The mood in the operating room had soured. What had, just moments before, been the peaceful hum of Frank Ocean’s cover of “Moon River” flowing from my birth playlist and friendly chatting among medical staff was now a foreboding quiet. My husband had left my side, but from the corner of the room, I heard my newborn baby gurgle and grunt at being confronted with the new reality of life and felt a wave of relief. That moment was all too short.
“Are you sure you’ve never had a procedure done on your uterus before?” My ob-gyn at Cedars-Sinai, who had been by my side through the ups and downs of pregnancy, sounded uncharacteristically tense. I assured her, between deep breaths and medication-induced gags, that I had not. Prior to this, I had never experienced a pregnancy nor a miscarriage. Before this cesarean-section operation to deliver my baby, I had never had any kind of surgery at all.
Eventually, my son was brought to my side and we met for the first time. But he was soon whisked away again as I was told that the doctors had to work on me a bit longer. What I did not know at the time was that they had discovered on the operating table that I had placenta accreta, a condition where, instead of detaching after birth, the placenta embeds and grows into the surrounding organs of the pregnant person’s body. The placenta connecting me to the child I’d just given birth to had spread into my uterus, something I would later learn my doctors had to turn my uterus inside out to address.
One in 14 pregnant people in the US with accreta die, usually from hemorrhaging too much blood—as I nearly had—and its incidence has increased sharply over the decades, from 1 in 30,000 pregnancies in the 1960s to 1 in 533 pregnancies in the 2000s. (Prior cesarean delivery is a risk factor, so as C-section operations have become more common, so has the condition.) Typically, its threat can be managed by identifying the accreta during pregnancy via ultrasound, but mine was not detected in advance, making the discovery of my condition during surgery even riskier.
Add to that the stunning fact that the overall maternal death rate of Black and Indigenous pregnant people who are 30 or older is about four to five times higher than it is for white people who are pregnant. At 36 and as a person of Indigenous heritage, the likelihood of becoming another harrowing statistic was all too real to me. Now, I wonder if the fact that I live in California might just have saved my life.
About one ninth of all US births happen in California, and in the absence of national standards for maternal care, the progress in curbing maternal mortality in the state has been profound. (By contrast, Texas has the highest maternal mortality rate in the developed world.)
California’s efforts to quell maternal mortality rates are crystallized in the California Maternal Quality Care Collaborative, a revolutionary effort to make births safer for moms in the state. When the CMQCC was established almost 20 years ago by doctors and nurses at the Stanford University School of Medicine, it was the only statewide collaborative focused solely on maternal health. Since then, California has seen maternal death dramatically decline—down 65% between 2006 and 2016—while the national maternal mortality rate has continued to rise. Since the CMQCC was established, all 50 states have set out to create their own perinatal-quality collaboratives, though the rates of hospital participation vary widely—and only 36 states receive federal support for this work.
At the center of the CMQCC’s efforts? Free, downloadable tool kits to help hospitals prepare for and manage potentially deadly scenarios that arise with childbirth. In my case, the doctors at Cedars-Sinai used hemorrhage guidelines with specific information on placenta accreta spectrum created by Stanford professor Elliott Main for the CMQCC.
The days and weeks after my delivery were grueling, an emotional and physical gauntlet I feel grateful to have healed from under the thoughtful care of my husband. I’m not sure if I’ll ever finish processing the depths of what happened to me; at the time, even sharing details of the experience with friends and loved ones seemed bizarre, as if it had all happened to someone else. The immediacy of my son’s needs and the sheer magnitude of motherhood dwarfed most thoughts that I could have processed, anyway.
Ultimately, my doctor, Jamie Temko, and the team at Cedars-Sinai ensured that I survived to discover the mysteries of motherhood. Still, when preventable maternal deaths are on the rise around the country and deep inequities persist across imagined borders, those who don’t survive are never far from my thoughts. Without them here, who will continue to speak on their behalf?