America Is Blaming Pregnant Women for Their Own Deaths

1. America Is Blaming Pregnant Women for Their Own Deaths By Kim Brooks Nov. 16, 2018 https://www.nytimes.com/2018/11/16/opinion/sunday/maternal-mortality-rates.html

2. Thea (1) • Thea was 35 years old and 40 weeks pregnant when she went to her doctor for her final prenatal appointment. She was in good shape, didn’t smoke and had received regular prenatal care, though she wasn’t thrilled with the obstetrics practice she’d chosen in Chicago. The doctors were “more interested in protocols than people,” she said. • On that day, she was surprised to learn that her amniotic fluid was low, though the baby’s vital signs remained strong. The doctor informed Theathat she’d need to be induced right away. Thea questioned this directive, asking about the success rates for induction and whether she should consider a cesarean section instead. The doctor said she had no choice. She then asked if she could go home to get her overnight bag. She was told, she said, that if she left she could be “arrested for endangering the life of a child.”

3. Thea (2) • Thea asked that I refer to her only by her first name because the details of her story are so personal. She also cautioned that “in trauma, memory can be fragmented and skewed.” But over a decade later, she remembers this confrontation with her doctor as the moment it became clear to her that in becoming a mother, she was no longer seen as a person: “I really felt like I was a piece of meat, like I was not being considered in this. It was all about the baby.” • I’ve been thinking lately about the remarkable ways in which American women continue to be devalued and disempowered through the prism of motherhood, even as we insist on the pre-eminence of mothers’ status. Alabama voters have just approved a constitutional amendment recognizing “fetal personhood,” a measure that could be used to further curtail the rights of pregnant women in favor of the safety of fetuses.

4. Comments (1) • Em • NY Nov. 17 • In the '50s I grew up in a very religious Catholic neighborhood, Young pregnant women never wanted to have their babies in a Catholic Hospital because the life of the unborn took precedence over the mother's life. How catastrophically cruel that women must be ashamed of wanting to live.

5. Comments (2) • Danielle Price • Harrisonburg VA Nov. 16 • I had my first child in Massachusetts in 1999, and I almost died after--more than once. I attribute some of the problem to the reluctance to keep me in the hospital after my first episode of prolonged bleeding (followed by a D& C and transfusions). On my third trip back--in an ambulance--and after emergency surgery I insisted on being kept in the hospital until there was absolutely no risk of hemorrhaging. With my second child (Michigan), a planned C-section, I was yelled at by the hematologist for requiring so much blood during the surgery. Seriously. This article is spot on: insurance factors + blame the victim. What of the women with no one to advocate for them? I shudder to imagine.

6. Economics? • Arguably … there are two arguments in the “societal utility function” • Mother’s health • Utility • Future productivity • Child’s health • Utility • Future productivity • Save mother, baby, both?

7. Optimization • Presumably the first order conditions “should” be simple. • Future discounted (utility, productivity) of the mother “should (?)” equal future discounted (utility, productivity) of the baby • Are there ethical considerations? • Are there religious considerations?

8. Agency • Who is the best agent for the mother? • Who is the best agent for the fetus? • What about accountability of the caregivers? • Physicians • Nurses • Administrators • Insurers

9. Evidence-based Medicine • Evaluates and includes research evidence in the medical decision-making • Guidelines on birthing • Sometimes hard to implement • May be a threat to physician autonomy