April 23, 2020 • 31 mins
Long before COVID-19 hit the U.S. in early 2020, the American health system was suffering another crisis: alarmingly high — and rising — rates of maternal mortality, particularly among black women. In this country, an estimated two women die every day from pregnancy and childbirth-related causes. And 60 percent of those deaths could have been prevented. And now, the coronavirus is forcing tens of thousands of women to give birth in unprecedented circumstances — sometimes alone, and often without the support networks they need to stay healthy.
In Part 1 of a special episode of “Next Question with Katie Couric,” Katie talks to Charles Johnson, whose wife Kira died in 2016 just hours after giving birth to their second son, Langston. “I thought that what happened to Kira was an isolated incident,” Charles tells Katie. “I thought, this doesn’t happen in 2016, in our country.” Why are women like Kira Johnson — healthy, prepared, and insured — dying? And how did the U.S. become one of the most dangerous places in the developed world to have a baby?
Guests and resources for this episode include:
- Charles Johnson, founder of 4Kira4Moms, a non-profit dedicated to maternal mortality advocacy.
- Dr. Debra Bingham, founder and executive director of the Institute for Perinatal Quality Improvement, and associate professor at the University of Maryland
- Monica Rose McLemore, associate professor in the family health care nursing department at the University of California, San Francisco
- Nina Martin, an investigative reporter at ProPublica and co-author of the award-winning ProPublica and NPR series “Lost Mothers.”
For more information, sign up for Katie Couric’s newsletter Wake-Up Call at KatieCouric.com.
Learn more about your ad-choices at https://www.iheartpodcastnetwork.com
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hi everyone, I'm Katie Current and welcome to next question.
And that same set of double doors opened, and those
same two residents came through that set of double doors
along with another doctor that I had never laid eyes on,
and they told me that um, she passed and there
(00:26):
was nothing else that they could do to Saber. I
just remember the scream that my mother in law at all.
I remember, you know, her aunt falling to the floor.
I remember her brother just yelling, and I just remember
I'm just looking around at all these people that I
love so much and that love cure so much and
(00:47):
so much pain, and I'm just standing there in shock.
It's like no, no, no, no, and just insisting that
they something didn't happen, because literally twelve hours earlier we
walked into this hospit but with a woman that and
only was in good health, it was an exceptional health.
Not only that, I was just talking to her when
(01:07):
she walked away from me, I was holding her hand,
I was talking to her. How did this happen? On
April two thousand sixteen, Charles Johnson and his wife Kia
became a part of a shameful statistic America's maternal mortality
rate in the US and estimated two women die every
(01:27):
day from pregnancy and childbirth related causes, and six of
those deaths could have been prevented. What's scary now is
that those numbers don't take the coronavirus into consideration and
the effect a pandemic could have on an already fragile
maternal health system. The fact is the situation was bleak
(01:50):
long before COVID nineteen hit the US in early Over
the past three decades, while the world has drastically reduced
its maternal more vality rate, the U s is the
only developed nation to see its rate go up, and
go up significantly. The US now has one of the
highest mortality rates in the developed world, a fact that
(02:13):
was so shocking to me, that seems so incongruous, that
I set out to understand how this could be possible.
And so today part one of our look into America's
maternal mortality crisis and my next question, what's behind this
devastating trend. To answer that question, we have to go
(02:36):
back to cure a story. We were just over the moon,
ecstatic to welcome our first son, Charles. It was just
such a tremendous blessing We've always talked about having back
to back boys. You know. The first time around, we
talked about all the politically correct stuff. We're not really
worried about what jenitors. As long as it's a healthy baby,
(02:59):
we don't care. But by the time the second one
came around, Kira had her mind made up. She was like,
I'm a boy's mom. This is where I get in,
where I fit in. Kira and Charles were married in
two thousand and twelve. Two years later, they welcomed their
first son, Charles the fifth, via C section in Atlanta,
and two thousand and fifteen, a job opportunity moved the
(03:20):
young family out to Los Angeles, where they were preparing
for the birth of their second son, who they decided
to call Langston. We interviewed about I think about three
or four different O. B. G Yan's, and we had
also made the decision very early on that we wanted
to deliver at Cedar Sinai Hospital. It was our understanding
(03:41):
that Cedar sign I was supposed to be, you know,
one of the best places, certainly in the state of California,
and it had a reputation of being, you know, one
of the best places in the country. Particularly in the
area of eccentrics and delivery. Beyond a little bit of
nausea early on, Kira's second pregnancy passes without incident. She's thirty,
she's fit, she's healthy, and she has the resources to
(04:04):
choose her care. Because Kira had a C section with
her first delivery, her doctor recommends they do the same
for the second. She's scheduled for a routine C section
on April twelve, two thousand and sixteen, at Cedars Sinai
Hospital in l A. So we walked in for Lengthson's
delivery for the scheduled C section at two o'clock, and
(04:27):
so Lengthon is born, perfectly healthy, tin fingers, tin toes,
you know, super super handsome, looking just like me. And
it's just we're just overwhelmed with all this, just joy
and pride of just welcoming this precious gift into our lives.
And so shortly after the delivery, they take us back
(04:48):
to recovery. You're sitting in the bed resting, and Lengthon
is there and the little incubator toaster thingy. And as
I'm sitting there, I looked down here's bedside, and I
begin to see the calf that are the fully catheter
coming from her bedside begin to turn pink with blood.
(05:09):
And so this was around four o'clock in the afternoon,
and I brought it to the attention to the doctors
and the nurses and cedars, and they come in, they
examine cure, They examine her physically and take her vitals.
They do an art sound, but very importantly, they order
a CT scan to be performed stat When the results
(05:30):
from those initial tests come back, they're not good. Kira's
blood levels are abnormal and the ultrasound shows fluid filling
her abdomen, but there's no action from the staff. As
CIA's condition continues to deteriorate, she's forced to wait for
the next step. The CT scan. Six o'clock comes, no
(05:53):
CT scan. Seven o'clock, no CT scan, eight o'clock, Still
no CT scans, Still haven't take her back to surgery.
Ten o'clock comes, no CT scan. E eleven o'clock comes,
no CT scan. At this point, Kira's pale, shivering, uncontrollably,
(06:14):
and sensitive to touch. In the seven hours since Charles
first noticed blood and Kira's catheter, he and his family
have been relentlessly advocating for her, asking for help, asking
for that CT scan, for attention, for anything. Were you
going crazy, Charles? I can only imagine that you were, uh,
(06:35):
you know, I think about Shirley McClain in terms of endearment,
that you were just furious. I was doing my best
to stay calm in this In this moment, I have
a wife who is clearly um fighting for her life.
I have a newborn baby. I have family members that
(06:55):
are all looking and saying, what's going on? We need answers.
And Kira's whole time, even her most vulnerable, her thing
to me was, baby, just stay calm in that moment.
As much as I wanted to yell and scream and
slam my fists on the nurses station or grab a
doctor by the collar, what Kira knew, even her most
vulnerable state, was that the moment I raised my voice,
(07:18):
the moment I become too aggressive as an African American male,
I become seen as a threat. And ultimately she was
concerned that I would be then that they would call security,
and then I'd be removed from the situation. Um. And
so even in my most heightened the point of anger,
(07:39):
I do my best to stay calm and communicated as
effectively as I can, and even to the point around
nine o'clock Katie, I pulled a nurse to the side
of Cedars and as I grabbed her by her hands
and I just said, look, I looked turned eyes and said,
I need help. My wife isn't doing good. They're telling
us they're gonna take her back to surgery. They're telling
us that they need to do a CT scam, but
nobody's coming. They haven't done anything. We need help. And
(08:01):
the woman looked me in my eyes and said, sir,
your wife just isn't a priority right now, and then
she just walked away. That CT scan never comes and
it isn't until after midnight that the staff makes the
decision to take your back to surgery. At this point,
(08:25):
she's extremely weak, but she's conscious and has been since
Charles first alerted the staff that something was wrong more
than eight hours ago. I'm frustrated, I'm angry, I have
all this mix of emotions, but a certain part of
me is relieved because they're finally doing something. And you know,
(08:46):
as we're walking down the hall uh towards the o
R and I'm walking next to her bedside and I'm
holding here's hand. She's holding my hand, and she's saying, baby,
I'm scared. I can't even really think of many times
and the you know, years I've known this woman that
(09:07):
she's ever uttered those words. And as I'm walking next
to her, I'm doing the only thing I know how
to do as a husband, which is just trying and
tell her that maybe everything's gonna be okay. It's gonna
be okay. They wheel her away and finally get to
this point where these double doors open and they close
(09:28):
behind her. Ah. They take me into a waiting room,
the exact same waiting room that we were in that afternoon,
full of mothers with these humongous bellies and balloons and
families with cameras and all this wonderful, beautiful, anxious anticipation
(09:52):
to welcome these new lives into the world. And now
it's almost one o'clock in the morning and I'm in
the I'm the only person in the room, all by myself,
and it is just eerily silent, and the only thing
I hear is literally the janitor's vacuum going back and forth.
(10:17):
And about twenty minutes go by, and the set of
double doors open and a set of two residents come
walking through the doors, and as they get closer to me,
I can see that the looks on their face it
was not good. He said, look, we couldn't be back
there any longer without letting you know what happened. Um
(10:39):
when he opened her up, there was a lot of
blood and she coded. And then they go on to
tell me situation is critical and they're continuing to work
on her. And at that point, it's you know, Cure's energy,
(11:02):
the way I am, the way we are. I was
just I'm just I'm just an optimist. When you told
me that you're continuing to work on her in her
situation is critical, that's all I needed to hear, because
I'm thinking, it's Kira. She's the closest thing that I've
ever met to a superhero. She's gonna be okay. Right,
we had to scare but she's gonna be okay, is
what I was thinking at that point. And I probably
(11:22):
told him I said, look, thank you for coming out
and telling me, but you're not doing anything for me
by being out here. I need you to get back
in there and bring me my wife back. Minutes later,
surrounded by Kira's loved ones, Charles gets the unimaginable news.
They told me that um she had passed and there
(11:44):
was nothing else that they could do to Saber. Literally
twelve hours earlier, we walked into this hospital with a
woman that not only was in good health, it was
an exceptional health. And what you're telling me, it's not computing.
This doesn't make sense. How can this happen? What did
happen is that Kira's bladder was nicked during her C section,
(12:07):
and for nearly ten hours from incision to returning to
the o R, Kira bled to death. When they opened
her up, they found three and a half liters of
blood in her abdomen and her heart had given out.
That was the last time I saw my wife. A laar,
We'll be right back. On April two thousand sixteen, Kira
(12:44):
Johnson became one of the approximately nine women who die
every year from pregnancy and childbirth related causes. To understand
how we got to Kira, we have to go back
to the nineteen eighties. For much of the twentieth century,
the US enjoyed decades of essentially an uninterrupted decline in
(13:04):
its maternal mortality rate, but then in the nineteen eighties,
that rate started to tick back up. We thought maternal
mortality was essentially solved, as we could um make improvements,
we could bring down by a few deaths. But I
had no idea that actually deaths were increasing. That's Dr
(13:26):
Deborah Bingham, founder and executive director for the Institute for
Parnatal Quality Improvement and associate professor at the University of Maryland.
Deborah has also been working as a pernatal nurse, bedside
and administration, and in public health since nineteen seventy eight.
By the two thousand's, she was the director of nursing
(13:47):
for two hospitals in New York City. We only had
one death in like a five year period, so we
I didn't have any data to tell me Otherwise, I
had no personal experiences to say this is a problem.
I didn't think this was a crisis, but Deborah soon
found out it was in two thousand and six. She
(14:08):
was working on her doctorate when she accepted a position
in California to form the state's first Maternal Quality Care Collaborative,
an initiative to improve maternal outcomes. During the fall of
two thousand and six, she was pulled into a private
meeting with leaders from the California Department of Health. In
this private meeting, we we were shown, um that rates
(14:33):
of maternal death had been rising in California, and they
didn't know why, nor did we. It was shocking. We
knew our rates um even in the nineties were still
higher than other countries, so we not significantly higher, but
slightly higher than other developed countries. So UM, I should
(14:56):
say I knew that. I knew that our rates of
maternal deaths in the United States were a little higher
than other developed countries. So to even have any increase
was just is very shocking. I thought we were getting better,
not worse. And I still remember the room I was
in and how that felt to just like, oh my gosh,
(15:19):
what is going on? And is l And I didn't
know at that time whether that was just unique to
California or was that issue for the entire country. The
issue was not unique to California. It was a national
trend that would only continue to rise. In n seven,
the maternal mortality rate was seven point two, meaning for
(15:41):
every one hundred thousand live births, about seven women died. Today,
that rate has more than doubled to seventeen point four.
Now to really understand why more mothers are dying today
than they were thirty years ago. Debra says, you have
to look at what's changed in the medical industry. You
can't ignore the fact that we've had a sixty nearly
(16:03):
a six increase in cesarean birth. Now about one third
of all women give birth surgically. And then there's fewer
women having vaginal births after cesarean and so there's more
repeat c sections, which add more risks to have the
same scar open multiple times, leads to all kinds of
(16:24):
potential complications. Another thing that has changed over the last
thirty years, more women are being admitted earlier in labor
and what that means that that in the United States,
we don't have a lot of hospitals, don't have like
labor lounges or places where women can keep moving around,
so they're often put in bad and um don't have
(16:44):
freedom of movement in the early stages of labor, where
in the past we used to help women UM have
confidence go home, walk around at home, UM and come
back several hours later or maybe even their labor would stop,
which now they're being admitted, and once they're admitted, then
all this whole what's called a cascade of interventions happen,
(17:06):
which then lead them down a path that could have
been avoided previously. You can think of it as a
path of interventions that could start with something like medication
to induce labor and then end with an emergency c section.
Interventions aren't necessarily dangerous, but each one has the potential
(17:27):
to at least introduce risk to the mother. I am
a high risk perinatal nurse, meaning that I take care
of Over many years, I've taken care of very, very
sick women with very serious medical conditions, So I'm not
opposed in any way to using induction agents or interventions
(17:49):
medical interventions. I personally have helped intervene in many ways
when needed, but as I've learned, we should not intervene
for the heck of it. Devor says, there's one final
element that's worth noting here. When we're talking about this
increase in the maternal mortality rate over the last thirty years,
we started counting better, So we need to acknowledge that
(18:11):
some of this increases due to better counting, which is
a good thing because every death deserves to be counted
and needs to be counted. So we can learn from
all all of the deaths. It's a way to honor
the women who died. It's a way to honor the
teams who tried to save their lives. But changes in
the medical system still don't give us the full picture.
(18:35):
There are other forces, major structural issues that caused between
seven hundred and nine hundred women to die every year.
A really major problem and cause is the focus on
babies and fetuses rather than mothers. It's a problem that's
(18:57):
been developing over five decades. Nina Martin is an investigative
reporter at pro Publica. She spent her career reporting on
women's health. In two thousand and seventeen, Nina, along with
the team at pro Publica and her partners at NPR,
released a massive investigative report on the maternal mortality crisis.
It was called the Lost Mother's Project, and it would
(19:21):
go on to win a Peabody Award. Women used to die,
you know, hundreds of thousands of women used to die
probably a year in the turn of the twentieth century
um from pregnancy and childbirth complications. And there was enormous
progress over many, many decades to to bring those numbers
(19:42):
down and then UM. Somewhere around the fifties and the
sixties UM the numbers got to be good enough where
people started taking the eye off there there, you know,
started really thinking about it differently. Before the nineteen sixties,
the fetus was essentially inaccessible to doctors. They literally couldn't
(20:04):
examine it, so care had to focus on the mother.
But then technological advancements and new techniques like testing amniotic
fluid and sonogram imaging made it possible for doctors to
monitor the fetus in utero. With the fetus now a patient,
the next few decades saw a pronounced shift of care
(20:25):
and attention away from the mother. Today, Nina Martin says,
it's clear where the priorities are. You know, think about
smoking and and and sort of some of the messaging
around smoking during pregnancy. It's not about the fact that
smoking is really bad for moms. It's about smoking for
the babies. Think about when you're giving birth. You go
(20:46):
in and you get hooked up to monitors and everything,
and the monitor is mostly there to check the fetal
heart rate and to make sure that the baby signs
are okay. And if the baby signs aren't okay, then
it's you know, rush, rush, rush in to get the
C section. Mom signs are monitored at a much lesser rate,
(21:07):
So much of the attention in the maternity ward after
mom gives birth is around feeding the baby, taking care
of the baby. What do you do? Do you know,
how are you to have the car seat? You know,
all of that. It's not about well, who's going to
take care of you when you go home? And do
you know warning signs and everything. We just kind of
kick her home with the baby and don't pay any
(21:28):
attention to her. I mean, it's just really shocking. But
there's still another structural issue putting so many American mothers
at risk. Will explore that right after this. When Kia
(21:50):
Johnson died in April of two thousand sixteen, the cause
of death would be listed as hemorrhage shock. But the
truth is much more complicated. What happened to Cira was
not just a medical tragedy, was a medical catastrophe. Everything
that could have went wrong, in fact did so. Not
(22:10):
only did that doctor failed Kira, but the hospital and
their policies and procedures failed her. Let's talk about the
role race might have played. Do you believe that it
did do you believe that you were you and Kira
were dismissed or not treated seriously because of because of
(22:32):
your skin color. Absolutely, and the reality of the situation
is this is that what is clear about what happened
on April twelve of two thousand and sixteen Seater Sina
is that the staff and the doctors and the nurses
(22:53):
that were responsible for Cura's life failed to seek Kira
in the same way that they would see their daughter,
or their mother or their wives. I thought that what
happened to here was an isolated incident. I thought that
a woman who is an exceptional health who has access
to care, who does all the things right, walking into
(23:13):
a hospital like Cedar Sinai in exceptional health and not
walking out to raise her boys, I thought that it
was an anomal I thought, this is something that doesn't
happen in two thousand and sixteen in our country. But
it does happen. And of that nine hundred or so
women who die every year, the vast majority are black.
(23:35):
Black women are more likely to die during pregnancy, three
to four times more likely to die during pregnancy than
white women. Monica Rose McLamore is an associate professor at
the University of California, San Francisco. She has dedicated her
entire career to reproductive health and justice. So when you
think about that, that group of between seven hundred and
(23:57):
nine hundred, you know, maternal deaths in the United States,
you can argue that you know, three hundred of them
potentially could be black and brown women, and so that
disparity or that difference is actually huge. And that's when
you control for education, income status, um, insurance type, place
(24:21):
of care, that risk is equally shared by Black women. Regardless.
If you ask Monica what's causing such a disparity, what's
killing so many Black women like Kia Johnson, he agrees
with Charles it's racism, pure and simple. The truth of
the matter is is that you know, black death during pregnancy,
(24:44):
in my opinion, is a canary in a coal mine.
It tells us where our priorities are. It tells us.
You know that that again, you know, we don't listen
to and or believe black women, whether it's about pain
or whether it's about pregnancy related symptoms, contractions, whatever. We
we don't value black women. It's because our lives aren't
(25:05):
worth saving to some people. And so you know, to
say that as a black woman is a really hard thing.
But that that's what my gut tells me, That's what
my lived experience tells me. Every time I use the
word racism, people always go to the you know, interpersonal level.
I am calling you a bad person in there for
your racist That's not what I'm talking about. I actually
think most people actually inherently are trying to do as
(25:28):
well as they can do with what they have, and
when you know better, you should do better. But the
truth of the matter is, structural racism is a different
beast altogether, um because it's really about institutions, policies, and
structures that actually privilege one group over another based on
race or ethnicity. We know that there is an overrepresentation
(25:52):
of of of black people in poverty, and again that's
a structural racism problem. When you think back to things
like you know, red Line, where you know people were
denied mortgages or given high risk mortgages, like it is
a structural reason why Black people are overrepresented in being poor.
I think it also shows up in terms of the
(26:13):
differential treatment that people receive based on insurance status. Why
are we giving people different care? You know when clinical
guidelines are standard based on who's paying for it back
in hospitals. Systematic racism also shows up in the actual
makeup of who is overwhelmingly caring for black mothers. We
(26:35):
have not had enough courage and diversifying our health care workforce.
The fact that you know, I believe one percent of
physicians in the United States are are Black Americans, and
I don't think nursing is much better. UM, we need
to diversify our healthcare workforce. A structural problem is if
we don't believe that people of color and black people
in particular have the aptitude or capacity to be able
(26:59):
to care for communities that we come from, live and
work and serve UM. I think that's just like a
really really racist thing to think. At both the individual
level and at a structural level. We can see the
effects of institutional racism play out right now with the
coronavirus pandemic. While anyone can get COVID nineteen, racial data
(27:20):
shows that more Black Americans are contracting and dying from
COVID than whites. One analysis showed that in Chicago, black
residents so far make up of the deaths there, get
the account for only nine percent of the city's population.
In New York City, the epicenter of the pandemic. COVID
is hitting black and brown neighborhoods the hardest, like in
(27:43):
Jackson Heights, Queens, which is the most ethically diverse neighborhood
in the country. It's a very underserved community and the
community right now is being hit very, very hard by
the COVID epidemic. You may recognize Dr Tracy bone Hemmerdinger
from last week's episode. She's the chief of Obstetrics at
the Elmhurst Hospital Center. The population that we generally see
(28:04):
at Elmhurst is mixed community of new immigrants. We see
all different ethnic backgrounds. The number one language spoken is Spanish,
followed I think very closely by Bengali. And I think
that a lot of the patients that we see fall
into the category of people who can't social distance because
they live with large numbers of people in their homes,
(28:25):
people who are responsible for caring for not only many children,
but also their parents and their extended family uh and
and people whose jobs are either domestic workers or you know,
people whose jobs and livelihood may be cut off completely
and not have any access to their regular daily needs,
and so I think that that puts them at significant
risk for any illness. Before COVID nineteen hit, Elmer's was
(28:49):
running programs in partnership with the Maternal Hospital Quality Improvement Network,
a part of a citywide plan to reduce maternal deaths
and life threatening complications among women of color. There are
other initiatives as well. In California, for example, a bill
that passed last year requires implicit bias training for all
(29:10):
healthcare workers. But Monica Macklemore says, it's just to start
to really address something so widespread, prevalent, and daunting as
institutional racism, you have to begin by making things better
for those who have it the worst. If you're centering
the people who are most vulnerable, everybody's care should actually
get better because then those innovations should be translated for everybody.
(29:34):
But a lot of people don't believe that that if
you center to people who are experiencing the greatest amount
of burden, they think they're losing something. And I'm like, no,
you don't understand. If we are really really like making
things better for the people who have it worse, everybody
should should actually experience an improvement in their care in
industrialized nations. Our maternal death rate is one of the
(29:58):
highest for income countries. We can do better. It doesn't
have to be like this. Tomorrow on a special episode
of Next Question, Part two of our look at America's
maternal mortality crisis. Don't worry your little head about it,
(30:19):
because you're fine now in your baby spine, and go
home and live your life and be happy that everything's okay.
And so her experience was completely erased. Why maternal deaths
are only the tip of the iceberg being a professional athlete,
I just thought that will never happen to me. An
intimate conversation with Olympian Alison Felix and the courageous people
(30:43):
who are working to save American mothers. That's tomorrow on
Next Question. To understand how the coronavirus is affecting pregnant women,
check out last week's episode called how Do You have
a Baby during a Pandemic? On Apple podcast, the I
Heart Radio app or wherever you listen to your podcasts.
(31:12):
Next Question with Katie Couric is a production of I
Heart Radio and Katie Curreic Media. The executive producers are
Katie Currik, Courtney Litz, and Tyler Klang. The supervising producer
is Lauren Hansen. Our show producer is Bethan Macaluso. The
associate producers are Emily Pinto and Derek Clements. Editing by
Derrek Clements, Dylan Fagan and Lowell Berlante, Mixing by Dylan Fagan.
(31:36):
Our researcher is Gabriel Loser. For more information on today's episode,
go to Katie Currek dot com and follow us on
Twitter and Instagram at Katie Couric. For more podcasts for
my heart Radio, visit the I heart Radio app, Apple podcast,
or wherever you listen to your favorite shows,
Hi everyone, I'm Katie Current and welcome to next question.
And that same set of double doors opened, and those
same two residents came through that set of double doors
along with another doctor that I had never laid eyes on,
and they told me that um, she passed and there
(00:26):
was nothing else that they could do to Saber. I
just remember the scream that my mother in law at all.
I remember, you know, her aunt falling to the floor.
I remember her brother just yelling, and I just remember
I'm just looking around at all these people that I
love so much and that love cure so much and
(00:47):
so much pain, and I'm just standing there in shock.
It's like no, no, no, no, and just insisting that
they something didn't happen, because literally twelve hours earlier we
walked into this hospit but with a woman that and
only was in good health, it was an exceptional health.
Not only that, I was just talking to her when
(01:07):
she walked away from me, I was holding her hand,
I was talking to her. How did this happen? On
April two thousand sixteen, Charles Johnson and his wife Kia
became a part of a shameful statistic America's maternal mortality
rate in the US and estimated two women die every
(01:27):
day from pregnancy and childbirth related causes, and six of
those deaths could have been prevented. What's scary now is
that those numbers don't take the coronavirus into consideration and
the effect a pandemic could have on an already fragile
maternal health system. The fact is the situation was bleak
(01:50):
long before COVID nineteen hit the US in early Over
the past three decades, while the world has drastically reduced
its maternal more vality rate, the U s is the
only developed nation to see its rate go up, and
go up significantly. The US now has one of the
highest mortality rates in the developed world, a fact that
(02:13):
was so shocking to me, that seems so incongruous, that
I set out to understand how this could be possible.
And so today part one of our look into America's
maternal mortality crisis and my next question, what's behind this
devastating trend. To answer that question, we have to go
(02:36):
back to cure a story. We were just over the moon,
ecstatic to welcome our first son, Charles. It was just
such a tremendous blessing We've always talked about having back
to back boys. You know. The first time around, we
talked about all the politically correct stuff. We're not really
worried about what jenitors. As long as it's a healthy baby,
(02:59):
we don't care. But by the time the second one
came around, Kira had her mind made up. She was like,
I'm a boy's mom. This is where I get in,
where I fit in. Kira and Charles were married in
two thousand and twelve. Two years later, they welcomed their
first son, Charles the fifth, via C section in Atlanta,
and two thousand and fifteen, a job opportunity moved the
(03:20):
young family out to Los Angeles, where they were preparing
for the birth of their second son, who they decided
to call Langston. We interviewed about I think about three
or four different O. B. G Yan's, and we had
also made the decision very early on that we wanted
to deliver at Cedar Sinai Hospital. It was our understanding
(03:41):
that Cedar sign I was supposed to be, you know,
one of the best places, certainly in the state of California,
and it had a reputation of being, you know, one
of the best places in the country. Particularly in the
area of eccentrics and delivery. Beyond a little bit of
nausea early on, Kira's second pregnancy passes without incident. She's thirty,
she's fit, she's healthy, and she has the resources to
(04:04):
choose her care. Because Kira had a C section with
her first delivery, her doctor recommends they do the same
for the second. She's scheduled for a routine C section
on April twelve, two thousand and sixteen, at Cedars Sinai
Hospital in l A. So we walked in for Lengthson's
delivery for the scheduled C section at two o'clock, and
(04:27):
so Lengthon is born, perfectly healthy, tin fingers, tin toes,
you know, super super handsome, looking just like me. And
it's just we're just overwhelmed with all this, just joy
and pride of just welcoming this precious gift into our lives.
And so shortly after the delivery, they take us back
(04:48):
to recovery. You're sitting in the bed resting, and Lengthon
is there and the little incubator toaster thingy. And as
I'm sitting there, I looked down here's bedside, and I
begin to see the calf that are the fully catheter
coming from her bedside begin to turn pink with blood.
(05:09):
And so this was around four o'clock in the afternoon,
and I brought it to the attention to the doctors
and the nurses and cedars, and they come in, they
examine cure, They examine her physically and take her vitals.
They do an art sound, but very importantly, they order
a CT scan to be performed stat When the results
(05:30):
from those initial tests come back, they're not good. Kira's
blood levels are abnormal and the ultrasound shows fluid filling
her abdomen, but there's no action from the staff. As
CIA's condition continues to deteriorate, she's forced to wait for
the next step. The CT scan. Six o'clock comes, no
(05:53):
CT scan. Seven o'clock, no CT scan, eight o'clock, Still
no CT scans, Still haven't take her back to surgery.
Ten o'clock comes, no CT scan. E eleven o'clock comes,
no CT scan. At this point, Kira's pale, shivering, uncontrollably,
(06:14):
and sensitive to touch. In the seven hours since Charles
first noticed blood and Kira's catheter, he and his family
have been relentlessly advocating for her, asking for help, asking
for that CT scan, for attention, for anything. Were you
going crazy, Charles? I can only imagine that you were, uh,
(06:35):
you know, I think about Shirley McClain in terms of endearment,
that you were just furious. I was doing my best
to stay calm in this In this moment, I have
a wife who is clearly um fighting for her life.
I have a newborn baby. I have family members that
(06:55):
are all looking and saying, what's going on? We need answers.
And Kira's whole time, even her most vulnerable, her thing
to me was, baby, just stay calm in that moment.
As much as I wanted to yell and scream and
slam my fists on the nurses station or grab a
doctor by the collar, what Kira knew, even her most
vulnerable state, was that the moment I raised my voice,
(07:18):
the moment I become too aggressive as an African American male,
I become seen as a threat. And ultimately she was
concerned that I would be then that they would call security,
and then I'd be removed from the situation. Um. And
so even in my most heightened the point of anger,
(07:39):
I do my best to stay calm and communicated as
effectively as I can, and even to the point around
nine o'clock Katie, I pulled a nurse to the side
of Cedars and as I grabbed her by her hands
and I just said, look, I looked turned eyes and said,
I need help. My wife isn't doing good. They're telling
us they're gonna take her back to surgery. They're telling
us that they need to do a CT scam, but
nobody's coming. They haven't done anything. We need help. And
(08:01):
the woman looked me in my eyes and said, sir,
your wife just isn't a priority right now, and then
she just walked away. That CT scan never comes and
it isn't until after midnight that the staff makes the
decision to take your back to surgery. At this point,
(08:25):
she's extremely weak, but she's conscious and has been since
Charles first alerted the staff that something was wrong more
than eight hours ago. I'm frustrated, I'm angry, I have
all this mix of emotions, but a certain part of
me is relieved because they're finally doing something. And you know,
(08:46):
as we're walking down the hall uh towards the o
R and I'm walking next to her bedside and I'm
holding here's hand. She's holding my hand, and she's saying, baby,
I'm scared. I can't even really think of many times
and the you know, years I've known this woman that
(09:07):
she's ever uttered those words. And as I'm walking next
to her, I'm doing the only thing I know how
to do as a husband, which is just trying and
tell her that maybe everything's gonna be okay. It's gonna
be okay. They wheel her away and finally get to
this point where these double doors open and they close
(09:28):
behind her. Ah. They take me into a waiting room,
the exact same waiting room that we were in that afternoon,
full of mothers with these humongous bellies and balloons and
families with cameras and all this wonderful, beautiful, anxious anticipation
(09:52):
to welcome these new lives into the world. And now
it's almost one o'clock in the morning and I'm in
the I'm the only person in the room, all by myself,
and it is just eerily silent, and the only thing
I hear is literally the janitor's vacuum going back and forth.
(10:17):
And about twenty minutes go by, and the set of
double doors open and a set of two residents come
walking through the doors, and as they get closer to me,
I can see that the looks on their face it
was not good. He said, look, we couldn't be back
there any longer without letting you know what happened. Um
(10:39):
when he opened her up, there was a lot of
blood and she coded. And then they go on to
tell me situation is critical and they're continuing to work
on her. And at that point, it's you know, Cure's energy,
(11:02):
the way I am, the way we are. I was
just I'm just I'm just an optimist. When you told
me that you're continuing to work on her in her
situation is critical, that's all I needed to hear, because
I'm thinking, it's Kira. She's the closest thing that I've
ever met to a superhero. She's gonna be okay. Right,
we had to scare but she's gonna be okay, is
what I was thinking at that point. And I probably
(11:22):
told him I said, look, thank you for coming out
and telling me, but you're not doing anything for me
by being out here. I need you to get back
in there and bring me my wife back. Minutes later,
surrounded by Kira's loved ones, Charles gets the unimaginable news.
They told me that um she had passed and there
(11:44):
was nothing else that they could do to Saber. Literally
twelve hours earlier, we walked into this hospital with a
woman that not only was in good health, it was
an exceptional health. And what you're telling me, it's not computing.
This doesn't make sense. How can this happen? What did
happen is that Kira's bladder was nicked during her C section,
(12:07):
and for nearly ten hours from incision to returning to
the o R, Kira bled to death. When they opened
her up, they found three and a half liters of
blood in her abdomen and her heart had given out.
That was the last time I saw my wife. A laar,
We'll be right back. On April two thousand sixteen, Kira
(12:44):
Johnson became one of the approximately nine women who die
every year from pregnancy and childbirth related causes. To understand
how we got to Kira, we have to go back
to the nineteen eighties. For much of the twentieth century,
the US enjoyed decades of essentially an uninterrupted decline in
(13:04):
its maternal mortality rate, but then in the nineteen eighties,
that rate started to tick back up. We thought maternal
mortality was essentially solved, as we could um make improvements,
we could bring down by a few deaths. But I
had no idea that actually deaths were increasing. That's Dr
(13:26):
Deborah Bingham, founder and executive director for the Institute for
Parnatal Quality Improvement and associate professor at the University of Maryland.
Deborah has also been working as a pernatal nurse, bedside
and administration, and in public health since nineteen seventy eight.
By the two thousand's, she was the director of nursing
(13:47):
for two hospitals in New York City. We only had
one death in like a five year period, so we
I didn't have any data to tell me Otherwise, I
had no personal experiences to say this is a problem.
I didn't think this was a crisis, but Deborah soon
found out it was in two thousand and six. She
(14:08):
was working on her doctorate when she accepted a position
in California to form the state's first Maternal Quality Care Collaborative,
an initiative to improve maternal outcomes. During the fall of
two thousand and six, she was pulled into a private
meeting with leaders from the California Department of Health. In
this private meeting, we we were shown, um that rates
(14:33):
of maternal death had been rising in California, and they
didn't know why, nor did we. It was shocking. We
knew our rates um even in the nineties were still
higher than other countries, so we not significantly higher, but
slightly higher than other developed countries. So UM, I should
(14:56):
say I knew that. I knew that our rates of
maternal deaths in the United States were a little higher
than other developed countries. So to even have any increase
was just is very shocking. I thought we were getting better,
not worse. And I still remember the room I was
in and how that felt to just like, oh my gosh,
(15:19):
what is going on? And is l And I didn't
know at that time whether that was just unique to
California or was that issue for the entire country. The
issue was not unique to California. It was a national
trend that would only continue to rise. In n seven,
the maternal mortality rate was seven point two, meaning for
(15:41):
every one hundred thousand live births, about seven women died. Today,
that rate has more than doubled to seventeen point four.
Now to really understand why more mothers are dying today
than they were thirty years ago. Debra says, you have
to look at what's changed in the medical industry. You
can't ignore the fact that we've had a sixty nearly
(16:03):
a six increase in cesarean birth. Now about one third
of all women give birth surgically. And then there's fewer
women having vaginal births after cesarean and so there's more
repeat c sections, which add more risks to have the
same scar open multiple times, leads to all kinds of
(16:24):
potential complications. Another thing that has changed over the last
thirty years, more women are being admitted earlier in labor
and what that means that that in the United States,
we don't have a lot of hospitals, don't have like
labor lounges or places where women can keep moving around,
so they're often put in bad and um don't have
(16:44):
freedom of movement in the early stages of labor, where
in the past we used to help women UM have
confidence go home, walk around at home, UM and come
back several hours later or maybe even their labor would stop,
which now they're being admitted, and once they're admitted, then
all this whole what's called a cascade of interventions happen,
(17:06):
which then lead them down a path that could have
been avoided previously. You can think of it as a
path of interventions that could start with something like medication
to induce labor and then end with an emergency c section.
Interventions aren't necessarily dangerous, but each one has the potential
(17:27):
to at least introduce risk to the mother. I am
a high risk perinatal nurse, meaning that I take care
of Over many years, I've taken care of very, very
sick women with very serious medical conditions, So I'm not
opposed in any way to using induction agents or interventions
(17:49):
medical interventions. I personally have helped intervene in many ways
when needed, but as I've learned, we should not intervene
for the heck of it. Devor says, there's one final
element that's worth noting here. When we're talking about this
increase in the maternal mortality rate over the last thirty years,
we started counting better, So we need to acknowledge that
(18:11):
some of this increases due to better counting, which is
a good thing because every death deserves to be counted
and needs to be counted. So we can learn from
all all of the deaths. It's a way to honor
the women who died. It's a way to honor the
teams who tried to save their lives. But changes in
the medical system still don't give us the full picture.
(18:35):
There are other forces, major structural issues that caused between
seven hundred and nine hundred women to die every year.
A really major problem and cause is the focus on
babies and fetuses rather than mothers. It's a problem that's
(18:57):
been developing over five decades. Nina Martin is an investigative
reporter at pro Publica. She spent her career reporting on
women's health. In two thousand and seventeen, Nina, along with
the team at pro Publica and her partners at NPR,
released a massive investigative report on the maternal mortality crisis.
It was called the Lost Mother's Project, and it would
(19:21):
go on to win a Peabody Award. Women used to die,
you know, hundreds of thousands of women used to die
probably a year in the turn of the twentieth century
um from pregnancy and childbirth complications. And there was enormous
progress over many, many decades to to bring those numbers
(19:42):
down and then UM. Somewhere around the fifties and the
sixties UM the numbers got to be good enough where
people started taking the eye off there there, you know,
started really thinking about it differently. Before the nineteen sixties,
the fetus was essentially inaccessible to doctors. They literally couldn't
(20:04):
examine it, so care had to focus on the mother.
But then technological advancements and new techniques like testing amniotic
fluid and sonogram imaging made it possible for doctors to
monitor the fetus in utero. With the fetus now a patient,
the next few decades saw a pronounced shift of care
(20:25):
and attention away from the mother. Today, Nina Martin says,
it's clear where the priorities are. You know, think about
smoking and and and sort of some of the messaging
around smoking during pregnancy. It's not about the fact that
smoking is really bad for moms. It's about smoking for
the babies. Think about when you're giving birth. You go
(20:46):
in and you get hooked up to monitors and everything,
and the monitor is mostly there to check the fetal
heart rate and to make sure that the baby signs
are okay. And if the baby signs aren't okay, then
it's you know, rush, rush, rush in to get the
C section. Mom signs are monitored at a much lesser rate,
(21:07):
So much of the attention in the maternity ward after
mom gives birth is around feeding the baby, taking care
of the baby. What do you do? Do you know,
how are you to have the car seat? You know,
all of that. It's not about well, who's going to
take care of you when you go home? And do
you know warning signs and everything. We just kind of
kick her home with the baby and don't pay any
(21:28):
attention to her. I mean, it's just really shocking. But
there's still another structural issue putting so many American mothers
at risk. Will explore that right after this. When Kia
(21:50):
Johnson died in April of two thousand sixteen, the cause
of death would be listed as hemorrhage shock. But the
truth is much more complicated. What happened to Cira was
not just a medical tragedy, was a medical catastrophe. Everything
that could have went wrong, in fact did so. Not
(22:10):
only did that doctor failed Kira, but the hospital and
their policies and procedures failed her. Let's talk about the
role race might have played. Do you believe that it
did do you believe that you were you and Kira
were dismissed or not treated seriously because of because of
(22:32):
your skin color. Absolutely, and the reality of the situation
is this is that what is clear about what happened
on April twelve of two thousand and sixteen Seater Sina
is that the staff and the doctors and the nurses
(22:53):
that were responsible for Cura's life failed to seek Kira
in the same way that they would see their daughter,
or their mother or their wives. I thought that what
happened to here was an isolated incident. I thought that
a woman who is an exceptional health who has access
to care, who does all the things right, walking into
(23:13):
a hospital like Cedar Sinai in exceptional health and not
walking out to raise her boys, I thought that it
was an anomal I thought, this is something that doesn't
happen in two thousand and sixteen in our country. But
it does happen. And of that nine hundred or so
women who die every year, the vast majority are black.
(23:35):
Black women are more likely to die during pregnancy, three
to four times more likely to die during pregnancy than
white women. Monica Rose McLamore is an associate professor at
the University of California, San Francisco. She has dedicated her
entire career to reproductive health and justice. So when you
think about that, that group of between seven hundred and
(23:57):
nine hundred, you know, maternal deaths in the United States,
you can argue that you know, three hundred of them
potentially could be black and brown women, and so that
disparity or that difference is actually huge. And that's when
you control for education, income status, um, insurance type, place
(24:21):
of care, that risk is equally shared by Black women. Regardless.
If you ask Monica what's causing such a disparity, what's
killing so many Black women like Kia Johnson, he agrees
with Charles it's racism, pure and simple. The truth of
the matter is is that you know, black death during pregnancy,
(24:44):
in my opinion, is a canary in a coal mine.
It tells us where our priorities are. It tells us.
You know that that again, you know, we don't listen
to and or believe black women, whether it's about pain
or whether it's about pregnancy related symptoms, contractions, whatever. We
we don't value black women. It's because our lives aren't
(25:05):
worth saving to some people. And so you know, to
say that as a black woman is a really hard thing.
But that that's what my gut tells me, That's what
my lived experience tells me. Every time I use the
word racism, people always go to the you know, interpersonal level.
I am calling you a bad person in there for
your racist That's not what I'm talking about. I actually
think most people actually inherently are trying to do as
(25:28):
well as they can do with what they have, and
when you know better, you should do better. But the
truth of the matter is, structural racism is a different
beast altogether, um because it's really about institutions, policies, and
structures that actually privilege one group over another based on
race or ethnicity. We know that there is an overrepresentation
(25:52):
of of of black people in poverty, and again that's
a structural racism problem. When you think back to things
like you know, red Line, where you know people were
denied mortgages or given high risk mortgages, like it is
a structural reason why Black people are overrepresented in being poor.
I think it also shows up in terms of the
(26:13):
differential treatment that people receive based on insurance status. Why
are we giving people different care? You know when clinical
guidelines are standard based on who's paying for it back
in hospitals. Systematic racism also shows up in the actual
makeup of who is overwhelmingly caring for black mothers. We
(26:35):
have not had enough courage and diversifying our health care workforce.
The fact that you know, I believe one percent of
physicians in the United States are are Black Americans, and
I don't think nursing is much better. UM, we need
to diversify our healthcare workforce. A structural problem is if
we don't believe that people of color and black people
in particular have the aptitude or capacity to be able
(26:59):
to care for communities that we come from, live and
work and serve UM. I think that's just like a
really really racist thing to think. At both the individual
level and at a structural level. We can see the
effects of institutional racism play out right now with the
coronavirus pandemic. While anyone can get COVID nineteen, racial data
(27:20):
shows that more Black Americans are contracting and dying from
COVID than whites. One analysis showed that in Chicago, black
residents so far make up of the deaths there, get
the account for only nine percent of the city's population.
In New York City, the epicenter of the pandemic. COVID
is hitting black and brown neighborhoods the hardest, like in
(27:43):
Jackson Heights, Queens, which is the most ethically diverse neighborhood
in the country. It's a very underserved community and the
community right now is being hit very, very hard by
the COVID epidemic. You may recognize Dr Tracy bone Hemmerdinger
from last week's episode. She's the chief of Obstetrics at
the Elmhurst Hospital Center. The population that we generally see
(28:04):
at Elmhurst is mixed community of new immigrants. We see
all different ethnic backgrounds. The number one language spoken is Spanish,
followed I think very closely by Bengali. And I think
that a lot of the patients that we see fall
into the category of people who can't social distance because
they live with large numbers of people in their homes,
(28:25):
people who are responsible for caring for not only many children,
but also their parents and their extended family uh and
and people whose jobs are either domestic workers or you know,
people whose jobs and livelihood may be cut off completely
and not have any access to their regular daily needs,
and so I think that that puts them at significant
risk for any illness. Before COVID nineteen hit, Elmer's was
(28:49):
running programs in partnership with the Maternal Hospital Quality Improvement Network,
a part of a citywide plan to reduce maternal deaths
and life threatening complications among women of color. There are
other initiatives as well. In California, for example, a bill
that passed last year requires implicit bias training for all
(29:10):
healthcare workers. But Monica Macklemore says, it's just to start
to really address something so widespread, prevalent, and daunting as
institutional racism, you have to begin by making things better
for those who have it the worst. If you're centering
the people who are most vulnerable, everybody's care should actually
get better because then those innovations should be translated for everybody.
(29:34):
But a lot of people don't believe that that if
you center to people who are experiencing the greatest amount
of burden, they think they're losing something. And I'm like, no,
you don't understand. If we are really really like making
things better for the people who have it worse, everybody
should should actually experience an improvement in their care in
industrialized nations. Our maternal death rate is one of the
(29:58):
highest for income countries. We can do better. It doesn't
have to be like this. Tomorrow on a special episode
of Next Question, Part two of our look at America's
maternal mortality crisis. Don't worry your little head about it,
(30:19):
because you're fine now in your baby spine, and go
home and live your life and be happy that everything's okay.
And so her experience was completely erased. Why maternal deaths
are only the tip of the iceberg being a professional athlete,
I just thought that will never happen to me. An
intimate conversation with Olympian Alison Felix and the courageous people
(30:43):
who are working to save American mothers. That's tomorrow on
Next Question. To understand how the coronavirus is affecting pregnant women,
check out last week's episode called how Do You have
a Baby during a Pandemic? On Apple podcast, the I
Heart Radio app or wherever you listen to your podcasts.
(31:12):
Next Question with Katie Couric is a production of I
Heart Radio and Katie Curreic Media. The executive producers are
Katie Currik, Courtney Litz, and Tyler Klang. The supervising producer
is Lauren Hansen. Our show producer is Bethan Macaluso. The
associate producers are Emily Pinto and Derek Clements. Editing by
Derrek Clements, Dylan Fagan and Lowell Berlante, Mixing by Dylan Fagan.
(31:36):
Our researcher is Gabriel Loser. For more information on today's episode,
go to Katie Currek dot com and follow us on
Twitter and Instagram at Katie Couric. For more podcasts for
my heart Radio, visit the I heart Radio app, Apple podcast,
or wherever you listen to your favorite shows,
Host
Katie Couric
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.