In her Vogue cover story earlier this year, Serena Williams shared how she nearly died after giving birth to her daughter, Alexis Olympia Ohanian Jr.
The day after having an emergency C-section, she suddenly felt short of breath. With a history of blood clots ("Serena lives in fear of blood clots," the story states), she assumed she was having another pulmonary embolism, so she told a sceptical nurse she needed a CT scan and a blood thinner. What she got was an ultrasound of her legs.
"I was like, a Doppler? I told you, I need a CT scan and a heparin drip," Williams remembers telling the staff, according to Vogue.
It turned out that she was right: "Several small blood clots had settled in her lungs. Minutes later she was on the drip."
Pulmonary embolism is a form of venous thromboembolism, one of the leading causes of maternal death. If Williams hadn't been so in tune with her health and what she needed, her outcome could have been much worse.
Her episode punctuates the fact that preventable complications from pregnancy and childbirth are growing in the US. ProPublica had been investigating maternal mortality for nearly a year, and reported these findings: About 700 to 900 women die each year from maternal complications. One study found that 60 per cent of these deaths are preventable. Australia does better, with an average of six deaths per 100,000 live births compared to America's 14 as of 2015.
Addressing the issue of maternal mortality, of course, goes far beyond a post urging women to "know the symptoms". There's also "fix the systemic problems of the healthcare system". Racial disparities in maternal health is a national problem both in the US and Australia. In the US, black women are 243 per cent more likely to die from pregnancy- or childbirth-related causes than white women, ProPublica reports. The disparity has persisted for decades. In Australia, Aboriginal and Torres Strait Islander women are twice as likely to die from issues surrounding pregnancy and childbirth than non-Indigenous Australian women.
All around, education is critical. Here are the symptoms to know about the three leading causes of maternal death: Venous thromboembolism (blood clots), obstetric haemorrhage (severe bleeding), and severe hypertension in pregnancy (high blood pressure). If you've recently given birth and have any of these symptoms, tell a doctor right away.
Venous Thromboembolism (Blood Clots)
Venous thromboembolism (VTE) is a blood clot that starts in a vein. There are two types: Deep vein thrombosis and pulmonary embolism (what Williams experienced). According to the American Pregnancy Association, women are most likely to experience a blood clot in their first three months of pregnancy or in the first six weeks after giving birth.
Deep vein thrombosis
What it is: American Heart Association describes it as "a clot in a deep vein, usually in the leg, but sometimes in the arm or other veins".
Most common symptoms:
- Swelling or pain in one leg
- Pain that worsens when you walk
- Veins that look larger than normal
What it is: A condition that occurs when a DVT clot breaks free from a vein wall, travels to the lungs, and blocks some or all of the blood supply.
Most common symptoms: Pulmonary embolism symptoms can vary greatly, depending on factors such as the size of the clots and how much of your lung is affected, but these are the most common symptoms according to the Mayo Clinic:
- Shortness of breath. This symptom typically appears suddenly and always gets worse with exertion.
- Chest pain. You may feel like you're having a heart attack. The pain may become worse when you breathe deeply (pleurisy), cough, eat, bend or stoop. The pain will get worse with exertion but won't go away when you rest.
- Cough. The cough may produce bloody or blood-streaked sputum.
Obstetric Haemorrhage (Severe Bleeding)
What it is: Excessive bleeding following the birth of a baby. Stanford Children's Health states that about one to five per cent of women have postpartum haemorrhage, and it is more likely with a cesarean birth. Most time, it occurs right after delivery, but it can happen later on as well.
Most common symptoms:
- Uncontrolled bleeding
- Decreased blood pressure
- Increased heart rate
- Decrease in the red blood cell count (hematocrit)
- Swelling and pain in tissues in the vaginal and perineal area, if bleeding is due to a hematoma
Severe Hypertension in Pregnancy
What it is: Severely high blood pressure.
The most common symptoms: High blood pressure is a largely symptomless, but it can increase your risk of heart disease, kidney disease and stroke. Another possible complication is preeclampsia, which typically begins after the 20th week of pregnancy. Not all women have noticeable symptoms of preeclampsia, but when symptoms do occur, the most common ones include:
- Changes in vision
- Abdominal pain
- Rapid swelling (edema)