Three weeks ago, when I was nearly six months pregnant, my baby died. I have no framework for understanding the magnitude of this loss, no clear path through the grief.
But I haven’t had a chance to even begin the grieving process. Because also three weeks ago, I had a postpartum hemorrhage that a team of medical providers ignored, then failed to properly treat. I live in Georgia, the state with the worst maternal mortality rate in the nation and a higher maternal mortality rate than 100 other countries. And now I understand why our maternal death count is so high.
I sat in the emergency room and was ignored while a nurse told me to wait my turn and I saturated the chair, my pants, and everything around me with blood. When a nurse finally called my name, he separated me from my husband and put me alone, bleeding and confused, in a waiting room where there were no medical professionals, no one there to help me should I lose consciousness. I watched as the emergency room staff consulted with a guy whose finger was sore before seeing me. I thought I was going to die alone in that room. By the time a doctor finally examined me, I had been waiting for more than two hours.
Protocols for treating postpartum hemorrhage are well-established. Yet even when I finally saw a doctor, even when the hospital finally stopped ignoring me, no one followed standard hemorrhage protocols. I waited several more hours to receive any actual treatment or medication.
Postpartum hemorrhage is the leading cause of maternal mortality. It’s also the primary reason the United States has the worst maternal mortality rate in the developed world. The overwhelming majority of hemorrhages are preventable, and almost all of them are treatable. Yet women keep dying. That’s because my story of being ignored is not an isolated occurrence. It’s common, perhaps even standard, practice. Media reports on maternal mortality are littered with stories of women who bled to death while begging for help. Like Kira Johnson, who died as clinicians told her she wasn’t a priority.
We all want to believe this won’t happen to us, that surely I must have done something or not done something to cause this. Being ignored to death—a sort of death by misogyny—is terrifying. So we victim-blame. And that allows the true guilty parties—the people who don’t believe women, who don’t care about women, who give them substandard treatment—to escape responsibility. Continue blaming women, telling them how they just need to advocate better, behave differently, learn more, and watch as they continue to die.
In my paid life, I’m a medical writer who has spent years scouring the scientific literature on maternal health. In my volunteer life, I run a maternal health nonprofit. I’m a lifelong activist who knows how to advocate for myself. I’m married to a lawyer. I’m white, affluent, and am able to check virtually every privilege box.
If this happened to me, it can happen to anyone. The next person it happens to might not be as lucky as me. Indeed, research tells us that a woman will die today of a preventable maternal health complication. And another one—or two or three—will die tomorrow.
It doesn’t have to be this way. The problem here is not that birth is inherently dangerous or that there’s some deep mystery about how to manage this problem. Hospitals know how to treat hemorrhages. They know how to prevent them, too. They’re just not doing it.
In a system that systematically ignores and fails women, women and those who love them must become aggressive advocates. Here’s what you need to know to prevent this from happening to you or to someone you love.
Doctors Don’t Believe Sick Women
Since my hemorrhage, I’ve talked to dozens of people who had postpartum hemorrhages. Many of them have stories similar to mine, of being ignored for hours or not given proper treatment. Inevitably, the reason they give is the same: a doctor told them that women often fake hemorrhage. Many even believed that this is true, and that they were the exception to the rule of women who exaggerate their symptoms.
The myth of the malingering woman seems to pervade much of medicine. But it’s not rooted in reality. Given that hemorrhage is the leading cause of maternal death in a nation with skyrocketing maternal mortality, there’s no reason to believe women fake it. Instead, doctors ignore real symptoms based on misogynist beliefs about women’s pain and other symptoms.
We have a veritable avalanche of research showing that doctors ignore women’s pain, even when doing so endangers their lives. Though highly pervasive in obstetric and emergency care, it extends to every branch of medicine. Doctors often dismiss women’s heart attack symptoms, attributing those symptoms to anxiety or emotional problems. Tashonna Ward, a 25-year-old teacher who recently sought help for symptoms of cardiovascular disease, died in the emergency room waiting for help. There are hundreds of other stories just like hers.
For black women, the situation is even worse. Research shows that many doctors believe racist myths about black people and pain, that hospitals that serve black populations offer lower quality care, and that doctors are less likely to provide black people with adequate pain management.
Women seeking treatment for hemorrhages should be prepared to prove that they are indeed hemorrhaging. Take your blood clothes with you. Show the emergency department how many pads you are soaking. And, as one NPR article recently advised, don’t clean up the bloody mess.
Hemorrhage 101: What Everyone Needs to Know
When I had my first baby, I knew that a postpartum hemorrhage was possible, but didn’t know much about it. My provider, though otherwise excellent, sent me home with some vague guidelines about what to do if I started hemorrhaging. Women need more than this.
First, it’s important to know what a hemorrhage looks like. Many women have heard that soaking more than a pad an hour means they may be hemorrhaging. While this is true, it’s an incomplete tip. The real determinant of a hemorrhage is how much blood you lose over time. This means you might be fine if you soak a single pad in an hour. What’s more troubling is if you soak a single pad in 5 minutes—or multiple pads in an hour. The faster you are bleeding, the more likely it is that you are hemorrhaging. Most women I’ve talked to say that they could feel blood pouring out of them. That’s my experience, too.
So what if you start hemorrhaging? These strategies may save your life:
- Don’t delay care. If you have to wait for a call back from a nurse’s line, take your phone with you and go straight to the hospital. It’s better to survive and be thought a hypochondriac than to die and prove that you weren’t overreacting.
- Apply fundal pressure. Most hemorrhages are caused by uterine atony, which happens when the uterus does not contract back down. Fundal pressure is pressure on the uterus. It won’t hurt you, and could save your life. Ask your providers to apply continual fundal pressure from the moment you check in; this is hemorrhage 101, but it’s something many providers don’t do.
- Track your bleeding. Hemorrhage protocols demand that providers measure bleeding, but many refuse to. Don’t throw away bloody pads. Keep them, because this may be the only way to document how much blood you are losing.
- Don’t accept long waits. Ask why the hospital is not following hemorrhage protocols. Ask to speak to a supervisor, another nurse, a doctor. Women are socialized to be nice and patient. And it can kill us. A hemorrhage is a life-threatening emergency. Demand that your providers treat it as such.
Holding Medical Providers Accountable Can Be a Survival Tool
When I began to lose consciousness in a small hospital waiting room and sought help from a nurse, he didn’t spring into action as expected. He expressed annoyance and told me to sit down and wait. That is, until my husband began aggressively advocating for me and threatening to hold the nurse accountable if anything happened to me.
Media coverage and political stump speeches continue to treat maternal deaths like some sort of mystery. Many candidates have proposed more research as a solution, but we already have the research. We already know why hemorrhages happen and what to do about them. Instead, we need to start holding bad medical providers and reckless hospitals accountable.
For now, we can only do that on an individual level. Women seeking care for hemorrhages and other oft-overlooked maternal health conditions should be prepared to advocate for themselves and aggressively enforce their rights. Some strategies that can help include:
- Recording your birth and postpartum care. In most states, you don’t need the other party’s permission to take an audio recording. A recording can support your story if you later have to sue or file a medical board complaint. And if you get really desperate, you can tell a provider you’re recording their behavior so they can be held accountable if you die.
- Telling others about bad providers. Women are often reluctant to publicly call out bad doctors. They fear retaliation. Or they worry that medical privacy laws prevent public shaming. Privacy laws are designed to protect patients, not doctors, and one of the best ways to stop further abuse is to warn others. Defamation is only relevant if what you say is untrue, so don’t let hollow threats deter you. Perhaps if more people had spoken out earlier, Christopher Duntsch, who killed two patients and maimed more than 30 others, would not have injured so many. There are other Dr. Duntsches at hospitals across the world. Warn others about them.
- Filing complaints with every available entity. Depending on the circumstances, you may be able to complain to the joint commission, to hospital administrators, to insurance review committees, and to licensing boards. These complaints may not change anything at first, but when there are multiple complaints about a single provider or hospital, regulators may be willing to dig more deeply.
Death by Misogyny: The Real Culprit in the Maternal Death Epidemic
As long as doctors don’t believe women or refuse to provide evidence-based treatment, they will continue dying. We don’t need more study committees and expensive research to tell us what we already know. We need action.
It’s no coincidence that the people protesting outside of abortion clinics, who claim to be so deeply invested in life, don’t also show up to protest when a hospital fails to save a woman. They—and the collective we—do not care about mothers once the baby is out. We send them home from the hospital with little help and no support because we have collectively decided that the human being who grew the baby does not matter. And if your baby dies like mine did, you matter even less.
Her name was Ember Lucy.
We can do better than this. There is no excuse for this.