5.3 Complications of Pregnancy and Delivery
Learning Objectives
- Explain potential complications of pregnancy and delivery
There are a number of common side effects of pregnancy. Not everyone experiences all of these nor do gestational parents experience them to the same degree. And although they are considered “minor” these problems are potentially very uncomfortable. These side effects include nausea (particularly during the first 3-4 months of pregnancy as a result of higher levels of estrogen in the system), heartburn, gas, hemorrhoids, backache, leg cramps, insomnia, constipation, shortness of breath or varicose veins (as a result of carrying a heavy load on the abdomen). What is the cure? Delivery!
Major Complications
The following are some serious complications of pregnancy which can pose health risks to the gestational parent and child and that often require special care.
- Gestational diabetes is when a gestational parent without diabetes develops high blood sugar levels during pregnancy.
- Hyperemesis gravidarum is the presence of severe and persistent vomiting, causing dehydration and weight loss. It is more severe than the more common morning sickness.
- Preeclampsia is gestational hypertension. Severe preeclampsia involves blood pressure over 160/110 with additional signs. Eclampsia is seizures in a pre-eclamptic patient.
- Deep vein thrombosis is the formation of a blood clot in a deep vein, most commonly in the legs.
- A pregnant person is more susceptible to infections. This increased risk is caused by an increased immune tolerance in pregnancy to prevent an immune reaction against the fetus.
- Peripartum cardiomyopathy is a decrease in heart function which occurs in the last month of pregnancy, or up to six months post-pregnancy.
Maternal Mortality
Maternal mortality is unacceptably high. About 830 parents die from pregnancy or childbirth-related complications around the world every day. It was estimated that in 2015, roughly 303,000 women died during and following pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. The high number of maternal deaths in some areas of the world reflects inequities in access to health services and highlights the gap between rich and poor. Almost all maternal deaths (99%) occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia.
Almost all maternal deaths can be prevented, as evidenced by the huge disparities found between the richest and poorest countries. The lifetime risk of maternal death in high-income countries is 1 in 3,300, compared to 1 in 41 in low-income. [1]
Table 5.2 Maternal Mortality Rate per 100,000 Live Births in 1990, 2000, and 2015
| Region | 1990 | 2000 | 2015 |
|---|---|---|---|
| Sub-Saharan Africa | 987 | 846 | 546 |
| South Asia | 558 | 388 | 182 |
| Middle East and North Africa | 221 | 170 | 110 |
| Latin America and Caribbean | 135 | 99 | 68 |
| East Asia and Pacific | 165 | 118 | 62 |
| CDD/CIS | 69 | 56 | 25 |
| Least Developed Countries | 903 | 732 | 436 |
| World | 385 | 341 | 216 |
Even though maternal mortality in the United States is relatively rare today because of advances in medical care, it is still an issue that needs to be addressed. The number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 18.0 deaths per 100,000 live births in 2014. The Centers for Disease Control and Prevention define a pregnancy-related death as the death of a person while pregnant or within 1 year of the end of a pregnancy–regardless of the outcome, duration, or site of the pregnancy–from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. The reasons for the overall increase in pregnancy-related mortality are unclear. What do you think are some reasons for this surprising increase in the United States? What can be done to change this statistic?
Links to Learning: Maternal Mortality Among Black Women in the United States
In the United States, Black women are disproportionately more likely to die from complications related to pregnancy or childbirth than women from any other race; they are three or four times more likely than white women to die due to pregnancy-related death and are more likely to receive worse maternal care.[2]
Black women from higher income groups and with advanced education levels also have heightened risks, and many Black professional female athletes are drawing attention to the Black maternal health crisis. Tennis superstar Serena Williams had near-deadly complications during the birth of her daughter, Olympia, and Allyson Felix, the most decorated track and field athlete of all time, experienced life-threatening complications including preeclampsia during her pregnancy and delivery. Of the four athletes who won the gold medal in the 4 x 100 meter relay for the United States at the 2016 Rio Olympics, the second-fastest team in history, two nearly died during their labor and deliveries (including Ms. Felix and her teammate, Tianna Madison) and one died from complications during childbirth (Tori Bowie, on May 2, 2023).
Watch It
Why are Black women at such a high risk for pregnancy-related complications? Watch this video to learn more:
The data below shows percentages of the causes of pregnancy-related deaths in the United States during 2011–2014:
- Cardiovascular diseases, 15.2%.
- Non-cardiovascular diseases, 14.7%.
- Infection or sepsis, 12.8%.
- Hemorrhage, 11.5%.
- Cardiomyopathy, 10.3%.
- Thrombotic pulmonary embolism, 9.1%.
- Cerebrovascular accidents, 7.4%.
- Hypertensive disorders of pregnancy, 6.8%.
- Amniotic fluid embolism, 5.5%.
- Anesthesia complications, 0.3%.
The cause of death is unknown for 6.5% of all 2011–2014 pregnancy-related deaths.[3]
Miscarriage
Spontaneous abortion is experienced in an estimated 20-40 percent of undiagnosed pregnancies and in another 10 percent of diagnosed pregnancies. Usually, the body aborts due to chromosomal abnormalities and this typically happens before the 12th week of pregnancy. Cramping and bleeding result and normal periods return after several months. Some gestational parents are more likely to have repeated miscarriages due to chromosomal, amniotic, or hormonal problems; but miscarriage can also be a result of defective sperm (Carroll et al., 2003).
Try It
Supplemental Materials
- This U.S. Department of Health and Human Services website shows infant mortality rate statistics by ethnicity.
https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=23
- This Ted Talk features a doula and journalist, Miriam Zoila Pérez, who explores the relationship between race, class. and illness. Further, Pérez discusses a radically compassionate prenatal care program that can buffer pregnant women from the stress that people of color face every day.
- This book provides a troubling study of the role that medical racism plays in the lives of black women who have given birth to premature and low birth weight infants.
Davis, D. (2019). Reproductive Injustice (Vol. 7). New York: NYU Press.
- This article details the experience of Dr. Tressie McMillan Cottom, a professor who dealt with pregnancy and birthing complications due to systemic racism.
- This website provides resources related to Black women and prenatal and maternal health.
https://everymothercounts.org/anti-racist-reading/
- The Center for Disease Control (CDC) has started a program called “Hear Her” to create awareness and provide better medical support for women of color.
https://www.cdc.gov/hearher/index.html
Licenses & Attributions (Click to expand)
CC Licensed Content
- Complications of Pregnancy and Deliversy. Authored by: Julie Lazzara for Lumen Learning. Provided by: Lumen Learning. Located at: https://courses.lumenlearning.com/wm-lifespandevelopment/chapter/pregnancy-and-childbirth/. License: CC BY: Attribution
- Modification, adaptation, and original content. Authored by: Meredith Palm Provided by: Baylor University License: CC CC BY-SA: Attribution-ShareAlike
- Psyc 200 Lifespan Psychology. Authored by: Laura Overstreet. Located at: http://opencourselibrary.org/econ-201/. License: CC BY: Attribution
- Complications of pregnancy. Provided by: Wikipedia. Located at: https://en.wikipedia.org/wiki/Complications_of_pregnancy. License: CC BY-SA: Attribution-ShareAlike
Media Attributions
- Pregnant person © Ella Jardin is licensed under a Public Domain license
- Profile of Olympic Athletes © Brazilian Photography Agency is licensed under a Public Domain license
- Maternal mortality graph. Provided by: UNICEF. Located at: https://data.unicef.org/topic/maternal-health/maternal-mortality/. License: All Rights Reserved
- U.S. Maternal Mortality is Much Higher for African-Americans. Provided by: Healthcare Triage. Located at: https://www.youtube.com/watch?v=VYc-Eq-vDuA%20. License: Other. License Terms: Standard YouTube License
- Maternal mortality (https://www.who.int/news-room/fact-sheets/detail/maternal-mortality ↵
- Black Women’s Maternal Health: A Multifaceted Approach to Addressing Persistent and Dire Health Disparities (April 2018). National Partnership for Women and Families. Retrieved from http://www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html. ↵
- Reproductive Health. Pregnancy Mortality Surveillance System. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm ↵