Serena Williams, beloved Tennis all-star, almost died from giving birth in late 2017. Beyoncé, the same year, suffered from a common complication known as preeclampsia, which endangered her as well as her twins’ lives. Both were bedridden for weeks after their C-sections. And now, Amy Schumer, who identifies as a comedian, is suffering from an intense form of morning sickness called hyperemesis gravidarum, which she has been quite open about on Instagram, where she filmed herself throwing up in a public toilet.
These three celebrity figures have two very important things in common — traits that are harming the American’s woman’s ability to give birth, while increasing her risk of death. Maternal mortality as it’s called, defined as dying from complications associated with pregnancy or childbirth within 42 days of giving birth, has been covered at length by numerous media sources, including npr and ProPublica, to promulgate the gynocentric narrative that never gets old: [American] women have it hard.
The subtitle for ProPublica’s piece reads: “The health care system focuses on babies but often ignores their mothers,” calling the problem a “profound disparity.” What if this so-called disparity, if true, was caused by American women themselves?
The Real Reason Maternal Mortality in the United States Has Gone Up
Due to the publicized hardships of pregnancy, a commonly accepted myth is that American women are dying from childbirth more so than in other developed countries. ProPublica released a piece (co-published with npr) titled “The Last Person You’d Expect to Die in Childbirth,” outlining the death of a neonatal intensive care nurse, who had taken care of babies for several years (the irony of this situation was meant to evoke feelings of sadness and sympathy).
ProPublica created a figure depicting the sky high maternal mortality rates in the US, based off a study published in The Lancet, which examined global trends in maternal mortality among 186 countries. This figure depicts maternal mortality rising consistently in the United States, while dropping everywhere else.
If this graph was correct, it would indeed be frightening. In third-world countries, maternal mortality is much higher than in the United States because of HIV/AIDS. But in the US, where resources are aplenty, mothers shouldn’t be dying. Further, the rate has gone up here, whereas in almost every other country out of the 186 studied in The Lancet’s report, maternal mortality has declined. How could the US be so behind the curve?
The answer may have nothing to do with a disparity in care, as npr and ProPublica put forth, but rather, in the way deaths are recorded. The most recent and most comprehensive study on the causes of maternal mortality in the United States, published in Obstetrics and Gynecology, examined the causes of maternal death from 1993–2014 in the US. Although women overall died less from all causes over that time span, mothers died more often from a variety of disease-conditions. In fact, deaths due to some disease classifications, such as “deaths due to other specified pregnancy-related conditions,” went up 23-fold. Others, such as deaths from renal failure, went up by less than 2-fold, the disparity perplexing the researchers.
But maternal deaths, defined as dying from complications associated with pregnancy and childbirth within 42 days of giving birth, didn’t go up. What went up were deaths due to other disease classifications, due to the introduction of the ICD-10, the tenth revision of the International Classification of Diseases.
After it was introduced in 1999, it took a few years for states to adopt it. And once they did, “maternal mortality” skyrocketed (see Figure 1 of paper). The authors concluded that maternal death seemed to go up from 1993–2014 because of “improvements in maternal death surveillance and changes in the coding of maternal deaths.” The results of their study were “not consistent with any serious deterioration in maternal health or maternal health services in the United States.”
The maternal mortality scare was a farce. Previously, maternal mortality strictly included deaths from childbirth or pregnancy within 42 days (6 weeks) of giving birth. New ICD-10 codes expanded the definition of maternal mortality, such as O96, which entails “death from any obstetric cause occurring more than 42 days but less than 1 year after delivery.” When these codes were removed, there was no uptick in maternal deaths between 2014 and 1993 (bottom half of Figure 1).
Maternal mortality is the sob story that never was. And that includes the case of California, the only state where the maternal mortality trend went down after a brief and significant uptick after the introduction of ICD-10. Once again, npr suggests that California is doing something different. As Renee Montagne reports:
From 2006 to 2013, the maternal death rate in California fell 55 percent. These protocols — the checklists, carts, drills and teamwork — have not only saved women from dying, but they have also dramatically reduced the rate of women who nearly died.
If this was true, we would see fewer “protocols” and “checklists” in other states. Further, conflating maternal mortality, with maternal morbidity, or sickness and disease associated with childbirth, is a mistake. Overall, npr’s take on California did not do that. However, it does seem as if almost dying from childbirth is causing the media to assume that women are dying from childbirth more often than they used to.
The cause of California’s decline in maternal mortality (after its initial increase with the introduction of ICD-10), once again, is explained by K.S. Joseph and others in Obstetrics and Gynecology:
…the decline in all cause and cause-specific mortality rates among women aged 15–44 years, and the decline in maternal deaths from these two causes in California from 2003–05 to 2014 suggests that coding issues are a more likely explanation for the large increase in maternal deaths from these two causes.
Maybe Renee is correct. But without an adequate comparison to other states, it’s just a story, without substance.
Nevertheless, maternal morbidity in the United States is clearly a widespread issue. Women are experiencing a rise in C-sections, preeclampsia, morning sickness and nausea, and numerous other complications, all of which increase with one of the two factors Amy Schumer, Beyonce, and Serena Williams have in common: age.
Having Kids After 35 Is Dangerous
I was born via a c-section, and consequently had allergies as a kid to dust, horse dander, cats, dogs, and ragweed. My story is typical, as c-sections increase the risk of allergy by preventing the fetus’s bath in the mother’s vaginal microbiome in transit to newborn status. But c-sections have another problem: they’re overdone.
One in three children are born via a c-section in the United States. The global use of C-sections is at almost half that, at 18.6%. And the older you give birth, the more likely you will be advised to undergo an “emergency” c-section, with one in two women giving birth over 40 taking that route (figure 2 from the CDC). Both Serena and Beyoncé experienced this “emergency.”
Regardless of age, the use of c-sections has risen in the United States in all races and all age groups by 50%. Yes — in every single racial category, and every single age group, the rate of C-sections went up 50% between 1996–2007. This alarming statistic begs the question: have American women forgotten how to give birth? Or are doctors finding new ways to sell this surgical technique to unknowing mothers?
Serena’s C-section wound hemorrhaged (not an uncommon complication), due to anti-clotting medication she took after giving birth. Serena, Beyoncé and Amy have one thing in common: they are all 37, and they decided to get pregnant after 35, increasing their risk of preventable complications.
35 is a magic number, probably because it is divisible evenly by 5. After this age, giving birth increases the mother’s risk of numerous complications, and one of them is preeclampsia. The increased risk, is 63%.
Serena, Beyoncé and Amy have one other thing in common: they are career-focused, which is the cause of their choice to have kids later in life. Clearly, motherhood are important goals for all three of these career-driven women. Unfortunately, they aren’t told that pregnancy will be a lot smoother before their ovaries become aged.
The mean age of mothers in the US is on the rise, and shows no signs of stopping soon. Much of this trend has been attributed to women under 20 using birth control, which leftist media outlets such as Vox refer to as “progress.” Perhaps they missed the video where Amy threw up in a toilet because her body isn’t adequately prepared to give birth.
Women aren’t just having kids older, they’re having fewer kids, and they’re having their first kids later. Women who pursue education and live in cities further are likely to have fewer kids. And now, based on recent report from the CDC, fear that the population is going to shrink is very real.
Career and Motherhood are Mutually Exclusive
Beyoncé wants her daughters to know that they can be CEO’s, she told Ellemagazine. Amy Schumer tried to go on tour during her pregnancy, but had to cancel several tours due to difficulties with pregnancy. Serena wanted to continue playing tennis after childbirth, aiming for 25 grand slam wins, she told Vogue. But at the same time, she asked herself: “Why do I feel so sad when I have a beautiful baby?”
Unfortunately, the stresses of managing a successful career often leave one too worn out to have a child. The converse is also true: having a child leaves the American woman too worn-out to focus on her career. Serena’s dramatic loss to Naomi Osaka in the US Open last year symbolized this message perfectly, but resounded on mostly deaf ears. Serena complains that Roger Federer had had kids and still won grand slams, but she has had to take so much time off — to be a mother. “It’s so unfair,” she told Vogue.
This sentiment answers the question posed by the title of this piece. American women, in the pursuit of freedom and extrication from the alleged confinement of the patriarchy, have forgotten the roles and responsibilities of motherhood. They focused on themselves, so much so that having a baby hospitalizes and nearly kills them.
Perpetuating the cycle, they encourage their daughters to do the same — to value being a CEO and “know that they can speak their minds and they have no ceiling” (Beyoncé to Elle magazine). But what if their daughters do still want to be good mothers, just like their mothers? Clearly, career-driven women still want to have their own kids. Motherhood is still desired, but it is devalued.
The consequences are expensive medical bills, C-sections, hemorrhages from C-sections, hospitalization, fear of impending death, stress, and being bedridden for weeks after pregnancy if one survives. Once American women value motherhood again, they will value having kids younger and spending less time worrying about their careers during pregnancy — and their bodies will reward them for it.
Motherhood is a selfless act (to an extent), whereas her career and independence is more selfish (to an extent). And if women value the latter over the former, how can they give birth seamlessly?
Women of the past valued motherhood by preparing themselves for pregnancy. Time was allotted not only to take care of a newborn, but to ensure the healthful and smooth passing of the newborn into the world months if not years before conception.
The modern American woman, aspiring for career-success, has forgotten these customs. With a medical system ready to extricate a fetus from her womb at moment’s notice, she doesn’t even have to care anymore. Maybe that was a mistake.