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Serena Williams and the risk black women face during and around pregnancy

Serena Williams: I almost died after giving birth to my daughter

Grand slam champion says she was lucky to receive excellent care, but that others are not so fortunate after giving birth

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Serena Williams made her return to competitive tennis this month.
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Serena Williams has written about the complications surrounding the birth of her daughter in an article for CNN.

The former world No1 had already revealed in an interview with Vogue that she was bedridden for six weeks after the birth of Alexis Olympia last year following an emergency caesarean section. Writing on Tuesday, she gave more details of the difficulties she experienced.

“I almost died after giving birth to my daughter, Olympia,” she wrote.

Williams said the pregnancy had gone smoothly before she encountered problems: “First my C-section wound popped open due to the intense coughing I endured as a result of the embolism. I returned to surgery, where the doctors found a large hematoma, a swelling of clotted blood, in my abdomen. And then I returned to the operating room for a procedure that prevents clots from traveling to my lungs.”

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Serena Williams’s husband Alexis Ohanian and their daughter Alexis Olympia watch her in action at the Fed Cup earlier this month.
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Williams said that she was lucky to have received excellent medical care but others are not so lucky: “According to the Centers for Disease Control and Prevention, black women in the United States are over three times more likely to die from pregnancy or childbirth-related causes. But this is not just a challenge in the United States. Around the world, thousands of women struggle to give birth in the poorest countries. When they have complications like mine, there are often no drugs, health facilities or doctors to save them. If they don’t want to give birth at home, they have to travel great distances at the height of pregnancy.”

Williams goes on to urge people to donate to charities that help mothers and newborns around the world.

The 23-time grand slam singles champion made her return to competitive tennis this month after time away during her pregnancy and to recover from the birth of Alexis Olympia. Her last grand slam victory came at the 2017 Australian Open while she was pregnant.

SOURCE 1.

In a related link at the BBC, "Williams [speaks] on 'heartbreaking' childbirth statistics". "Serena Williams says it is "heartbreaking" black women in the United States are more likely than white women to die from complications in pregnancy or childbirth. In an interview with BBC Sport's Russell Fuller the 23-time Grand Slam singles champion speaks about the issues facing pregnant black women, equality, and her desire to get back on the court after giving birth to her daughter last September."
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Pregnancy Mortality Surveillance System

When did CDC start conducting national surveillance of pregnancy-related deaths?

CDC initiated national surveillance of pregnancy-related deaths in 1986 because more clinical information was needed to fill data gaps about causes of maternal death.

How does CDC define pregnancy-related deaths?

A pregnancy-related death is defined as the death of a woman while pregnant or within 1 year of the end of a pregnancy –regardless of the outcome, duration or site of the pregnancy–from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

How are the data collected and coded?

Each year, CDC requests the 52 reporting areas (50 states, New York City, and Washington DC) to voluntarily send copies of death certificates for all women who died during pregnancy or within 1 year of pregnancy, and copies of the matching birth or fetal death certificates, if they have the ability to perform such record links. All of the information obtained is summarized, and medically trained epidemiologists determine the cause and time of death related to the pregnancy. Causes of death are coded by using a system established in 1986 by the American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention Maternal Mortality Study Group.

How are the data used?

Data are analyzed by CDC scientists. Information about causes of pregnancy-related deaths and risk factors associated with these deaths is released periodically through peer-reviewed literature, CDC’s Morbidity and Mortality Weekly Reports, and the CDC Web site. This information helps clinicians and public health professionals to better understand circumstances surrounding pregnancy-related deaths and to take appropriate actions to prevent them.

How is data confidentiality protected?

Pregnancy mortality surveillance data are protected under 308(d) Assurance of Confidentiality. Because of this Assurance, all data and documents are considered confidential materials and are safeguarded to the greatest extent possible. This Assurance extends to all pregnancy mortality surveillance data obtained from individual states and reporting areas.

What is the pregnancy-related mortality ratio?

The pregnancy-related mortality ratio is an estimate of the number of pregnancy-related deaths for every 100,000 live births. This ratio is often used as an indicator to measure the nation’s health. Factors that affect the health of the entire population can also affect mortality among pregnant and postpartum women.

The pregnancy-related mortality ratio fell significantly in the United States during the 20th century. This historic decline was because of medical and technological advances. Interest and concern at the local, state, and federal levels for why pregnancy-related deaths occur led to the development of systems for identifying, reviewing, and analyzing pregnancy-related deaths.

Trends in Pregnancy-Related Deaths

Since the Pregnancy Mortality Surveillance System was implemented, the number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to a high of 17.8 deaths per 100,000 live births in 2009 and 2011. The graph below shows trends in pregnancy-related mortality ratios defined as the number of pregnancy-related deaths per 100,000 live births in the United States between 1987 and 2013 (the latest available year of data).

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The reasons for the overall increase in pregnancy-related mortality are unclear. The use of computerized data linkages by the states, changes in the way causes of death are coded, and the addition of a pregnancy checkbox to the death certificate in many states have likely improved identification of pregnancy-related deaths over time. Whether the actual risk of a woman dying from pregnancy-related causes has increased is unclear. Many studies show that an increasing number of pregnant women in the United States have chronic health conditions such as hypertension, diabetes, and chronic heart disease. These conditions may put a pregnant woman at higher risk of pregnancy complications. Although the overall risk of dying from pregnancy complications is low, some women are at a higher risk than others. The higher pregnancy-related mortality ratios during 2009–2011 are due to an increase in infection and sepsis deaths. Many of these deaths occurred during the 2009–2010 influenza A (H1N1)pdm09 pandemic which occurred in the United States between April 2009 and June 2010.  Influenza deaths accounted for 12 percent of all pregnancy-related deaths during that 15-month period. Variability in the risk of death by race, ethnicity, and age indicates that more can be done to understand and reduce pregnancy-related deaths.

Causes of and risk factors for pregnancy-related deaths between 1987 and 2013 have already been published. Key pregnancy-related mortality data for 2011–2013 (the latest data available) are summarized below.

In the United States

Of the 5,259 deaths within a year of pregnancy completion that occurred during 2011–2013 and were reported to CDC, 2,009 were found to be pregnancy-related. The pregnancy-related mortality ratios were 17.8, 15.9, and 17.3 deaths per 100,000 live births in 2011, 2012 and 2013, respectively.

Considerable racial disparities in pregnancy-related mortality exist. During 2011–2013, the pregnancy-related mortality ratios were–

  • 12.7 deaths per 100,000 live births for white women.
  • 43.5 deaths per 100,000 live births for black women.
  • 14.4 deaths per 100,000 live births for women of other races.

The graph below shows percentages of pregnancy-related deaths in the United States during 2011–2013 caused by–

  • Cardiovascular diseases, 15.5%.
  • Non-cardiovascular diseases, 14.5%.
  • Infection or sepsis, 12.7%.
  • Hemorrhage, 11.4%.
  • Cardiomyopathy, 11.0%.
  • Thrombotic pulmonary embolism, 9.2%.
  • Hypertensive disorders of pregnancy, 7.4%.
  • Cerebrovascular accidents, 6.6%.
  • Amniotic fluid embolism, 5.5%.
  • Anesthesia complications, 0.2%.

The cause of death is unknown for 6.1% of all 2011–2013 pregnancy-related deaths.

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Note: The cause of death is unknown for 6.1% of all 2011-2013 pregnancy-related deaths.

SOURCE 2.
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Additional links:
-Childbirth is killing black women in the US, and here's why.
-Pregnant women's medical care too often affected by race.
-Black moms die in childbirth 3 times as often as white moms. Except in North Carolina.
-The Black Maternal Mortality Rate in the US Is an International Crisis.
-Has Maternal Mortality Really Doubled in the U.S.? (Discusses the racial inequality in maternal mortality, as well as whether overall maternal mortality has really increased in the US (i.e. whether there has been an overall increase in maternal mortality is debated in the article, the racial inequality in maternal mortality is not).)

Source: ONTD_Political

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