For most of human history, pregnancy and childbirth was the cause of many women’s deaths. In the modern era, this should be an extremely rare event, and in most of the developed world, it is.

            About 800 women in the United States die every year during pregnancy, delivery or the six weeks that follow delivery. Our maternal mortality statistics are our shame. Maternal mortality per 100,000 live births is 4.4 in Sweden, 8.0 in France, 9.2 in the United Kingdom and 7.3 in Canada, while in the U.S. it is 26.4.

            Globally, maternal mortality has been steadily falling, while in the U.S., it has been rising.

            There is a clear racial disparity, with deaths from pregnancy much higher among Black and Native American women than among white, Asian and Hispanic women. For Black women, poorer care compounds their tendency to more of the hypertensive disorders of pregnancy. However, even white women die at a higher rate in the U.S. than in any of our peer-developed countries.

            Why is this? Doctors here are often too slow to recognize the importance of even mild, high blood pressure in a pregnant woman and fail to treat it, leading to the dangerous condition called eclampsia.

            Because severe complications of pregnancy at any given hospital are rare, most hospitals do not have an organized plan to deal with severe hemorrhage after delivery or embolism of the amniotic fluid (large bubbles of amniotic fluid entering the mother’s circulation).

            Experts who study maternal deaths estimate that about 70% of the deaths due to hemorrhage, infection or cardiovascular conditions are preventable. California adopted a comprehensive plan to lower maternal deaths, with “best practice” guidelines widely distributed to every hospital and obstetrician and was able to cut its death rate in half between 2006 and 2013.

            Additionally, many women die from treatable mental-health problems, notably depression and suicide that are missed often because the new mother is not seen after delivery. While most women bring their infants in for a well-baby visit, many skip their own postpartum check, often because they do not want to take time off from work.

            Most western countries provide ample, paid time off for new mothers, no matter their occupation, while in the U.S., this tends to be a “luxury” afforded only to highly paid professionals. We should be advocating for three months paid maternity leave for all women.

            Ask your local hospital if it has systems in place to deal with the infrequent but lethal emergencies that occur during pregnancy and delivery. Make sure any friends and relatives who deliver have adequate support. Offer to take them for postpartum checks.

            We should be emulating Sweden and Canada, not Afghanistan and Swaziland.

            Dr. Ed Hoffer is the chairman of the Marion Board of Health, a graduate of MIT and Harvard Medical School. He is Associate Professor of Medicine, part-time, at Harvard and a Senior Scientist at the Massachusetts General Hospital.

What Does The Doctor Say?

By Dr. Ed Hoffer

            A woman stopped me in the post office the other day to tell me how much she liked my last column. I politely said thank you, though I had no idea what she was talking about. I could not for the life of me remember what I had written only a few days before.

            Truth be told, the minute I press the send button on my computer, the essay I had just written is gone out of my mind. There is only so much room in my memory bank to retain all the trivial nonsense I foist upon you every week.

            I have always thought I have a pretty good memory, particularly with faces; I never forget one. Unlike one friend of mine who can recall the name of every person he ever met, names for me disappear as quickly as my weekly musings. I still remember my children’s names and their birthdays, but for the life of me I cannot tell you what years they were born without doing the math (another skill that is rapidly vanishing from my talent pool).

            I remember our anniversary and my wife’s birthday, including the year she was born, which she rarely admits to. I seem to remember things that happened years ago better than what occurred recently. Is that a sign of diminished cognitive ability?

            There has been a lot of talk about memory loss and cognitive ability in the news these days, especially in the political arena. So, I decided to check out one of these tests that have showed up online lately.

            I chose the MoCA (Montreal Cognitive Assessment). Appropriately enough, the first part was about memory. The first question asked me to read five names, then repeat them. They were face, velvet, church, daisy and red. Well, I figured that would be easy since I still remember how to read. I aced it. Then I had to wait until the end of the test and say them again, in order, from memory.

            The second part, the “Alternating Trail Making,” was all about drawing. Now this is my thing, I shouldn’t have a problem here. The test showed letters and numbers and asked me to draw a line “going from a number to a letter in ascending order.” One to A and 2 to B and so on. Easy, peezy! Things are looking up.

            Next, I had to draw a clock (digital clocks don’t count) with the numbers set to 10 minutes past 11. No problem. On to the “Abstraction Thinking” section, it asked, “How are an orange and a banana alike?” clarifying that there are “…no second guesses allowed.” Then the test asked how a ruler and a watch are alike (remember digital doesn’t count). If you said they both had numbers, you’d be wrong. Join the club for the cognitive impaired. The correct answer is they are both measuring instruments.

            Next up, it asked me to say as many words as possible in one minute that begin with the letter F except proper names, numbers, words that sound alike, dirty words, foreign words … whoa, wait, now this was getting complicated. I am a dedicated user of a thesaurus. (Do you think I know all the big words I use in these columns?) This spontaneous stuff is asking too much.

            Thankfully the test was coming to an end. One more thing. It was time to repeat those five words from the first section. Boy am I in trouble. I could only recall “daisy,” which was the name of our dear, departed dog. I know I said I remember any face. I didn’t say I could remember the word.

            So, there you go. I was too chicken to count up my score. After all, I have no intention of running for president or any public office. If someone stops me to say how much they like this column, I’ll just say, “thank you” and be on my way.

            Editor’s note: Mattapoisett resident Dick Morgado is an artist and retired newspaper columnist whose musings are, after some years, back in The Wanderer under the subtitle “Thoughts on ….” Morgado’s opinions have also appeared for many years in daily newspapers around Boston.

Thoughts on…

By Dick Morgado