The US has an unusually high death rate, but in California collaborations between health experts helped rates drop

Alisha Berry was at the doctor for what she thought was a normal check-up at 18 weeks pregnant. But she gradually realized that it wasn’t normal at all.

“I could tell something was wrong,” she said. “They were looking through the scans and whispering.”

The doctors didn’t immediately tell her what was going on. She recalled later: “Like a lot of situations, they treat women with delicate words, when in reality we just want to know the truth.” Eventually, they did tell her what the problem was.

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“They mentioned the word accreta,” she said. “And that was it. ‘There’s a possibility you might have accreta,’ they said.”

They sent her off until her next check-up, at 28 weeks. And she spent two months Googling accreta.

She found that accreta is a serious, potentially fatal, syndrome where the placenta attaches too deeply to the uterine wall – or even grows through the uterine wall into other organs.

The condition is just one of a variety that can kill women during pregnancy, childbirth or its aftermath – and the United States has an unusually high maternal death rate.

Facebook Twitter Pinterest Nick, Alisha, Olivia and Annabelle Berry on 26 August 2018. Photograph: Alisha Berry

But, perhaps against the odds, despite having the diagnosis of accreta confirmed, Berry survived a difficult pregnancy and risky delivery. She was surrounded by medical professionals who had specially prepared for the possibility of dangerous bleeding because of her condition, and Berry welcomed her daughter Annabelle into the world in 2015.

Now experts in California who help patients like Berry give birth safely want to spread the word to others hospitals across America.

In the US, about 26 women are dying for every 100,000 live births, almost triple the rate of most western European countries – and some countries, such as Finland, have a rate as low as three deaths. But in California, new collaborations between health experts have helped those rates drop precipitously – to about seven deaths per 100,000 births, according to an article in the September issue of the Health Affairs journal, which reviews the statistics and some of the improvements that drove them.

Since 2006, a team of researchers at Stanford University’s California Maternal Quality Care Collaborative (CMQCC) have been trying to answer the question of why it is disproportionately dangerous to give birth in America and what can be done about it.

In a new study released by the CMQCC, the center reviewed its methods and accomplishments – including the drop in maternal mortality – and looked to its goals: an ongoing project to reduce the rate of caesarean sections, which are associated with some complications like accreta; bringing the CMQCC program to hospitals across the country; and looking into why African American mothers are still three times as likely to die in childbirth as their white counterparts.

The CMQCC medical director, Elliott Main, said it had become clear the group could not simply recommend guidelines for hospitals. “There are a number of studies indicating that the amount of time for a guideline to make its way into practice in the United States is 17 years,” he said. “That’s pretty devastating, and pretty sad.”

So the CMQCC took a different route. Change in California has come from partnerships with a variety of public and private groups, Main said, including a collaborative of hospitals adopting standards that are designed to better prepare staff for cases like Berry’s.

Improved monitoring of birth records, better databases and much better training for professionals about what can go wrong during pregnancy have all helped.

So had greater publicity about the problems, risks and solutions, he said.

“Most recently, [there’s been attention] from the fourth estate [the media]. There have been a lot of articles in the last year about maternal mortality, and they’ve gotten a lot more scrutiny from policy folks than anything I write in medical journals.”

Hellen Rodriguez is the maternal-fetal medical director at Pomona Valley hospital medical center, near Los Angeles, one of the collaborating hospitals leading the charge on changing standards for maternal health in California. She said that part of that process was training doctors and nurses to recognize how symptoms might present differently in expectant or post-delivery mothers.

“I think really the major problem is that we all anticipate that a mother that gives birth is healthy and nothing’s going to happen,” Rodriguez said. “A lot of the things that are considered normal in pregnancy can be clues to a catastrophic event.”

For the past three years at Pomona Valley hospital, staff have been trained through a series of simulations of things that can go wrong in a pregnancy, from the relatively common, such as hemorrhaging, to the very rare, such as cardiac arrest.

Patricia Lirio, who’s been a nurse at the hospital for 12 years and acts in the simulations as a patient, says the simulations are partly about getting staff to prioritize the mother’s needs as well as the baby’s. In one situation, staff are presented with a baby whose heart rate is slowly dropping.

“In the beginning, when we started doing this, they’d panic and want to bring the patient to surgery because the baby’s heart rate is down,” Lirio said. “What we want is for them not to rush that patient for a C-section. That’s the goal.”

Meanwhile, Alisha Berry, who co-founded an organization called the National Accreta Foundation, said that, in addition to all the changes the CMQCC was working on, she’d like to see more monitoring of maternal health past the delivery date. She has continuing lung and bladder issues, and problems with anxiety.

“It made me realize we take for granted childbirth, because it’s supposed to be this safe place,” Berry said. “I feel really lucky that I survived.”

Accreta itself is relatively rare – it occurs in about one of every 500 pregnancies – but it’s one of a slew of oft-overlooked conditions that researchers have identified as threats to expectant mothers’ health before, during and after the pregnancy.

Accreta is especially common among women who have had one or more C-sections, as Berry had.



But when she went in to give birth, the doctors were prepared. There was a team of 20 people in the operating room.

“I remember having to wait an hour because they were making sure enough of my blood type was in the room,” she said. “They were preparing to infuse blood as fast as possible, [because] you can bleed out in seconds.”

After giving birth, Berry was in and out of the ICU for weeks, and she’s still in recovery, two years later. But she survived. And that may be thanks, in part, to the fact that she gave birth in California.

She’d also like to see a change in the way doctors talk to women – and expectant mothers in particular – about health problems. Some of that will come from women demanding more information, which starts with mothers sharing stories like hers, even if they are awkward to talk about, she said.

“You can’t treat women like we’re delicate little flowers,” Berry said. “Women can advocate for themselves. That’s why I’m doing this. It’s not comfortable, but I think it’s important.”