Moani passed away in 2014 shortly after giving birth to her daughter. Nearly two-thirds of maternal deaths occur during the postpartum period, which includes immediately following birth to a year later, with most occurring during the first 42 days. The international guidelines developed by the World Health Organization recommend at least four health contacts within the first six weeks after birth - in the US, a full forty percent of women don’t even receive their one and only postnatal appointment covered by US health insurance companies. A focus on maternal health, both physically and mentally, could end this crisis. We are the only high-income country where there is no federally mandated paid maternal leave policy, and that comes at the expense of moms.
The phrase “it takes a village” might sound old-fashioned, but until we have formal systems in place to help care for moms and babies during these critical weeks, we need to turn to our communities for support. Here are a few closing thoughts for how we can support ourselves and each other.
1. “A family cannot thrive when a parent sets themselves on fire to keep the rest of the family warm.” Embody a self-first, others second mentality. Be ok with asking for help
2. Be aware of the signs of postpartum depression, and know that late onset PPD exists - symptoms can develop up to 8-12 months post-birth, or following hormonal shifts during and after weaning
3. Ongoing bleeding or spotting greater than 6 weeks postpartum or pregnancy loss is a warning sign. While this is usually due to doing too much, too soon, and affecting uterine wound healing, check in with your care provider to rule out a more sinister cause
4. Have a blood pressure cuff in the home and know how to accurately take blood pressure - this is for both the postpartum AND prenatal periods!
5. Moms should not suffer in silence. They deserve to feel safe, heard, cared for, and supported. Take care of yourselves, and each other 💜
Research studies have identified a number of social determinants that affect maternal health outcomes, including income, education, employment, housing, personal relationships, food access, and access to transportation. SDoH variables affect moms in countless ways - moms of lower socioeconomic status generally receive prenatal care at lower rates, and begin seeking care later in their pregnancies. Delayed access to care is associated with higher risk of complications like pre-eclampsia, gestational diabetes, and premature birth.
Outreach programs including income assistance and tax credits have been shown to positively affect birth outcomes, with research suggesting links to lower maternal stress levels, better maternal mental health, and healthier birth weights.
With variables including income and education controlled for, racial disparities in maternal health outcomes persist. Both non-Hispanic Black and Native American moms are disproportionately affected in the US, with the pregnancy-related mortality rate for non-Hispanic Black moms 2.9 times and American Indian and Alaskan Native moms 2.3 times higher than non-Hispanic White moms. It is important to note that race and ethnicity are not the actual risk factors for poorer maternal health outcomes, but a signifier of structural racial disparities. While higher education is a protective factor for white and Hispanic mothers, it is much less so for Black mothers. Even among college-educated mothers, five times as many Black mothers die as White mothers.”This leads to the startling finding that maternal deaths are more common among Black mothers with a college education than they are among white mothers with less than a high school education.”
... continued in comments
In 2022, there were 22 maternal deaths for every 100,000 live births in the U.S. — more than double the rate for most other high-income countries. One of the key drivers that has significant impact on these causes is access to care.
Where you live matters when it comes to the options available for maternity care - place related factors include the availability of hospitals and birth centers, travel time to care, and the obstetric clinician workforce (both OB/GYNs and certified midwives).
According to the March Of Dimes Maternity Care Desert Report, a full 35% of counties are considered Maternity Care Deserts. 1,104 counties across the country do not have a single birthing facility or obstetric clinician. About 60% of these deserts are rural areas, but then so they covered a population of 2.3 million women of childbearing age and 150,000 babies in 2022. The number of women in maternity care deserts has been rising, primarily due to hospital closures and practitioners leaving rural areas. Data show that women who live in these areas receive less prenatal care and have a 13% higher rate of preterm birth, with higher risk of poor health outcomes, including death. Women in maternity care deserts travel, on average, 38 minutes to reach a birthing hospital, compared to 14 minutes for those with full access to care. Longer travel times are associated with negative health outcomes for both moms and babies.
The March of Dimes cites six recommended policies to improve outcomes for moms and babies; addressing reimbursement and administrative barriers, exploring alternative payment methods for maternity care, adopting medicaid expansion to one year of coverage after birth in all states, removing regulatory barriers with respect to birth centers, expanding opportunities for midwifery care, and investing in telehealth and other digital technologies.
For more information on how these policy recommendations can help change the landscape of maternal health in the US, read the full report, titled “Nowhere to Go: Maternity Care Deserts Across the US.'
In the non-CrossFit hours of my day, I study Social Determinants of Health - the non-medical variables that influence a person's health and quality of life. According to The Commonwealth Fund’s most recent report, the United States was one of only seven countries to report a significant increase in the proportion of pregnancies that result in the death of the mother since 2000.
Later this week, our gym memorial workout for Lt. Moani “Mo” Daniel will be on the whiteboard. In 2014, Moani passed away due to complications during childbirth after delivering her daughter, Victoria. While you’ll be able to read about Moani and her story on Thursday, this week we’ll also be sharing some statistics and information about maternal mortality in the US, including general trends, geographic differences, disparities in care, and ways that we can help support moms and moms-to-be. Knowledge is power, after all!
(presenting at a health conference with 5-month old baby emeline, way back in 2013)
@brinybagels killing it with circle foods - still warm everything bagel and freshly bagged chocolate chip cookies. That French butter brought tears to my eyes 🤌🏼
Little bit of self care reading. This magazine is a brain cleanser for me 🥰
Already made the cover recipe, love a good Bolognese that doesn't take hours!
Had another crack at Battle Grappling yesterday and managed to come out on top, this time! Thankful for the best hype squad, I love that we have each other's backs both literally and figuratively 🤣
Lots of takeaways from this but the biggest one - even if you think you felt a tap, hang onto that choke until the ref stops the match because maybe she just wanted to touch your butt 🤦🏼♀️
@battle_grappling
I love this idea, and I'm appreciative of the librarian who convinced me to take the one I was looking at even though I felt bad taking it and undoing the packaging 🤣
"The Change-Up"
CrossFit workouts have some generally accepted standards that most gyms follow (usually referred to "RX," or "as prescribed"), like 20"/24" box heights, 65#/95# barbells for light and fast, 95#/135# for moderate weights, 500m row or 400m run for a quick heart rate elevation....
We get used to how these standards feel and know what to expect of our bodies and minds as we move through a workout that includes, for example, a 14#/20# wallball, thrown to 9/10 foot targets. We know about how many we can do unbroken, or how many we SHOULD do unbroken depending on what comes next. We know how our legs and shoulders and lungs are going to feel after small sets, after big sets, and we know the difference between when we *could* hold on longer but really don't *want* to and when really we just need to drop it because we've reached our maximum capacity.
One of the foundational pieces of CrossFit is "constantly varied," yet these pieces of our workouts often remain constant - so what happens when the variables change? When the ball gets heavier or the target gets higher? Are we prepared to adjust our expectations and have a different experience than we're used to? Are we comfortable enough to try new things and (literally) reach new heights? Challenge ourselves to pass over our favorite, perfectly shaped wallball and pick up a heavier version, or stick with your old reliable friend but jump it a foot higher than you're used to?
Sometimes we need that extra push of a different standard on the whiteboard, a gentle reminder from our coaches that we can do hard things in the gym, in a safe and controlled environment, and when things pop up unexpectedly out in the real world, we've got a little bit more experience pivoting and adjusting our expectations. CrossFit for life 🥰
