Doctors Are Giving Women Preventable Hysterectomies After Childbirth

Today, the excellent ProPublica and NPR investigative series on maternal mortality published a story about the estimated 80,000 women a year who almost die after giving birth.

According to the CDC, the number of American women who suffer severe complications following childbirth nearly tripled between 1993 and 2014. But per the publications’ investigation, most of the U.S. medical system “bases care on the idea that it’s rare for a woman to die in childbirth,” creating a system that directs its funding and resources mostly toward saving babies.

This newborn-centric healthcare system creates an environment where women’s concern for their own bodies is often ignored and chalked up to paranoia, or the hormonal effects of having recently delivered a new person into the world—and in multiple horrifying cases studied by NPR, women who might have been treated earlier end up in emergency surgery for hysterectomies:

Samantha Blackwell doesn’t remember much about her ordeal. It began 11 days after giving birth, when she sat up in bed with a terrible pain. By the time she got to the emergency room, her medical records show, she was in septic shock from a massive infection. For weeks, her doctors couldn’t promise her family that she would live.

“They just knew that it was bad,” she says, “to a point of ‘expect the worst. We don’t know if she’s going to come out of this.’ “

When Blackwell did emerge from her coma, she discovered she had undergone an emergency hysterectomy, a last-ditch effort to stop the infection that had originated in her uterus.

Complications after childbirth can include infections like Blackwell’s, excessive bleeding, and organ failures, which bring with them agonizing periods of uncertainty and serious mortal risk. You’d think if the hospital had been monitoring Blackwell correctly, they would have discovered a nascent infection before she went septic.

NPR and ProPublica spoke to another woman, Alicia Nichols, who also went through an emergency hysterectomy after hemorrhaging blood that was repeatedly dismissed by a doctor as her normal period. Nichols, who was familiar with the medical industry, insisted the blood flow was heavier than usual, but the doctor dismissed her concerns in person and on the phone. Later, when she started hemorrhaging in earnest, she lost half the blood in her body and had part of her uterus removed in a last-ditch and preventable attempt to save her life.

When new mothers make it after something like this, they are saddled with hefty hospital bills for ICU care, surgery, or other treatments that come in addition to the already steep cost of giving birth. Hysterectomies can cost over $95,000. Nichols told NPR and ProPublica she considers the true cost of what happened to her to be the $80,000 she’d have to spend on a surrogate to have a baby, now that she can’t have one herself.

The doctors that appear in NPR and ProPublica’s report are the kind many women have encountered: well-meaning people capitalizing on their medical knowledge and the power it confers without taking into account their patients’ understanding of their own bodies, and people with less knowledge or interest in the female body than they should have. Which is how, one would imagine, surgically removing reproductive organs ends up being the treatment for otherwise preventable infections or complications. (As an analyst is quick to point out to NPR and ProPublica, the healthcare system could actually save money by catching these sorts of things earlier.)

The thinning of specialized maternal care across many states, and particularly in rural areas, compounds these issues to make it more likely a woman will find herself rushed through an examination and get, say, a hysterectomy rather than preventative treatment for a swelling of the blood vessels in the uterus, which was the condition Nichols actually had. And that hysterectomies are the eventual treatment for some of these women is cruelly indicative of broader trends in healthcare for women.

We don’t remove women’s uteri to treat mental illness anymore, but over the years medical studies have shown that hysterectomies are overly diagnosed. In 2015 a much-cited study in the American Journal of Obstetrics and Gynecology found that one in five out of 3,400 hysterectomies performed in a selection of respected hospitals were unnecessary, and that other treatment options had existed but had not been discussed with patients. The procedure was being recommended to many women with abnormal uterine bleeding or pelvic pain. It’s impossible to imagine something similar happening with any other vital organs.

Not that pelvic pain is the same as a massive infection after giving birth. But it’s impossible not to see the pattern in all this pat, distracted treatment of womens’ bodies after they’ve given birth, or the fact that the institutions serving them are more interested in taking care of the babies they’ve ejected than investing in their continued physical and reproductive health.

Having a surprise hysterectomy while you’re in a coma must be goddamn horrifying. But like most harrowing medical disaster stories, it’s not an inevitability: It’s a constellation of financial decisions and systemic failures that made that the only option the system felt it had.