CATHY WURZER: The first part of the show is kind of focused on health and well-being. New data from the CDC out this month shows that the rate of folks dying in pregnancy or childbirth has risen considerably in recent years. There was a 40% increase in maternal deaths between 2020 and 2021, and that rate was more than twice as high for Black women whose maternal mortality rate was 70 deaths for every 100,000 live births.

What gives with that? We have Dr. Jay-Sheree Allen on the line from the Mayo Clinic. She's going to talk about why pregnancy and birth is still so very unsafe for some women in the US. Dr. Jay, welcome back.

JAY-SHEREE ALLEN: Thank you so much for having me again, Cathy. It's great to be here.

CATHY WURZER: Well, this is serious, serious stuff here. I mean, you look at the figures from the CDC. Maternal death is 10 times likelier in the US than it is in countries like Australia. You wouldn't think that to be true, but it is. What's going on?

JAY-SHEREE ALLEN: This is a tough one. This is a really hard one. Many of the things I talk to you about-- I'm the physician telling you kind of that perspective. But having had complications after my pregnancy, I felt like this article hit a little close to home for me. It's multifactorial, Cathy.

It's not any one answer, right? So we have to think of things like increased rates of chronic illness in our OB population, so rates of obesity, diabetes, heart disease in women who are giving birth-- in our country, prenatal care and inadequate prenatal care. I think it was the March of Dimes put out some statistics that said there are 6.9 million women in this country of childbearing age with no access or little access to care.

That all matters. Cost-related issues when it comes to care-- and we have to think too about missed or even delayed opportunities for treatment. We've heard the stories from Beyonce and from Serena Williams. I mean, some of the most well resourced women in this country still experiencing complications. And of course, I'd be remiss, right, if we don't bring up some of the structural biases and racism that are kind of ingrained in our system.

CATHY WURZER: I'm wondering about the role that COVID may have played in this, too. Can we attribute some of this spike to the pandemic?

JAY-SHEREE ALLEN: Yes. So these more recent numbers-- so we've been on the rise for the past few years, but there's certainly been a larger increase. I think up to 25% of those new numbers reported in 2021 are being attributed to COVID. And it's not entirely clear why, but some of the things-- blood clots with this virus, rates of pre-eclampsia.

Even I've seen mentions of people delaying or forgoing visits or going to appointments when the virus was at its height, and we really didn't understand what was taking place.

CATHY WURZER: I'm wondering-- you lay out a really dire situation here. What are doctors doing to try to help pregnant women?

JAY-SHEREE ALLEN: We in the medical community are aware that this is a major problem, and we've certainly been working on this on the back end. I think, though, it's multilayered. So with any institution, you see that there is training happening at this point, whether it's upstander training or there's more attention being placed on biases that we once had-- some women being able to tolerate pain than others, trusting or not believing.

I think the doctors are working on that. We do participate in continuing medical education courses to ensure that our knowledge base is at its height when we are caring for our vulnerable patients. But I think this goes beyond what an individual doctor or even just the health system is able to do. I think we need to take that 40,000 foot view and look a little bigger, right?

What are the policies like in this country that support or don't support the health and the well-being of women who are pregnant? Just getting granular for a second, Cathy. Think of just how common-- even the healthiest pregnancy with zero complications, you still have a certain number of appointments that you need to attend to see your midwife or to see your physician who's caring for you.

What are our jobs like in terms of giving us time off for these very much expected appointments, right? What sort of schedule templates are built in to allow us to not have to use PTO, which most women are trying to save so they can spend more time with the child after they are born considering our laws in the postpartum period? So it's really complex and beyond just the doctor.

CATHY WURZER: Wow. So I wonder, getting back toward the beginning part of our conversation about the public health aspects of this, do we also, do you think, need to have more education for women to be healthier going into a pregnancy? You mentioned diabetes, obesity, heart disease-- work on those public health issues as well?

JAY-SHEREE ALLEN: I think yes. I think yes, but I am not one of the "fix the woman" sort of-- I think we need to take that bigger, that larger view so we're addressing all of the different areas we can and not just victim blaming. But I think there's definitely room for improving our lifestyles or healthier lifestyles as much as we possibly can.

And again, recognizing that this is within the confines of the society in which we live, right? I heard someone say that the social determinants of health is the fishbowl we all swim in. It's the water we're all in, right? So you can be motivated to change some of those things, but your environment has a lot to do with this.

And then another important thing to recognize in this data that came out from the CDC-- the rates of maternal mortality also increased with age. And so older women, women over the age of 40 in particular, had higher rates than younger women under the age of 25. So I think that's also worth mentioning.

CATHY WURZER: Does that come as a surprise to you?

JAY-SHEREE ALLEN: No, it doesn't. It doesn't. And even now, a lot of us-- and I say us, myself included-- are delaying childbirth for many different reasons, in pursuit of our professional goals or working around our careers, and again, trying to fit within the standards in the confines of the society that we live in.

CATHY WURZER: There's a lot to unpack here. Always a pleasure talking to you, though, Doctor. I appreciate this. Thank you so much.

JAY-SHEREE ALLEN: You're so welcome. Thanks for having me.

CATHY WURZER: Dr. Jay-Sheree Allen. She's a family medicine physician at Mayo Clinic, also the host of the podcast Millennial Health. Get it wherever you ever get your pods.

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Black pregnant people are twice as likely to die in childbirth. How ... - MPR News