ISSUE ADVISORY: Risks of Pregnancy Should Not be Minimized

June 2019

By: Samantha Chen, NOW Government Relations Intern

As the abortion debate rages on, abortion rights opponents are quick to point out supposed risks associated with abortion; but rarely do they mention the sobering reality of what following through with a pregnancy can mean to a woman. To be pregnant can be a great joy for some women, but pregnancy comes with its own set of very real risks.

A recent CDC study found that 700 women die from pregnancy complications each year and 60% of these deaths are preventable. About one-third die during pregnancy, another third die during childbirth, and another third die weeks or months after delivery. Heart disease and stroke are the leading causes of maternal death, accounting for nearly 33% of deaths. Infections and hemorrhaging, which can occur during or after childbirth, are also major causes of maternal death. Another 50,000 women are affected by complications that do not result in death but can have life-long health consequences. The United States falls far behind other wealthy countries when it comes to the health of pregnant women.

Most importantly, the study found that the risk of maternal death is up to four times higher for women of color. Black women are 3-4 times more likely to die from pregnancy and much more likely to lose their infants; this is true even for black women who do have access to healthcare. In fact, black women with advanced degrees are still more likely to lose an infant compared to white women with less than an eighth-grade education. Even incredibly healthy and wealthy black women, like Serena Williams, who suffered from a blood clot, have an increased chance of suffering from harrowing ordeals associated with birth. Pregnancy can be painful, and even deadly for women; no one should be forced into it.

First Trimester Risks

In the first trimester of pregnancy, 75% to 80% of women experience nausea and vomiting, commonly termed “morning sickness.” Despite the term, women experience this discomfort throughout the day and can be triggered by strong odors, heat, and certain foods among other things. Some women have no triggers at all.

Between 0.3% and 2.3% of all pregnant women experience hyperemesis gravidarum, an extreme form of morning sickness that involves uncontrolled vomiting. This can result in extreme dehydration, muscle wasting, electrolyte imbalance, and weight loss of more than 5% of body weight. The severity of these symptoms varies from person to person, but moderate to severe symptoms often require immediate hospitalization and IV treatment. If left untreated, there is great risk of long-term health concerns for both the woman and her child. Maternal death is possible for the most severe cases of untreated hyperemesis gravidarum. While the causes of the disease is unknown, women who experience hyperemesis gravidarum for one pregnancy are more likely to experience it again with subsequent pregnancies.

Outside of the physical distress that hyperemesis gravidarum causes, women also report the effects of the disease spreading to other parts of their lives. They may lose time from work and are restricted in their everyday activities, often for weeks to months. Even after the vomiting stops, women report to suffer from the psychological pain of being ill for such a long period of time and constantly worrying about their health as well as their fetus’. Due to loss of time from work, frequent hospital and doctor’s office visits, and necessary medication, there is often also great financial strain involved.

For women that want to carry their pregnancy to term, the first few months are already difficult. Expecting mothers experience a huge range of changes to their body, including tender or swollen breasts, increased urination, fatigue, heartburn, food aversions, constipation, emotional stress, and morning sicknessー all in the first few months of becoming pregnant. Pregnancy also leads to suppression of the immune system to prevent the mother’s immune system from attacking or responding to fetal tissue. Those who are having a planned pregnancy often prepare months in advance by seeking prenatal care, getting physically healthy, and planning their finances.

Women who are forced to carry a pregnancy experience all of these symptoms with enormous additional burdens. If a pregnant woman is underage and still in school, their education can be punctuated with random bouts of nausea and vomiting, preventing them from fully participating in class. If a pregnant woman is working a minimum wage job with little other financial support, she cannot afford to lose time at work. If a pregnant woman already has a depressed immune system and is in a delicate health situation, she may not be able to risk further physical stress. And if a pregnant woman suffers from severe hyperemesis gravidarum and has no healthcare, no financial support and no emotional support, they could die. Pregnancy, even in its early months, has consequences.

Second and Third Trimester Risks

The second trimester (weeks 13 to 28) is largely considered to be the safest and most comfortable time during pregnancy but is not without hurdles to overcome. As the fetus continues to grow, it presses up against the organs surrounding the uterus. In the second trimester, it is common for a woman to experience the onset of respiratory problems both due to increased pressure on the lungs as well as hormonal changes and immunosuppression. This can cause minor discomforts like a constantly stuffy nose and snoring, or it can cause major health problems like insomnia and worsening asthma.

Asthma affects 3.7-8.4% of all pregnancies and is one of the most common diseases that can complicate a pregnancy. Women who live in areas containing bad air pollution, have little access to healthcare, or struggle with obesity, are more likely to live with uncontrolled or untreated asthma, which is an indicator for worsening symptoms during pregnancy. Studies using data collected from thousands of women found that there is a 35% increased risk of stillbirths and infant deaths was observed in the pregnancies of women with asthma. Worsening symptoms also means the pregnant woman’s quality of life significantly drops. She may experience asthma attacks with more frequency, which could result in more emergency hospital visits. When a pregnancy is unplanned, these complications can quickly become impossible to handle.

Later in the second trimester and during the third trimester, there is also the risk of preeclampsia, which affects 2-8% of all pregnancies. Preeclampsia occurs when the body has a sudden adverse reaction to the pregnancy and is associated with high blood-pressure, protein in urine, and a slew of other symptoms all over the body, including brain injury to both woman and fetus and possible separation of the placenta from the uterine wall. The complications from preeclampsia, especially left untreated, can cause lifelong disability and lasting organ damage; it is also the leading cause of maternal death.

Risk of preeclampsia is significantly increased with certain populations. This includes women that become pregnant when they are under the age of 20 or over the age of 35, have a personal or family history of preeclampsia, have diabetes or kidney disease, have nutritional deficiencies, and other variables. Multiple studies have found that taking vitamin supplements, specifically vitamin D, is associated with a lower risk of preeclampsia. Prenatal care, regular screenings, and early diagnosis also lower the risk. For women who contract preeclampsia, prompt treatment is vital and life-saving. Again, thinking about women who did not plan to become pregnant, it is incredibly difficult to take on these preventative measures and if faced with preeclampsia, the consequences can be even more burdensome

Preeclampsia is also 60% more prevalent in black women in the United States and often far more severe. The cause of this elevated risk of maternal death by preeclampsia is not explained by socioeconomic class nor whether or not the pregnancy was planned. Genetic predispositions have also been found to not be the cause. Instead, academic theory points to the “inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress” that leads to weakened health and makes the body more vulnerable to conditions like preeclampsia. When preeclampsia does develop, there are hundreds of stories of African American women going to their doctors with complaints of headaches and fainting spells that get dismissed. Studies have found that white individuals, including physicians, may have deeply ingrained unconscious stereotypes about black people’s health, including the belief that black people don’t experience pain the same way. As a result, black women suffering from severe preeclampsia often end up suffering harrowing near-death experiences or tragically die.

Over 120,000 pregnancies a year in the United States are affected by preterm premature rupture of membranes (PPROM), which typically occurs in the third trimester and on rare occasions, in the second trimester. It accounts for nearly one-third of all preterm births and has a recurrence rate of about 23%. PPROM is a condition in which the amniotic sac ruptures/breaks before week 37 of pregnancy. While a pregnant woman typically survives PPROM, there is an elevated risk of infant mortality. Studies have found that there are significant disparities in the results of PPROM between white mothers and black mothers, which is again theorized to be because of the constant stress of racism.

Other complications in the second and third trimester include gestational diabetes, which is found in 9% of pregnant people in the United States. Rare cases of placental abruption occur to 1% of pregnant women in which the placenta separates from the uterus prior to labor. It is a serious condition that can result in serious bleeding and shock for the pregnant woman and fetal death. Before and during delivery, 0.5% of first-time births are complicated by placenta previa where the placenta is placed too closely to the cervix. Women usually experience bright red, painless bleeding as a sign of placenta previa. Extreme bleeding can occur, leading to a life-threatening hemorrhage. The risk of placental abruption is further increased if a woman is suffering from preeclampsia or other hypertension related diseases.

During delivery a whole host of issues can occur. These issues include, but are not limited to tearing, damage to the pelvic floor, emergency caesarean sections, and complications from epidurals. Up to a year after delivery, women are still at risk for health issues and maternal death. Each person and each pregnancy is unique in its challenges. The listed complications are only some of the many difficulties that women can face during pregnancy.

Discussion

The point of this article is not to scare women away from pregnancy if they want to have a child. These complications, although challenging for any person, are surmountable with the help of a good healthcare provider, financial stability, and a supportive network. Rather, the point of this article is to tell the truth about what being pregnant can mean for women who are not sure if they are ready or not.

This article also demonstrates how much progress is still needed when it comes to maternal health. The United States should not have the worst maternal death rate in the developed world and the death rate should not be four times higher for Black and Native American women. NOW supports the Black Maternal Health Caucus and their Priorities in the Appropriations Bill. The reproductive rights community has also created the upcoming Blueprint for Sexual and Reproductive Health, Rights, and Justice, which details the standard of pregnancy care that should be mandated by policymakers in insurance coverage.

It is also important to note that nearly one sixth of hospitals in the United States are Catholic health care facilities. These Catholic hospitals follow restrictive and medically unsound guidelines, named Ethical and Religious Directives for Catholic Health Care Services (ERDs), that are provided by the U.S. Conference for Catholic Bishops. These guidelines prevent doctors from performing life-saving procedures, like abortions and simple birth control methods, even if the mother’s life is in danger. The New York Times printed a story of a woman with a history of severe preeclampsia who wanted to tie her tubes after a second, dangerous pregnancy. She did not know that she was in a Catholic hospital until her doctor informed her that they could not do the procedure because it was against guidelines. In fact, nearly one-third of women seeking care at Catholic hospitals are not aware of such restrictions. Women seeking healthcare during any point of potentially dangerous pregnancies should not be turned away from life-saving medical procedures because a group of old white men wrote some guidelines. Such guidelines would rather subject women to life and death scenarios than allow women to obtain an abortion, which is one of the safest medical procedures available.

Pregnancy can be beautiful – women can work, be active and thrive during this event in their lives, that being said, there are risks. Even without complications, pregnancy is difficult. Poverty, genetics, ignorance plus the lack of health care and little or no family support system are precursors to problem pregnancies. For nine months, a woman’s body is going through the changes necessary to grow a life. Creating life is not a miracle, it is the result of a hard and painful trial for women who need a supportive healthcare system. For women who want to have children, pregnancy is a choice that is carefully planned. No woman should be forced into this incredibly long process with the potential for life-threatening complications. Their bodies and quality of life are on the line. This is why we support the right for women to choose. Lives depend on it.