Mothers at Risk
“All I’ve wanted my whole life was to be a mom,” Abby Price said.
Abby and her husband, Joel, were elated when she became pregnant in 2015.
With the exception of her constant nausea, the Willowick couple said Abby’s pregnancy went well.
At the beginning of her third trimester, things changed.
She suddenly gained several pounds. She had developed preeclampsia, a common complication characterized by high blood pressure.
She called her doctor. They agreed to schedule additional appointments. She said no one, including her, was overly concerned.
Then, one night, intense back pain made it impossible for her to sleep. She felt hot. She was so uncomfortable she got up and laid down on the cold tile floor in her bathroom.
“Once I was feeling better, I stood up, and that’s when I felt a pop and blood started rushing out of me,” she said.
She screamed for Joel.
“He just shot out of bed,” she said. “He carried me into the car and just drove me straight to the hospital.”
The news was devastating. Doctors could not find Eloise’s heartbeat.
"I didn't even consider the fact that Abby was in any kind of danger,” Joel said. “I just got blindsided with, 'Your daughter's dead', and then [doctors] took my wife away.”
Joel soon realized he could lose Abby, too.
Her blood pressure was dangerously high. Her doctors worried her kidneys would fail. Her bleeding would not stop.
Doctors eventually stabilized her.
Three years later, the couple is still coping with Eloise’s death.
"We call them ‘Ellie days,’” Abby said. “I’ll just say, ‘Hey, I’m having an ‘Ellie day’ – I need some space.’ And I’ll just lie in bed and kind of be by myself. And then there's other ‘Ellie days’ where I need [Joel] because he’s the only other person that knows what has happened.”
Abby’s experience is far too common and has become more common in the United States over the last 15 years, according to health officials and patient safety advocates.
Our exclusive 5 On Your Side investigation found thousands of mothers die or suffer life-threatening complications related to childbirth every year in the United States, including in Ohio, in part because health officials have failed to adopt proven safety practices.
Dying from childbirth: By the numbers
Right now, the U.S. is the deadliest place to deliver a baby in the modern world.
As the maternal death rate decreased in other wealthy nations, it increased in the United States.
Between 1990 and 2015, the maternal mortality rate increased from 12 per 100,000 live births to 14 per 100,000 live births, according to a study funded by the Bill and Melinda Gates Foundation.
The study shows during the same time period that maternal death rates dropped in France, Germany, Italy, Japan and the United Kingdom.
Currently, more than 700 women die from childbirth-related causes in the United States each year, according to the Centers for Disease Control and Prevention (CDC).
Data from the Ohio Department of Health (ODH) shows 154 women died in Ohio related to their pregnancies from 2008 to 2014.
Just as troubling, each year, more than 52,000 mothers suffer life-threatening complications, according to the CDC.
In Ohio, there were 143 serious complications for every 10,000 live births in 2013.
“More women are dying in the United States because doctors, hospitals, and state officials aren’t taking the problem seriously,” said Cynthia Pearson, the executive director of the National Women’s Health Network, a consumer advocacy organization devoted to improving women’s health. “Most of the maternal deaths in this country could be prevented if we did what we know how to do.”
Women who survive serious complications are often left to cope with life-changing consequences, including infertility. That’s what happened to Samantha Blackwell.
The birth of her son, Max, at a Cleveland hospital in August of 2014 was uneventful, but as soon as she returned home, Blackwell felt sick.
She developed a fever. She shivered.
Eleven days after her delivery, her husband rushed her to an emergency room.
She remembers being assessed by triage nurses.
She remembers telling her husband she was scared.
Then, nothing. Blackwell regained consciousness five weeks later. Doctors had induced a coma to battle a rampant infection that brought her to the brink of death.
“I cry just thinking about it,” she said.
She was devastated she had missed so many of Max’s first moments. She worried her baby boy wouldn’t recognize her.
“I just felt that he could feel…his mom didn’t cuddle him,” Blackwell said.
Then, another devastating blow. One day she overheard a family member say, “If she ever wants a kid, I’ll carry it for her.”
“I just was like, ‘Who wants a baby?’” she said. “I realized they were talking about me.”
While she was in her coma, doctors had performed a hysterectomy to stop her infection. She hadn’t known until that moment.
"I could have decided not to have more kids,” Blackwell said. “I could have had 10 more. I'll never know.”
Golden State success
Pearson points to California for best practices.
Unlike the rest of the U.S., maternal deaths in California dropped by more than half between 2006 and 2013.
In 2006, state officials, along with the Stanford University School of Medicine, created the California Maternal Quality Care Collaborative (CMQCC).
The CMQCC provides toolkits to hospitals to help healthcare professionals respond to common obstetric emergencies, including hemorrhage and hypertension.
The toolkits, developed by experts across the state, include best practice tools and articles, hospital-level implementation guides, care guidelines as well as a professional education slide set.
No AIM in Ohio
California’s success sparked the creation of the Alliance for Innovation on Maternal Health (AIM), a collaboration of health organizations dedicated to eliminating preventable deaths and complications.
Eighteen states have joined AIM, and 13 states are preparing to submit enrollment applications. Several other states have expressed “serious interest.” Ohio is not among them.
“As far as I'm concerned, as a woman's health advocate, there's no good reason not to be part of the AIM program,” Pearson said. “An AIM program gives you best practices and actionable items.
“For a state to have to develop that on its own, that’s very time consuming, but if a state can join the program, have access to these resources, then it can focus where the work is needed with the hospitals.”
After we started asking questions about why Ohio is not part of the program, state health officials began discussions with AIM.
In an emailed statement, J.C. Benton, assistant director of communications with the Ohio Department of Health, said, “Ohio has an interest in the AIM and has been working with ACOG [American College of Obstetricians and Gynecologists] in Ohio to gather information and explore the process. In fact, ODH staff have led and participated in work groups in the Opiate AIM Bundle during the past year. Further consideration of joining AIM by ODH continues to be evaluated.”
After Rachel Yencha delivered her daughter, Carolyn, the Lakewood mother nearly bled to death – twice.
“If following these AIM guidelines will change or save one life, I think we need to implement it and make it happen,” Yencha said.
Her pregnancy was healthy until she reached 37 weeks. Then, during a routine appointment, her blood pressure reading was high.
Like Abby, she had developed preeclampsia.
Yencha said she was told to take it easy. She wasn’t worried.
Then, three days after her due date, alarm bells went off.
During another routine check-up, her blood pressure readings were sky high. She was told to get to the hospital immediately.
Once there, she received more bad news.
Tests showed she had HELLP (hemolysis, elevate liver, enzymes, low platelet count) syndrome, a rare, life-threatening condition that often occurs in conjunction with preeclampsia.
Doctors rushed to induce labor. Baby Carolyn soon arrived. Yencha was overjoyed, but just moments later, her joy turned to agony.
Her placenta would not come out. She was hemorrhaging. Her doctor tried to manually remove her placenta.
“It was the worst pain I’ve ever felt in my life,” she said. “I truly felt like I was dying and I was screaming like I was dying. He was literally using his fingers to try and pull the placenta and scrape the placenta off my uterus.”
His efforts were unsuccessful. She was still bleeding. She needed a blood transfusion, but that was easier said than done.
She said there wasn’t any blood available in the maternity ward at the Cleveland-area hospital where she gave birth.
The staff ran to the emergency room, gathered bags of blood and brought them to her room.
Finally, doctors stabilized her. The next morning, she was transferred to a larger hospital.
But she was still bleeding. Doctors performed surgery to try to stop the hemorrhage. Her bleeding would still not stop.
“It became a mad dash to try and save my life again,” she said. “The day after it had just happened.”
This time, the hospital staff was prepared for blood transfusions.
“I’m feeling the blood coming in my veins,” she said. “It was surreal.”
After she returned home, she struggled to piece together how she nearly lost her life.
“I was healthy, I ate right, I’ve never smoked. I didn’t drink when I was pregnant,” she said.
“I wonder now, looking back, if maybe it didn’t have to snowball like it did?”
More than anything, she mourns missing Carolyn’s first moments.
“That’s what really stuck with me,” she said. "I don’t remember much about her first five days.”
She and Abby recently became involved with the Preeclampsia Foundation, a non-profit group that raises awareness about pregnancy complications. Abby serves as the co-chair of its Cleveland fundraising walk.
“If I can help someone else not have to go through what we went through, that helps heal me,” Abby said.
“I’m still not the Rachel I was before,” she said. “But I’m still lucky, because I’m here. I’m alive. I’m healthy.”
Ohio’s efforts shrouded in secrecy
We found state health officials have taken important steps to save women’s lives and reduce pregnancy-related complications.
After maternal mortality rates increased a decade ago, Ohio created the Pregnancy-Associated Mortality Review (PAMR) in 2010. The 26-member committee meets four times a year to study every death involving a woman who was pregnant or who died within one year of her pregnancy.
In 2014, based on the PAMR, the state trained staff in 14 hospitals using “SimMom,” a high-tech mannequin, to treat common emergencies, like heart problems, hemorrhages and preeclampsia. State officials followed up with two additional sessions to “train the trainers” at the same hospitals.
The committee also created a series of webinars regarding perinatal emergencies.
However, key details about Ohio’s efforts are shrouded in secrecy, including why the state is not enrolled in AIM.
“The fact that Ohio has a state mortality review board is good,” Pearson said. “It tells me that they’re aware this is a problem. The fact that in the past they went out and trained some hospitals about best practice is also good, probably made change for the better in those hospitals, but what followed on? What’s happened since?”
Unlike many states, Ohio’s mortality review committee has failed to publish a report to share its findings, which could show what’s causing deaths, how hospitals may be failing patients and what solutions could be put in place to prevent future deaths.
Since its creation, the committee has not released any public recommendations.
The state even refused to release the names of the committee’s members, which is public information, to News 5.
“The fact that Ohio won’t even release the name of the people who are on this mortality review committee is just plain wrong,” Pearson said. “The public has a right to know that. Cause of death is something that has been turned over for public officials for centuries. This is an established thing that people should be able to count on.”
ODH spokesman Benton declined numerous requests for an interview with the state health officials overseeing efforts to reduce maternal mortality rates.
Dr. Cynthia Shellhaas, a maternal-fetal specialist who oversees the mortality review committee, also declined our interview requests.
Sandy Oxley, chief of the Bureau of Maternal, Child and Family Health did not respond to our calls or emails.
“It feels like no one cares about moms,” Abby said.
She and Joel are now struggling with infertility. She said their inability to conceive has amplified her grief.
“I want to hold my own baby for years,” Abby said. “Not just for a few hours and then have to say goodbye.”