.560 Ten o'clock comes, no CT scan. E eleven o'clock comes, 0:06:08.160 --> 0:06:13.720 no CT scan. At this point, Kira's pale, shivering, uncontrollably, 0:06:14.160 --> 0:06:17.640 and sensitive to touch. In the seven hours since Charles 0:06:17.680 --> 0:06:20.880 first noticed blood and Kira's catheter, he and his family 0:06:20.920 --> 0:06:25.320 have been relentlessly advocating for her, asking for help, asking 0:06:25.400 --> 0:06:30.760 for that CT scan, for attention, for anything. Were you 0:06:30.800 --> 0:06:35.239 going crazy, Charles? I can only imagine that you were, uh, 0:06:35.279 --> 0:06:38.479 you know, I think about Shirley McClain in terms of endearment, 0:06:38.600 --> 0:06:43.120 that you were just furious. I was doing my best 0:06:43.360 --> 0:06:48.400 to stay calm in this In this moment, I have 0:06:48.560 --> 0:06:53.239 a wife who is clearly um fighting for her life. 0:06:53.240 --> 0:06:55.479 I have a newborn baby. I have family members that 0:06:55.520 --> 0:06:58.000 are all looking and saying, what's going on? We need answers. 0:06:58.400 --> 0:07:01.840 And Kira's whole time, even her most vulnerable, her thing 0:07:01.880 --> 0:07:06.200 to me was, baby, just stay calm in that moment. 0:07:06.200 --> 0:07:08.520 As much as I wanted to yell and scream and 0:07:08.560 --> 0:07:11.880 slam my fists on the nurses station or grab a 0:07:11.920 --> 0:07:15.160 doctor by the collar, what Kira knew, even her most 0:07:15.200 --> 0:07:18.480 vulnerable state, was that the moment I raised my voice, 0:07:18.560 --> 0:07:22.360 the moment I become too aggressive as an African American male, 0:07:22.640 --> 0:07:26.800 I become seen as a threat. And ultimately she was 0:07:26.840 --> 0:07:29.920 concerned that I would be then that they would call security, 0:07:30.080 --> 0:07:33.600 and then I'd be removed from the situation. Um. And 0:07:33.640 --> 0:07:38.760 so even in my most heightened the point of anger, 0:07:39.160 --> 0:07:41.640 I do my best to stay calm and communicated as 0:07:41.640 --> 0:07:44.040 effectively as I can, and even to the point around 0:07:44.120 --> 0:07:46.320 nine o'clock Katie, I pulled a nurse to the side 0:07:46.320 --> 0:07:48.440 of Cedars and as I grabbed her by her hands 0:07:48.440 --> 0:07:50.240 and I just said, look, I looked turned eyes and said, 0:07:50.280 --> 0:07:52.840 I need help. My wife isn't doing good. They're telling 0:07:52.920 --> 0:07:54.800 us they're gonna take her back to surgery. They're telling 0:07:54.880 --> 0:07:57.320 us that they need to do a CT scam, but 0:07:57.360 --> 0:08:01.160 nobody's coming. They haven't done anything. We need help. And 0:08:01.200 --> 0:08:04.040 the woman looked me in my eyes and said, sir, 0:08:04.120 --> 0:08:08.360 your wife just isn't a priority right now, and then 0:08:08.400 --> 0:08:17.760 she just walked away. That CT scan never comes and 0:08:17.840 --> 0:08:21.120 it isn't until after midnight that the staff makes the 0:08:21.200 --> 0:08:25.280 decision to take your back to surgery. At this point, 0:08:25.400 --> 0:08:29.800 she's extremely weak, but she's conscious and has been since 0:08:29.920 --> 0:08:33.880 Charles first alerted the staff that something was wrong more 0:08:33.920 --> 0:08:39.560 than eight hours ago. I'm frustrated, I'm angry, I have 0:08:39.640 --> 0:08:41.760 all this mix of emotions, but a certain part of 0:08:41.760 --> 0:08:46.720 me is relieved because they're finally doing something. And you know, 0:08:46.760 --> 0:08:50.839 as we're walking down the hall uh towards the o 0:08:51.120 --> 0:08:53.800 R and I'm walking next to her bedside and I'm 0:08:53.840 --> 0:08:58.360 holding here's hand. She's holding my hand, and she's saying, baby, 0:08:58.360 --> 0:09:03.920 I'm scared. I can't even really think of many times 0:09:03.960 --> 0:09:07.920 and the you know, years I've known this woman that 0:09:07.960 --> 0:09:12.480 she's ever uttered those words. And as I'm walking next 0:09:12.520 --> 0:09:14.800 to her, I'm doing the only thing I know how 0:09:14.840 --> 0:09:17.080 to do as a husband, which is just trying and 0:09:17.120 --> 0:09:19.800 tell her that maybe everything's gonna be okay. It's gonna 0:09:19.840 --> 0:09:25.200 be okay. They wheel her away and finally get to 0:09:25.200 --> 0:09:28.800 this point where these double doors open and they close 0:09:28.920 --> 0:09:35.680 behind her. Ah. They take me into a waiting room, 0:09:35.720 --> 0:09:38.479 the exact same waiting room that we were in that afternoon, 0:09:39.960 --> 0:09:45.120 full of mothers with these humongous bellies and balloons and 0:09:45.280 --> 0:09:52.319 families with cameras and all this wonderful, beautiful, anxious anticipation 0:09:52.520 --> 0:09:57.200 to welcome these new lives into the world. And now 0:09:57.240 --> 0:09:59.720 it's almost one o'clock in the morning and I'm in 0:09:59.800 --> 0:10:03.480 the I'm the only person in the room, all by myself, 0:10:04.440 --> 0:10:09.920 and it is just eerily silent, and the only thing 0:10:09.960 --> 0:10:14.959 I hear is literally the janitor's vacuum going back and forth. 0:10:17.559 --> 0:10:20.960 And about twenty minutes go by, and the set of 0:10:20.960 --> 0:10:25.959 double doors open and a set of two residents come 0:10:26.040 --> 0:10:29.800 walking through the doors, and as they get closer to me, 0:10:29.840 --> 0:10:32.120 I can see that the looks on their face it 0:10:32.200 --> 0:10:35.199 was not good. He said, look, we couldn't be back 0:10:35.240 --> 0:10:39.640 there any longer without letting you know what happened. Um 0:10:39.720 --> 0:10:41.360 when he opened her up, there was a lot of 0:10:41.400 --> 0:10:48.280 blood and she coded. And then they go on to 0:10:48.320 --> 0:10:54.320 tell me situation is critical and they're continuing to work 0:10:54.360 --> 0:11:01.960 on her. And at that point, it's you know, Cure's energy, 0:11:02.000 --> 0:11:04.040 the way I am, the way we are. I was 0:11:04.080 --> 0:11:06.120 just I'm just I'm just an optimist. When you told 0:11:06.160 --> 0:11:08.480 me that you're continuing to work on her in her 0:11:08.520 --> 0:11:10.600 situation is critical, that's all I needed to hear, because 0:11:10.600 --> 0:11:13.480 I'm thinking, it's Kira. She's the closest thing that I've 0:11:13.520 --> 0:11:16.560 ever met to a superhero. She's gonna be okay. Right, 0:11:16.920 --> 0:11:18.920 we had to scare but she's gonna be okay, is 0:11:18.920 --> 0:11:22.040 what I was thinking at that point. And I probably 0:11:22.080 --> 0:11:23.720 told him I said, look, thank you for coming out 0:11:23.760 --> 0:11:27.080 and telling me, but you're not doing anything for me 0:11:27.120 --> 0:11:28.800 by being out here. I need you to get back 0:11:28.800 --> 0:11:33.080 in there and bring me my wife back. Minutes later, 0:11:33.640 --> 0:11:38.720 surrounded by Kira's loved ones, Charles gets the unimaginable news. 0:11:39.360 --> 0:11:44.280 They told me that um she had passed and there 0:11:44.320 --> 0:11:48.720 was nothing else that they could do to Saber. Literally 0:11:48.960 --> 0:11:51.599 twelve hours earlier, we walked into this hospital with a 0:11:51.640 --> 0:11:53.480 woman that not only was in good health, it was 0:11:53.480 --> 0:11:59.400 an exceptional health. And what you're telling me, it's not computing. 0:11:59.440 --> 0:12:03.480 This doesn't make sense. How can this happen? What did 0:12:03.559 --> 0:12:07.360 happen is that Kira's bladder was nicked during her C section, 0:12:07.840 --> 0:12:11.760 and for nearly ten hours from incision to returning to 0:12:11.840 --> 0:12:15.400 the o R, Kira bled to death. When they opened 0:12:15.400 --> 0:12:17.800 her up, they found three and a half liters of 0:12:17.840 --> 0:12:21.480 blood in her abdomen and her heart had given out. 0:12:22.240 --> 0:12:23.920 That was the last time I saw my wife. A laar, 0:12:27.320 --> 0:12:44.360 We'll be right back. On April two thousand sixteen, Kira 0:12:44.440 --> 0:12:48.200 Johnson became one of the approximately nine women who die 0:12:48.400 --> 0:12:53.840 every year from pregnancy and childbirth related causes. To understand 0:12:53.840 --> 0:12:56.000 how we got to Kira, we have to go back 0:12:56.000 --> 0:12:59.400 to the nineteen eighties. For much of the twentieth century, 0:12:59.760 --> 0:13:04.600 the US enjoyed decades of essentially an uninterrupted decline in 0:13:04.679 --> 0:13:08.520 its maternal mortality rate, but then in the nineteen eighties, 0:13:08.840 --> 0:13:12.400 that rate started to tick back up. We thought maternal 0:13:12.440 --> 0:13:18.160 mortality was essentially solved, as we could um make improvements, 0:13:18.400 --> 0:13:21.320 we could bring down by a few deaths. But I 0:13:21.360 --> 0:13:25.960 had no idea that actually deaths were increasing. That's Dr 0:13:26.080 --> 0:13:29.760 Deborah Bingham, founder and executive director for the Institute for 0:13:29.920 --> 0:13:34.960 Parnatal Quality Improvement and associate professor at the University of Maryland. 0:13:35.440 --> 0:13:39.840 Deborah has also been working as a pernatal nurse, bedside 0:13:39.960 --> 0:13:44.240 and administration, and in public health since nineteen seventy eight. 0:13:44.840 --> 0:13:47.600 By the two thousand's, she was the director of nursing 0:13:47.720 --> 0:13:51.520 for two hospitals in New York City. We only had 0:13:51.559 --> 0:13:54.880 one death in like a five year period, so we 0:13:55.000 --> 0:13:57.679 I didn't have any data to tell me Otherwise, I 0:13:57.760 --> 0:14:01.319 had no personal experiences to say this is a problem. 0:14:01.360 --> 0:14:04.800 I didn't think this was a crisis, but Deborah soon 0:14:04.920 --> 0:14:08.520 found out it was in two thousand and six. She 0:14:08.720 --> 0:14:11.679 was working on her doctorate when she accepted a position 0:14:11.679 --> 0:14:16.280 in California to form the state's first Maternal Quality Care Collaborative, 0:14:16.720 --> 0:14:20.480 an initiative to improve maternal outcomes. During the fall of 0:14:20.520 --> 0:14:23.280 two thousand and six, she was pulled into a private 0:14:23.360 --> 0:14:27.040 meeting with leaders from the California Department of Health. In 0:14:27.080 --> 0:14:33.200 this private meeting, we we were shown, um that rates 0:14:33.200 --> 0:14:38.520 of maternal death had been rising in California, and they 0:14:38.560 --> 0:14:42.480 didn't know why, nor did we. It was shocking. We 0:14:42.560 --> 0:14:46.440 knew our rates um even in the nineties were still 0:14:46.600 --> 0:14:51.680 higher than other countries, so we not significantly higher, but 0:14:52.440 --> 0:14:56.480 slightly higher than other developed countries. So UM, I should 0:14:56.480 --> 0:15:00.440 say I knew that. I knew that our rates of 0:15:01.000 --> 0:15:04.440 maternal deaths in the United States were a little higher 0:15:04.480 --> 0:15:08.440 than other developed countries. So to even have any increase 0:15:08.680 --> 0:15:12.520 was just is very shocking. I thought we were getting better, 0:15:12.640 --> 0:15:16.000 not worse. And I still remember the room I was 0:15:16.080 --> 0:15:19.520 in and how that felt to just like, oh my gosh, 0:15:19.720 --> 0:15:22.480 what is going on? And is l And I didn't 0:15:22.520 --> 0:15:24.520 know at that time whether that was just unique to 0:15:24.560 --> 0:15:29.400 California or was that issue for the entire country. The 0:15:29.560 --> 0:15:33.400 issue was not unique to California. It was a national 0:15:33.440 --> 0:15:37.400 trend that would only continue to rise. In n seven, 0:15:37.600 --> 0:15:41.360 the maternal mortality rate was seven point two, meaning for 0:15:41.440 --> 0:15:46.600 every one hundred thousand live births, about seven women died. Today, 0:15:46.640 --> 0:15:50.000 that rate has more than doubled to seventeen point four. 0:15:50.680 --> 0:15:53.640 Now to really understand why more mothers are dying today 0:15:53.680 --> 0:15:56.520 than they were thirty years ago. Debra says, you have 0:15:56.600 --> 0:16:00.160 to look at what's changed in the medical industry. You 0:16:00.200 --> 0:16:03.480 can't ignore the fact that we've had a sixty nearly 0:16:03.520 --> 0:16:08.640 a six increase in cesarean birth. Now about one third 0:16:08.680 --> 0:16:12.880 of all women give birth surgically. And then there's fewer 0:16:12.920 --> 0:16:17.080 women having vaginal births after cesarean and so there's more 0:16:17.120 --> 0:16:21.000 repeat c sections, which add more risks to have the 0:16:21.120 --> 0:16:24.320 same scar open multiple times, leads to all kinds of 0:16:24.320 --> 0:16:28.440 potential complications. Another thing that has changed over the last 0:16:28.480 --> 0:16:33.000 thirty years, more women are being admitted earlier in labor 0:16:33.160 --> 0:16:35.920 and what that means that that in the United States, 0:16:35.920 --> 0:16:38.440 we don't have a lot of hospitals, don't have like 0:16:38.560 --> 0:16:41.680 labor lounges or places where women can keep moving around, 0:16:41.720 --> 0:16:44.760 so they're often put in bad and um don't have 0:16:44.840 --> 0:16:48.240 freedom of movement in the early stages of labor, where 0:16:48.240 --> 0:16:51.560 in the past we used to help women UM have 0:16:51.760 --> 0:16:56.160 confidence go home, walk around at home, UM and come 0:16:56.200 --> 0:16:59.720 back several hours later or maybe even their labor would stop, 0:17:00.120 --> 0:17:02.920 which now they're being admitted, and once they're admitted, then 0:17:03.000 --> 0:17:06.359 all this whole what's called a cascade of interventions happen, 0:17:06.440 --> 0:17:10.399 which then lead them down a path that could have 0:17:10.440 --> 0:17:13.840 been avoided previously. You can think of it as a 0:17:13.920 --> 0:17:17.440 path of interventions that could start with something like medication 0:17:17.520 --> 0:17:21.640 to induce labor and then end with an emergency c section. 0:17:22.280 --> 0:17:27.119 Interventions aren't necessarily dangerous, but each one has the potential 0:17:27.440 --> 0:17:31.320 to at least introduce risk to the mother. I am 0:17:31.400 --> 0:17:35.440 a high risk perinatal nurse, meaning that I take care 0:17:35.480 --> 0:17:38.400 of Over many years, I've taken care of very, very 0:17:38.440 --> 0:17:42.439 sick women with very serious medical conditions, So I'm not 0:17:42.600 --> 0:17:48.959 opposed in any way to using induction agents or interventions 0:17:49.000 --> 0:17:53.359 medical interventions. I personally have helped intervene in many ways 0:17:53.600 --> 0:17:57.119 when needed, but as I've learned, we should not intervene 0:17:57.440 --> 0:18:00.520 for the heck of it. Devor says, there's one final 0:18:00.600 --> 0:18:03.919 element that's worth noting here. When we're talking about this 0:18:04.080 --> 0:18:08.359 increase in the maternal mortality rate over the last thirty years, 0:18:08.720 --> 0:18:11.480 we started counting better, So we need to acknowledge that 0:18:11.920 --> 0:18:15.119 some of this increases due to better counting, which is 0:18:15.160 --> 0:18:18.680 a good thing because every death deserves to be counted 0:18:19.240 --> 0:18:21.960 and needs to be counted. So we can learn from 0:18:22.160 --> 0:18:24.960 all all of the deaths. It's a way to honor 0:18:25.000 --> 0:18:27.080 the women who died. It's a way to honor the 0:18:27.160 --> 0:18:31.359 teams who tried to save their lives. But changes in 0:18:31.359 --> 0:18:34.560 the medical system still don't give us the full picture. 0:18:35.000 --> 0:18:39.520 There are other forces, major structural issues that caused between 0:18:39.600 --> 0:18:43.200 seven hundred and nine hundred women to die every year. 0:18:43.960 --> 0:18:51.359 A really major problem and cause is the focus on 0:18:52.280 --> 0:18:57.600 babies and fetuses rather than mothers. It's a problem that's 0:18:57.640 --> 0:19:02.080 been developing over five decades. Nina Martin is an investigative 0:19:02.080 --> 0:19:05.560 reporter at pro Publica. She spent her career reporting on 0:19:05.640 --> 0:19:09.280 women's health. In two thousand and seventeen, Nina, along with 0:19:09.320 --> 0:19:12.520 the team at pro Publica and her partners at NPR, 0:19:13.000 --> 0:19:17.240 released a massive investigative report on the maternal mortality crisis. 0:19:17.600 --> 0:19:21.040 It was called the Lost Mother's Project, and it would 0:19:21.040 --> 0:19:24.400 go on to win a Peabody Award. Women used to die, 0:19:24.840 --> 0:19:27.480 you know, hundreds of thousands of women used to die 0:19:28.080 --> 0:19:30.960 probably a year in the turn of the twentieth century 0:19:31.680 --> 0:19:38.120 um from pregnancy and childbirth complications. And there was enormous 0:19:38.200 --> 0:19:42.760 progress over many, many decades to to bring those numbers 0:19:42.800 --> 0:19:47.480 down and then UM. Somewhere around the fifties and the 0:19:47.560 --> 0:19:51.080 sixties UM the numbers got to be good enough where 0:19:51.760 --> 0:19:54.600 people started taking the eye off there there, you know, 0:19:54.680 --> 0:20:00.560 started really thinking about it differently. Before the nineteen sixties, 0:20:00.560 --> 0:20:04.880 the fetus was essentially inaccessible to doctors. They literally couldn't 0:20:04.880 --> 0:20:07.800 examine it, so care had to focus on the mother. 0:20:08.520 --> 0:20:13.400 But then technological advancements and new techniques like testing amniotic 0:20:13.480 --> 0:20:17.520 fluid and sonogram imaging made it possible for doctors to 0:20:17.600 --> 0:20:22.280 monitor the fetus in utero. With the fetus now a patient, 0:20:22.760 --> 0:20:25.600 the next few decades saw a pronounced shift of care 0:20:25.720 --> 0:20:30.040 and attention away from the mother. Today, Nina Martin says, 0:20:30.359 --> 0:20:33.920 it's clear where the priorities are. You know, think about 0:20:33.960 --> 0:20:37.400 smoking and and and sort of some of the messaging 0:20:37.440 --> 0:20:40.399 around smoking during pregnancy. It's not about the fact that 0:20:40.440 --> 0:20:42.960 smoking is really bad for moms. It's about smoking for 0:20:43.040 --> 0:20:46.520 the babies. Think about when you're giving birth. You go 0:20:46.800 --> 0:20:49.320 in and you get hooked up to monitors and everything, 0:20:49.480 --> 0:20:53.000 and the monitor is mostly there to check the fetal 0:20:53.040 --> 0:20:55.680 heart rate and to make sure that the baby signs 0:20:55.720 --> 0:20:58.320 are okay. And if the baby signs aren't okay, then 0:20:58.480 --> 0:21:00.679 it's you know, rush, rush, rush in to get the 0:21:00.680 --> 0:21:06.320 C section. Mom signs are monitored at a much lesser rate, 0:21:07.000 --> 0:21:09.760 So much of the attention in the maternity ward after 0:21:10.000 --> 0:21:13.679 mom gives birth is around feeding the baby, taking care 0:21:13.720 --> 0:21:15.239 of the baby. What do you do? Do you know, 0:21:15.320 --> 0:21:18.879 how are you to have the car seat? You know, 0:21:19.040 --> 0:21:20.840 all of that. It's not about well, who's going to 0:21:20.920 --> 0:21:22.800 take care of you when you go home? And do 0:21:22.840 --> 0:21:25.800 you know warning signs and everything. We just kind of 0:21:25.880 --> 0:21:28.560 kick her home with the baby and don't pay any 0:21:28.560 --> 0:21:31.679 attention to her. I mean, it's just really shocking. But 0:21:31.800 --> 0:21:36.480 there's still another structural issue putting so many American mothers 0:21:36.520 --> 0:21:49.960 at risk. Will explore that right after this. When Kia 0:21:50.080 --> 0:21:54.000 Johnson died in April of two thousand sixteen, the cause 0:21:54.040 --> 0:21:58.359 of death would be listed as hemorrhage shock. But the 0:21:58.400 --> 0:22:03.199 truth is much more complicated. What happened to Cira was 0:22:03.240 --> 0:22:07.000 not just a medical tragedy, was a medical catastrophe. Everything 0:22:07.040 --> 0:22:10.399 that could have went wrong, in fact did so. Not 0:22:10.480 --> 0:22:13.720 only did that doctor failed Kira, but the hospital and 0:22:13.760 --> 0:22:18.080 their policies and procedures failed her. Let's talk about the 0:22:18.359 --> 0:22:22.639 role race might have played. Do you believe that it 0:22:22.760 --> 0:22:26.440 did do you believe that you were you and Kira 0:22:26.560 --> 0:22:32.479 were dismissed or not treated seriously because of because of 0:22:32.480 --> 0:22:38.639 your skin color. Absolutely, and the reality of the situation 0:22:38.720 --> 0:22:42.720 is this is that what is clear about what happened 0:22:43.320 --> 0:22:47.000 on April twelve of two thousand and sixteen Seater Sina 0:22:47.240 --> 0:22:53.400 is that the staff and the doctors and the nurses 0:22:53.440 --> 0:22:57.120 that were responsible for Cura's life failed to seek Kira 0:22:57.280 --> 0:23:00.399 in the same way that they would see their daughter, 0:23:01.040 --> 0:23:04.919 or their mother or their wives. I thought that what 0:23:05.040 --> 0:23:07.720 happened to here was an isolated incident. I thought that 0:23:08.320 --> 0:23:11.040 a woman who is an exceptional health who has access 0:23:11.080 --> 0:23:13.480 to care, who does all the things right, walking into 0:23:13.480 --> 0:23:16.480 a hospital like Cedar Sinai in exceptional health and not 0:23:16.640 --> 0:23:19.280 walking out to raise her boys, I thought that it 0:23:19.359 --> 0:23:21.160 was an anomal I thought, this is something that doesn't 0:23:21.200 --> 0:23:26.720 happen in two thousand and sixteen in our country. But 0:23:26.840 --> 0:23:29.959 it does happen. And of that nine hundred or so 0:23:30.080 --> 0:23:34.560 women who die every year, the vast majority are black. 0:23:35.119 --> 0:23:38.600 Black women are more likely to die during pregnancy, three 0:23:38.640 --> 0:23:41.199 to four times more likely to die during pregnancy than 0:23:41.200 --> 0:23:45.639 white women. Monica Rose McLamore is an associate professor at 0:23:45.680 --> 0:23:49.720 the University of California, San Francisco. She has dedicated her 0:23:49.880 --> 0:23:53.919 entire career to reproductive health and justice. So when you 0:23:53.960 --> 0:23:57.320 think about that, that group of between seven hundred and 0:23:57.480 --> 0:24:00.960 nine hundred, you know, maternal deaths in the United States, 0:24:01.640 --> 0:24:05.560 you can argue that you know, three hundred of them 0:24:05.560 --> 0:24:09.680 potentially could be black and brown women, and so that 0:24:09.800 --> 0:24:14.880 disparity or that difference is actually huge. And that's when 0:24:14.920 --> 0:24:21.560 you control for education, income status, um, insurance type, place 0:24:21.640 --> 0:24:26.040 of care, that risk is equally shared by Black women. Regardless. 0:24:28.040 --> 0:24:31.280 If you ask Monica what's causing such a disparity, what's 0:24:31.359 --> 0:24:35.000 killing so many Black women like Kia Johnson, he agrees 0:24:35.080 --> 0:24:40.720 with Charles it's racism, pure and simple. The truth of 0:24:40.760 --> 0:24:44.680 the matter is is that you know, black death during pregnancy, 0:24:44.920 --> 0:24:47.800 in my opinion, is a canary in a coal mine. 0:24:47.880 --> 0:24:50.800 It tells us where our priorities are. It tells us. 0:24:51.040 --> 0:24:54.399 You know that that again, you know, we don't listen 0:24:54.440 --> 0:24:57.440 to and or believe black women, whether it's about pain 0:24:57.720 --> 0:25:01.840 or whether it's about pregnancy related symptoms, contractions, whatever. We 0:25:01.840 --> 0:25:05.000 we don't value black women. It's because our lives aren't 0:25:05.000 --> 0:25:07.800 worth saving to some people. And so you know, to 0:25:07.920 --> 0:25:10.160 say that as a black woman is a really hard thing. 0:25:10.200 --> 0:25:12.359 But that that's what my gut tells me, That's what 0:25:12.440 --> 0:25:15.520 my lived experience tells me. Every time I use the 0:25:15.560 --> 0:25:19.520 word racism, people always go to the you know, interpersonal level. 0:25:19.600 --> 0:25:22.040 I am calling you a bad person in there for 0:25:22.119 --> 0:25:24.560 your racist That's not what I'm talking about. I actually 0:25:24.640 --> 0:25:28.200 think most people actually inherently are trying to do as 0:25:28.240 --> 0:25:30.520 well as they can do with what they have, and 0:25:30.560 --> 0:25:33.199 when you know better, you should do better. But the 0:25:33.240 --> 0:25:35.920 truth of the matter is, structural racism is a different 0:25:36.359 --> 0:25:41.600 beast altogether, um because it's really about institutions, policies, and 0:25:41.760 --> 0:25:47.200 structures that actually privilege one group over another based on 0:25:47.640 --> 0:25:52.680 race or ethnicity. We know that there is an overrepresentation 0:25:52.800 --> 0:25:55.400 of of of black people in poverty, and again that's 0:25:55.440 --> 0:25:58.199 a structural racism problem. When you think back to things 0:25:58.320 --> 0:26:01.520 like you know, red Line, where you know people were 0:26:01.520 --> 0:26:04.399 denied mortgages or given high risk mortgages, like it is 0:26:04.400 --> 0:26:10.200 a structural reason why Black people are overrepresented in being poor. 0:26:11.200 --> 0:26:13.000 I think it also shows up in terms of the 0:26:13.080 --> 0:26:18.360 differential treatment that people receive based on insurance status. Why 0:26:18.359 --> 0:26:21.640 are we giving people different care? You know when clinical 0:26:21.680 --> 0:26:26.680