Kar­dashian sur­ro­gacy points to U.S. cri­sis

Re­port finds ma­ter­nal mor­tal­ity on rise; she has con­di­tion known to put moth­ers, ba­bies at risk

The Mercury News - - Your Life - By Martha Ross mross@ba­yare­anews­group.com

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.”

CRAIG BARRITT — GETTY IMAGES

Kim Kar­dashian and Kanye West at­tend the Alexan­der Wang Fash­ion Show in 2015 with daugh­ter North West.

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