Researchers say there's a less invasive, underused procedure that doctors should consider instead.
[Editor's note: The report discusses obstetrical negligence and may be triggering for some readers.]
Some women experience significant bleeding following the birth of a child. New research suggests that hysterectomies are being performed far more frequently to treat postpartum bleeding than a less invasive procedure known as uterine artery embolization (UAE).
"Giving birth has become increasingly dangerous for women in the U.S., and postpartum hemorrhage is a leading cause of the loss of life related to childbirth," said Janice M. Newsome, MD, FSIR, associate professor, Department of Radiology and Imaging Sciences at Emory University School of Medicine and a lead author of the study. "All patients should have consistent access to a treatment that is safer, has an easier recovery and could preserve their ability to continue to have children."
Postpartum bleeding is a serious but rare condition. It usually happens within one day of giving birth, but it can happen up to 12 weeks after having a baby. About one to five in 100 women will experience postpartum bleeding, according to the March of Dimes.
Researchers studied nearly 10 million hospital births between 2005 and 2017. While they found that a blood transfusion was the most common treatment for postpartum bleeding, hysterectomy was the second most common treatment, employed 60% more often than UAE.
According to the Cleveland Clinic, UAE is a minimally invasive treatment that uses a catheter to inject small particles into the uterine arteries to control the bleeding. By contrast, a hysterectomy involves the removal of the uterus. It is irreversible and makes a woman infertile.
While there are many reasons why doctors might choose to perform a hysterectomy over UAE, researchers found common links between race, geography and the patient's economic status.
"Hysterectomy was twice as common as embolization in Hispanic patients, and also more common in rural and nonteaching urban hospitals, in the South and among Medicaid and self-paying patients," say researchers.
The patients who received a hysterectomy were twice as likely to have longer hospital stays. They also received an average of $18,000 more in hospital charges.
"Postpartum hemorrhage can occur quickly, and effective treatment options should be readily available to every woman having a child in the United States," said Newsome. "For hospitals that have IR services available, this can be accomplished by creating a concrete care plan for new mothers who are at higher risk of dangerous bleeding during childbirth."
Newsome and her team presented their findings this week at the Society of Interventional Radiology Annual Scientific Meeting. They would like to see the development of postpartum hemorrhage response teams at hospitals, so medical teams are better able to identify which patients have a higher risk of postpartum bleeding and respond quickly.
Diana Spalding, CNM is Motherly's Health and Wellness Director. She says that it's essential that providers constantly reassess their practice and ensure that they are using the most up-to-date evidence available when making clinical decisions.
"That race, geography and economic status are all playing into these statistics is, quite frankly, horrifying—though in a country with such large maternal health disparities, it's not shocking. And that in and of itself is a huge problem." Spalding says that in addition to clinical education, providers must have regular training about bias in medicine, and must commit to doing the work of fixing a very racist and broken system.
If you're currently pregnant, it's worth having a conversation with your medical provider about postpartum bleeding and treatment options. Feel free to ask your doctor what type of resources are available at your hospital; ask if she considers you to be a high-risk patient. Don't be afraid to advocate for yourself, mama.