Kardashian surrogacy points to U.S. crisis
Report finds maternal mortality on rise; she has condition known to put mothers, babies at risk
Last week Kim Kardashian confirmed, via “inside sources,” that she was expecting her third child, though she also acknowledged that she wouldn’t be giving birth herself.
The reality TV star and husband Kanye West hired a surrogate to carry the baby girl for nine months and through the birth, which is expected to happen in January.
Given Kardashian’s penchant for nude selfies, it would be easy for skeptics to assume that the 36-year-old went the surrogacy route because she didn’t want her figure inconvenienced by a pregnancy. But that’s not the case. Numerous reports point out that Kardashian has a condition that is known to put mothers and their babies at risk of bleeding to death.
In this way, Kardashian didn’t want to become a part of a grim statistic in U.S. health care that will surprise many people. It is that women die at a higher rate of pregnancy- or childbirth-related causes in this country than women in other countries in the developed world, according to a joint investigative report published in May by ProPublica and NPR.
“They say that this is what some died from as a result of childbirth back in the day, without proper care,” Kardashian wrote on her website about her condition.
Actually, it’s not “back in the day” that American women more regularly died from placenta accreta or other issues related to pregnancy and childbirth. They are dying now at a rate that’s disturbingly high for a wealthy, developed country. Every year, 700 to 900 women die from pregnancy or childbirth-related causes — and some 65,000 nearly die.
What’s even more concerning to maternal health advocates is that the rates of maternal mortality have been falling in every other wealthy country — and in some less affluent ones. But in the United States, the rate of maternal deaths has increased between 2000 and 2014. Even more disturbing, almost 60 percent of such deaths were preventable.
What causes maternal death
In addition to placenta accreta, women die from from cardiomyopathy and other heart problems, infections and pregnancy-induced hypertension (preeclampsia, or high blood pressure), as well as rarer causes, ProPublica and NPR reported. Many died days or weeks after leaving the hospital.
The reasons for higher maternal mortality in the United States are complex, the report found. They include:
• New mothers are older, with more complex medical histories.
• Half of pregnancies in the U.S. are unplanned, so many women don’t address chronic health issues beforehand.
• The fragmented health system makes it harder for new mothers, especially those without good insurance, to get the care they need.
• Confusion about how to recognize worrisome symptoms and treat obstetric emergencies makes caregivers more prone to error.
Another factor: The greater prevalence of Csections is leading to more life-threatening complications, including placenta accreta, in which the placenta becomes deeply attached into the uterus.
Kardashian’s once rare condition
Placenta accreta was once “vanishingly rare,” with only one in 30,000 pregnancies affected in the 1950s, according to a 2013 article by Stanford Medicine. But placenta accreta now hits around one in 500 pregnancies, and up to 7 percent of placenta accreta patients die of the disease.
A normal placenta only attaches to the uterine lining, which is temporary, shed at delivery and distinct from the uterine muscle. When the placenta grows into the muscle, sometimes with a frightening tenacity, that’s when complications arise.
While scientists have linked the increase in cases to rising Caesarean rates, “the exact mechanism of the disease — a conversation gone awry between the placenta and the uterus — remains profoundly mysterious,” the Stanford story said.
The condition is often diagnosed during a prenatal ultrasound, but Kardashian points out on her website that there are often no symptoms. Kardashian says her doctors discovered she was affected only after she gave birth to her first child, North West, in 2013.
Through her pregnancy with North, she and her doctors were focused on preeclampsia, which she said caused her face and body to swell and forced induced labor at 34 weeks. It turned out that the delivery of North went fairly smoothly and Kardashian didn’t require a Caesarean.
A daunting treatment
But what happened next didn’t go smoothly. The Stanford article said that treating placenta accreta involves separating an entwined placenta and uterus, sometimes necessitating a hysterectomy. The procedure is “daunting,” technically challenging and potentially devastating for women.
“Right after the delivery, the placenta usually comes out,” Kardashian wrote on her website. “My placenta stayed attached inside my uterus. My doctor had to stick his entire arm in me and detach the placenta with his hand, scraping it away from my uterus with his fingernails. How disgusting and painful !!!! . My mom was crying; she had never seen anything like this before.”
“My delivery was fairly easy, but then going through that — it was the most painful experience of my life!” she continued. “They gave me a second epidural. But we were racing against time, so I just had to deal.”
Kardashian didn’t need the hysterectomy after North’s birth, which meant she could get pregnant for a second time with son Saint, who was born in December 2015. But with Saint, she again developed placenta accreta and a painful post-delivery.
Affecting women of all backgrounds
While maternal mortality is significantly more common among AfricanAmericans, low-income women and women in rural areas, pregnancy and childbirth complications kill women of every race and ethnicity, education and income level, and in every part of the United States, the ProPublica and NPRreport found.
A common theme that emerged in the report is that the medical system assumes that maternal mortality is no longer a problem in this country.
The focus has shifted instead to the safety and well-being of the fetus and newborns through efforts to prevent birth defects, reduce preterm birth and improve outcomes for very premature infants. As a result, infant mortality in the United States has fallen to its lowest point in history.
Unfortunately, this focus away from mothers means that some training programs allow medical fellows to finish their maternal-fetal training without ever spending time on a labor and delivery unit. When women are discharged, they routinely receive information about how to breast-feed and what to do if their newborn is sick but not necessarily how to tell if they need medical attention themselves.
Mothers who nearly died told ProPublica and NPR that their doctors and nurses were often slow to recognize warning signs that their bodies weren’t healing properly. Symptoms that indicate potentially life-threatening conditions include painful swelling, headaches, heavy bleeding and breathing problems.
While the ProPublica/ NPR report cited examples of scattered hospitals around the country that have adopted medical protocols to better monitor the mother’s health — including at UC San Francisco and Stanford University — it also noted that it can take a decade or more for a new medical protocol to be widely adopted.
“We worry a lot about vulnerable little babies,” said Barbara Levy, vice president for health policy/ advocacy at the American Congress of Obstetricians and Gynecologists and a member of the Council on Patient Safety in Women’s Health Care. Meanwhile, she added, “We don’t pay enough attention to those things that can be catastrophic for women.”