Maternal deaths just ‘one part of the story’ in NC. Pregnancy complications are rising

The number of women who nearly die from pregnancies in North Carolina has continued to hover around the highest level in five years, down slightly from a mid-pandemic peak.

That’s according to the latest state health data obtained by The News & Observer on severe maternal morbidity — serious complications like sepsis and organ failure that put the lives of new mothers in danger.

More than 1,000 women in North Carolina narrowly survived these complications in 2022, preliminary data show, a figure that jumped by more than 30% compared to 2018.

The upward trend in severe maternal complications largely follows increased rates of pregnancy-related deaths in North Carolina and across the country, where expectant mothers fare worse than other wealthy nations.

In relative terms, the number of these deaths is small: less than 100 for most states. And that can make identifying trends and potential fixes tricky.

“The death data is one part of the story,” said Belinda Pettiford, who heads the Women, Infant and Community Wellness Section of the state Division of Public Health. “We have really tried to step back more recently and look at the severe maternal mobility data … which are like the near misses.”

Tracking these “near misses” is critical, experts say, because there are so many more cases to analyze.

At their peak in 2021, for example, 1 out of every 100 deliveries in the state resulted in a close call that almost claimed a woman’s life.

Pregnancy is the most dangerous thing most young, healthy women have ever done, says Dr. Alan Rosenbaum, an obstetrician-gynecologist at UNC Rex Hospital in Raleigh.

“Especially — and unfortunately — in this country,” Rosenbaum said.

To save lives, he said, patients need ready access to high-quality care throughout their pregnancies, whether they live in a rural county or an urban center.

Because even in the most ideal conditions, things can go wrong fast.

It’s a reality Rosenbaum now understands more deeply than ever.

‘An image that certainly will never leave your head’

By all accounts, Stefanie Wisda’s pregnancy in the early months of 2022 was going great.

It helped, of course, that she was married to Rosenbaum, and worked as a physical therapist at UNC Rex alongside a cadre of other healthcare professionals.

“I always joke that one of the perks of marrying a doctor is a lot of your friends are doctors, and you get free consults — on demand,” Wisda said.

In her mid-30s, she was in the best shape of her life, the result of a beach-body workout she figured would avoid any possibility of gestational diabetes. She developed none of the food aversions common among pregnant women. For months, her regular doctor’s appointments revealed nothing abnormal.

“It was uneventful. I was just tired. I had no morning sickness. I was like, ‘This is gonna be a breeze,’” Wisda said. “I think that was when I triggered the universe.”

About seven months through her pregnancy, she noticed that her hands and feet were getting a little puffy. Her blood pressure started to rise, triggering a diagnosis of preeclampsia.

There’s a lot about that condition that’s not understood, Rosenbaum said, but it’s part of a spectrum of disease preceded by pregnancy-induced hypertension. At its core it is an “abnormal interaction” between the placenta and the mother’s body, he said.

Patients with preeclampsia experience a range of symptoms, like headaches, vision changes and elevated blood pressure. The condition can be serious without treatment and monitoring.

“You can end up with liver or kidney injuries in more severe forms of the disease,” he said.

In its most recent report, the N.C. Maternal Mortality Review Committee reported that preeclampsia and eclampsia — a potential later stage of the disease — accounted for about 10% of pregnancy-related deaths from 2014 to 2016.

Most cases don’t result in serious health problems during pregnancy, though.

“It’s something that is extremely commonly seen,” Rosenbaum said. “Almost every single shift when I go to work, I have a patient with preeclampsia.”

But in the days that followed Wisda’s diagnosis, she saw more swelling. She had numbness in her hands. Her endurance took a hit, and she had stopped exercising to avoid spiking her blood pressure.

At nearly 37 weeks, she was exhausted, and felt terrible at work.

The day before her planned induction, they drove to UNC Medical Center. But by the time she was checked into her hospital room, she was feeling better.

A few hours later, Wisda could sense something wasn’t right.

“I said, ‘Something’s happening with my hand,’” Wisda said. “It felt like a full muscle hand spasm. That is the last thing I remember.”

Rosenbaum watched his wife’s eyes roll back. Her face locked in a grimace as her body rocked with a grand mal seizure.

“It’s an image that certainly will never leave your head,” he said.

What happened next, happened fast.

The first round of seizures was followed by a second. With Wisda unconscious, her husband consented to an urgent C-section as soon as doctors got the convulsions under control.

“Her blood pressures were also sky high while this was happening,” Rosenbaum said. “One of the things that I was fearing the most was that she’d have a stroke.”

There was a real possibility his wife could die or suffer irreversible injuries.

Recovering, as a new mom

Wisda doesn’t remember giving birth.

On a May afternoon, Wisda and Rosenbaum sat together on the sofa of their Cary home as she tried to recall the details, occasionally passing their grinning baby boy, Eli, between them. She does remember a room with lots of lights. Wires. An oxygen line in her nose.

“And then, like, a baby on my chest,” she said during an interview, pausing when Eli quietly cooed on her lap. “Yeah. That’s you.”

Aside from being born a little underweight, he’s healthy and happy.

“We’ve been working to try to get fat rolls on him for the last several months — and are slowly succeeding,” Rosenbaum said.

Wisda has recovered physically too, although she’s still working through the heavy emotional toll with the help of counseling.

“When people ask, I say it was traumatic. They look at me horrified — no, but it was,” she said. “It was not rainbows and sunshine.”

A year later, Wisda is slowly piecing together memories from the end of her pregnancy. But sadness over missing her son’s birth — and the trauma over the ordeal — lingers.

She knows it’s OK to be sad.

But surviving that “near miss” granted her so many more moments, ones she tries to focus on. Seeing Eli roll over for the first time. Hearing his first word — “mama,” not “da-da” — which he murmurs into the baby monitor when he wants her.

She loves being his favorite person.

“When he smiles, it kind of helps me to forget everything.”

Rosenbaum is well aware their story could have been different.

What if his wife hadn’t worked in health care, where she could get her blood pressure checked regularly? What if she couldn’t text her OB-GYN, a family friend, any time she had a question or concern? What if they lived hours from a hospital? Or had trouble with transportation?

“This was something that happened just so suddenly to somebody who had amazing access to health care and resources,” Rosenbaum said. “And yet we still had this near miss.”

This story was originally published July 19, 2023 at 6:00 AM.

Tyler Dukes

The News & Observer

919-696-1935

Tyler Dukes is the lead editor for AI innovation in journalism at McClatchy Media, where he leads a small team of journalists that helps the company’s 30 local newsrooms responsibly harness data, automation and artificial intelligence to elevate and strengthen their reporting. He was previously an investigative reporter at The News and Observer in Raleigh, N.C. In 2017, he completed a fellowship at the Nieman Foundation for Journalism at Harvard University. He is a graduate of North Carolina State University and grew up in Elizabeth City, N.C.

Teddy Rosenbluth

The News & Observer

919-829-4569

Teddy Rosenbluth covers science for The News & Observer in a position funded by Duke Health and the Burroughs Wellcome Fund. She has covered science and health care for Los Angeles Magazine, the Santa Monica Daily Press, and the Concord Monitor. Her investigative reporting has brought her everywhere from the streets of Los Angeles to the hospitals of New Delhi. She graduated from UCLA with a bachelor’s degree in psychobiology.