Trying to understand the rise in maternal mortality leads quickly into technical abstraction. Papers on this problem are stacked with words borrowed from mathematics and epidemiology: population health, statistical risk ratios, morbidity, physician practice patterns, indications, and outcomes.
Absent from this vocabulary are proper names: Nancy, Susan, Liz.
Complications from a cesarean led to Nancy Lim's death some nine months after she gave birth to a healthy boy. Seventeen years later, her husband, Michael Barnes, still visits the place where her ashes are buried.
It’s a beautiful spot, on a rise looking down over the San Francisco Bay, the peaked TransAmerica building, Coit Tower, the curves of the Golden Gate, and the green rise of Marin to the north.
Lim was born in Texas to a Chinese family, and any good Chinese cemetery should have a view of mountains and water, Barnes said. Her marker is inscribed with words Barnes found in a letter Lim had written to a friend: “She said, ‘Just think, I get to be Max’s mom forever.’” Barnes remembers. “So that’s what we put on the grave marker.”
At first, Barnes thought he would become an advocate, fighting for women’s health and campaigning against medical error. But it was simply too hard to relive the process again and again. For this reason, Barnes said, a lot of the people affected by these tragedies simply move on to other things.
“You don’t have to sign the non-disclosure agreement with the hospital,” he said. “The nature of the grieving process makes you naturally non-disclose.”
California Watch collected many of these personal stories for its recent report on maternal deaths. As state researchers discovered, the rate of women dying from causes directly related to pregnancy has nearly tripled in the past ten years. It's more dangerous to give birth in California today than it has ever been since the 1930s.
Although the number of women who die is relatively small, the trend has doctors worried about an increased reliance on C-sections, as well as higher rates of obesity in expectant mothers.
“Steve” who lives in Orange County, found that grief can form a kind of muzzle. He asked California Watch to give him and his ex-wife pseudonyms, to protect their children. “Susan” passed away in 1998, and one of their children is now in college, but still, just seeing her real name in print could rattle the kids and other family members.
Steve and Susan were divorced, so he had some emotional distance from the tragedy when she died, which meant he was responsible for holding the family together.
“Everybody was just demolished to the point of not being able to function in life,” he said. “So it fell to me.”
But it wasn’t as if he was unaffected. Steve was at a business lunch when he checked his pager and saw the numbers 911. The call that followed left him reeling: “I start walking around dizzy in the restaurant,” he said.
Then he went to the hospital, where the ministers and doctors were waiting, where the children came running down the hall to him, crying.
“That was just the beginning,” Steve said. “The dominoes started falling.”
In a way, Steve had already dealt with the grief of losing Susan in their divorce, but the experience left him with a feeling that something larger was wrong. “How often do 36-year-old, healthy aerobics instructors die in Orange County, California?” he asked. “I think it bears closer examination.”
His emotional phone call to California Watch can be heard here:
For Matt Logelin, who lost his wife Liz Logelin in 2008, closer examination would be counterproductive. “If I found out that someone did do something wrong, I’d have to kill them, and I’d prefer not to go to jail for murder.” He’s joking.
But it doesn’t look like there is a villain in this story. The hospital staff was admirable, Logelin said. Liz had a genetic condition that predisposed her to blood clots. After her (almost certainly necessary) cesarean the hospital staff made sure she wore compression stockings, which can prevent the formation of blood clots in veins of the legs.
But the stockings weren’t enough. Logelin, who had been blogging about the birth notified his readers in a few short sentences that Liz had stood up, felt faint, then passed out.
“I cry for her every day,” he said. “I’m sad that my wife doesn’t get to see my daughter crawl for the first time – those things eat me up.”
In reporting this story, California Watch sent letters to families of women who had passed away, and made dozens of phone calls. Almost no one responded, and almost all who did respond, politely explained that they preferred to keep the matter private.
In Tennessee, midwife Ina May Gaskin, who has long believed that maternal mortality is a bigger problem than is commonly accepted, is quietly building a memorial. Every time she learns of a mother’s death, she sews a quilt square.
The idea is to stitch a remembrance of these women inspired by the AIDS Quilt. In this growing blanket there is no medical jargon, just one name after another.