Mountain OB/GYNs say having a baby is more dangerous than ever.
According to a report from nine maternal mortality review committees, including North Carolina, pregnancy complications resulted in 700 deaths and 50,000 injuries.
That same study found six out of 10 of those deaths are preventable.
Western North Carolina doctors News 13 spoke with tie issues back to an increase in C-sections, women over 35 having children and closures of rural labor and delivery units.
“Last push, oh, my gosh, there she is, congratulations,” Dr. Bre Bolivar said, as she ran through the training simulator inside MAHEC’s Simulation Center.
The simulation reminds medical professionals of the deadly consequences when simple safety measures aren't followed.
“My baby,” said the life-like mannequin that can talk physicians through how they’re feeling, giving them clues something might not be right.
“So, Noelle, you're having a little bit of bleeding,” Bolivar explained as she worked through the simulated complication that can quickly deliver life-altering consequences.
“It looks like she's having a hemorrhage,” Bolivar called as the team begins to react.
That's heavy bleeding after delivery and one factor behind the nation's climbing maternal mortality rate.
North Carolina’s rate is up 31 percent over the last two years, according to United Health Foundation's ranking.
“There's a lot of confounding factors, but it's getting more dangerous to have a baby,” said Bolivar, MAHEC’s OB/GYN specialist and a Mission Health hospitalist and OB Hemorrhage Team member.
“Every one of my grandbabies, I've been the first one to hold them,” said Sherry Wilkerson.
When now 2-year-old Ayiah was born, it was no different. Wilkerson was by her daughter India Rutherford’s side at Mission Health when the real life-threatening risk developed. India's doctor had directed them to MAHEC and Mission Health because of her previous high-risk delivery.
“She had put a mask over India and I could see the little vapors coming up where she was breathing and then all of a sudden I was looking at her and I saw none. And I thought, ‘Oh, gosh, she's dying’,” Wilkerson said, recounting the delivery.
When Rutherford hemorrhaged, doctors calmly worked the problem.
“They were trying to hide it, but I could still, I could see blood over here,” Wilkerson said.
Rutherford lost 6.5 liters of blood, that’s her entire blood volume, according to her doctors.
“I know her choice, what she would say, momma, if it come down between her and the babies, she says, momma, but I know what she’s going to say,” said Wilkerson.
“It could have been the other way around, either way you know, with me not being there or she not being there either,” Rutherford said about her close call.
Rutherford's case and hundreds like it are behind MAHEC's push for better training opportunities, getting medical staff to react sooner to a mom's blood loss or high blood pressure before it results in organ failure or stroke or worse.
“Sometimes, it’s just that we miss the recognition, we didn't weigh, we didn't realize how much blood she lost,” Bolivar said.
In 2017, MAHEC OB/GYN specialists delivered 1,913 babies, nearly 12 percent of the moms hemorrhaged, half of them required blood transfusions.
“Sometimes, asymptomatic patients don't have evidence that their blood loss was so great until 12 or 18 hours after they've had that blood loss,” said Lynn Blythe, BSN, RNC-OB, director of Pardee Women & Children's Center.
It’s past practices of hospitals not labeling pregnancies low- or high-risk and not accounting for blood loss that may have hurt delivering moms.
“Historically, I think it's an estimate, an estimation you just look and see how much you think the blood loss is. But you weigh it and you might be surprised how much volume of blood there really is on there,” said Blythe who recently conducted an experiment with the OB/GYN staff at Pardee.
Recent recommendations from two state groups studying maternal mortality have led to carts like this, specifically for hemorrhages, outside medium- to high-risk delivery rooms at Pardee UNC Health Care.
“We have a list of dry weights here that tell us how much things weigh dry,” said Blythe.
Putting tools to deal with blood loss at arm’s length, versus down the hall.
“It's a pressure bag that will infuse the fluids faster. That's going to be key as a rapid infusion to offset the blood loss,” said Blythe.
Hospitalists said it also comes down to tracking what's happening with moms. While there aren’t national guidelines for safety standards during delivery, Mission Health, Park Ridge Health and Pardee UNC Health all have OB hemorrhage protocols.
“Which medications should I be giving, what is the next step if what I've done hasn't worked, and what should I be thinking about in terms of vital signs or just looking at the clinical picture,” Bolivar said.
The Perinatal Quality Collaborative of North Carolina along with the Alliance for Innovation on Maternal Health or AIM launched a two-year initiative looking at why hemorrhage cases are leading to deaths, encouraging hospitals to ask why and review cases when complications occur.
“Why did she have a hemorrhage, why did she have to have a hysterectomy, why did she have to go to the ICU and then moving down and continuing to ask why until we can come to a point of this is something we hadn't thought about before,” Bolivar said.
Hoping what's learned and practiced in MAHEC’s Simulation Center translates into better outcomes for patients like India. Because Mission Health planned for India's blood loss they were ready when India's what if, became life threatening.
“I didn't know they had the things that they had in place, but I'm glad they did,” Rutherford said.
“My job is to think about all of the bad things that could happen and then try to prevent, and sometimes that means telling the mom what I'm thinking, I think sometimes keeping things sugar-coated or trying to keep a secret whispering to the nurse, I'm concerned about this, that's not helpful for anyone,” Bolivar said.
Leading to better outcomes, the alternative, unacceptable for Rutherford.
“Mommas have a big role to play. To think about me not being here, for them, really gets me tore up sometimes,” said Rutherford.
Are the changes making a difference?
Checking MAHEC's numbers for 2018, the hemorrhage rate is down slightly, the amount of blood transfusions is nearly the same, but fewer women need to go to intensive care after having their babies.
Slow but positive changes, according to MAHEC.
According to Park Ridge Health, nearly seven out of every 1,000 pregnancies in Henderson County will end with a complication that leads to the death of the baby.
North Carolina has one of the highest infant mortality rates related to obstetric emergencies.
North Carolina is also seeing an increase in the number of moms who are dying because of these obstetrical emergencies. One factor leading to this is the increase in the number of women who are waiting to have babies until age 35 or older.
MAHEC provided 1,438 high-risk OB/GYN consultations from July 2016 through June 2017.
MAHEC managed 437 high -risk deliveries for patients transferred to Mission Health from July 2016 through June 2017.
Medicaid/Medicare or self pay patients paid for 678 gynecological surgical procedures from July 2016 through June 2017.