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In Louisiana, pregnant women struggle to get maternal health care, and the situation is getting worse
By Sharyn Alfonsi
April 30, 2023 / 7:00 PM / CBS News
The United States is in the middle of a maternal health crisis. Today, a woman in the U.S. is twice as likely to die from pregnancy complications than her mother was a generation ago.
Statistics from the World Health Organization show the United States has one of the highest rates of maternal death in the developed world. Women in the U.S. are 10 or more times likely to die from pregnancy related causes than mothers in Poland, Spain, or Norway.
Some of the worst statistics come out of the South in places like Louisiana, where deep pockets of poverty, health care deserts and racial biases have long put mothers at risk.
Tonight, you will hear from some of the women trying to improve maternal health care in Louisiana and why they say last summer’s abortion ban set off a ‘domino effect’ – making a bad situation, worse.
Dr. Rebekah Gee: The state of maternal health in the United States is abysmal. And Louisiana is the highest maternal mortality in the U.S. So, in the developed world, Louisiana has the worst outcomes for women having babies.
As an OB-GYN, Louisiana’s former state secretary of health, and founder of Nest – a primary health service for families, Dr. Rebekah Gee spent a career advocating for better maternal care.
Renowned for its rich culture and legendary celebrations, Louisiana also holds the distinction of being one of the riskiest places in the country to give birth.
Thirty nine out of every 100-thousand mothers in Louisiana die during or shortly after childbirth.
Sharyn Alfonsi: How did we get here? Why is Louisiana in this position?
Dr. Rebekah Gee: The high C-section rates have contributed, the lack of access to well woman care before and after pregnancies. Fifty percent of the time women don’t get that postpartum care, which means they have untreated hypertension, untreated diabetes, untreated depression. The fact that we have racial bias in health care. And so all of these things are compounded especially worse for low income women.
As Louisiana’s secretary of health, Dr. Gee helped expand postpartum Medicaid coverage and pushed the state to track how race impacted care and maternal outcomes.
Sharyn Alfonsi: Was it under-reported?
Dr. Rebekah Gee: Absolutely. In the prior administration, when I was medical director, we were told we were not allowed to show data that showed health disparities.
Sharyn Alfonsi: Because why?
Dr. Rebekah Gee: Because the political establishment didn’t want to admit that there were disparities.
A state board now reviews and reports every maternal death in Louisiana. Dr. Gee worked with that board and found the results especially upsetting. Data showed 80 percent of maternal deaths in the state were potentially preventable.
Sharyn Alfonsi: You’ve looked at this as a doctor, as a policymaker. What needs to be done?
Dr. Rebekah Gee: We have to prioritize motherhood. Right? As a country, we have, and particularly in the Deep South, said that we’re pro-birth. If we’re really going to be pro-birth, we need to be pro-motherhood and pro-family. Right?
Sharyn Alfonsi: What does that look like?
Dr. Rebekah Gee: Making sure that women have time off to get their medical appointments, making sure that we have affordable childcare, making sure that women have access to well woman care.
Access is a big hurdle for many women in Louisiana.
Sharyn Alfonsi: So what’s it like to raise a family here?
Theresa Dubois: Uh, a struggle.
Twenty eight year old Theresa Dubois and 32-year-old Brittany Cavalier are both married, and mothers of two. They’re expecting their third babies this summer.
Brittany runs the local day care that Theresa’s younger daughter attends.
They live in Assumption Parish, a rural county of 21 thousand where sugarcane is plentiful…and doctors are scarce.
Sharyn Alfonsi: So to give us a sense of kind of where we are how close is the nearest
Brittney Cavalier: Almost 45 minutes.
Sharyn Alfonsi: OB-GYN?
Theresa Dubois: An hour and 35 minutes.
Sharyn Alfonsi: when you have to go to the OB-GYN it takes you an hour and a half…
Theresa Dubois: Oh, it’s a nightmare. It’s a lot. It’s a lot emotionally. It’s a lot in the car. It’s a lot just on your body, just waiting that long to get help.
A third of Louisiana’s parishes are maternal health deserts – meaning they don’t have a single OB-GYN, leaving more than 51 thousand women in the state without easy access to care and three times more likely to die of pregnancy related causes.
The only hospital in Assumption isn’t equipped to deliver babies so Cavalier and Dubois have to travel more than an hour to get to hospitals in Baton Rouge to give birth – a harrowing journey when there’s an emergency.
Brittney Cavalier: I mean, we are supposed to be one of the best countries in the world. And you’re just leaving the women out there to dry.
Latona Giwa saw those disparities when she worked as a delivery room nurse. In 2011 she co-founded the New Orleans based Birthmark Doula Collective.
Doulas provide emotional and physical support before, during and after childbirth. Last year, the collective worked with 2,000 mothers.
Latona Giwa: We work with the most marginalized families who are most at risk for poor birth outcomes and we prioritize working with Black and Brown families, with low-income families.
In Louisiana, Black women are up to four times more likely than white women to die during or after childbirth.
Sharyn Alfonsi: What do you see in your line of work that Black and Brown women are facing when they’re pregnant versus a White woman?
Latona Giwa: We live in a country that doesn’t guarantee insurance coverage and healthcare to everyone, there is different and discriminatory care. Black and Brown people are more likely to be on Medicaid. They’re going to practices that are busier, that take more patients. And that’s where the doula comes in.
Studies show better birth outcomes for Black women who’ve had doula care.
Birthmark’s work in Louisiana caught the attention of Every Mother Counts, a maternal advocacy group founded by model Christy Turlington after she suffered complications with the birth of her daughter in 2003.
Christy Turlington: I hemorrhaged. There was a lot of blood. There was a whole sort of stream of things that needed to happen.
Sharyn Alfonsi: Really scary.
Christy Turlington: Scary and painful. But it was when I got home and really started to think. ‘What about everyone else in the world that this happens to but doesn’t have that team of care working together, understanding what’s happening and actively managing it?’
Those questions led Turlington around the world to document the challenges women face giving birth – stories of midwives in Haiti and mothers in Baton Rouge.
Sharyn Alfonsi: How do you compare U.S. maternal health care to maternal health care in the rest of the world?
Christy Turlington: Well, the U.S. is one of eight countries that have actually had an increase in maternal mortality. So we’re certainly at the bottom rung.
Last year, Every Mother Counts distributed more than a million dollars to groups focused on strengthening maternal care in the U.S., a mission that became even more difficult last summer.
After Roe versus Wade was overturned by the Supreme Court in June, Louisiana implemented a sweeping abortion ban. The ban set off a domino effect across the state, impacting women like Kaitlyn Joshua, a community organizer.
Joshua and her husband were thrilled to learn she was pregnant last summer. The couple have a 4-year-old daughter and were looking forward to expanding their family.
Kaitlyn Joshua: We started experiencing cramping. I, you know, lost a lot of blood.
She told us she went to Woman’s Hospital in Baton Rouge where they did an ultrasound, examined and monitored her. Joshua says, that’s where the treatment ended.
Kaitlyn Joshua: And so I said, "Okay. So is this a miscarriage?" And the young lady she said, "I– I can’t really tell you that right now. I don’t know." And I said, "Well, what do you mean you don’t know? We did the ultrasound." I recall her saying "We’re just sending you home with prayers, we’re gonna hope for the best."
Sharyn Alfonsi: So you’re in pain.
Kaitlyn Joshua: Uh-huh.
Sharyn Alfonsi: You think you’re miscarrying, and they say, "We’re gonna send you home with prayers?"
Kaitlyn Joshua: Yes. You know we’re Christians too, like we pray but it just was very insulting in the moment just because women come there for answers. So, it would have been nice to get a definite response.
Woman’s hospital told 60 minutes, "it’s complex…when diagnosis of early pregnancy loss is unclear, the standard of care is to wait."
The next day Kaitlyn Joshua told us her pain became unbearable so she sought care from a second hospital – Baton Rouge General – where a doctor ordered another ultrasound.
Kaitlyn Joshua: She-straight up said, "This doesn’t look like a baby at all. Are you sure you were ever pregnant? This just looks like a cyst."
Sharyn Alfonsi: Wait. She–
Kaitlyn Joshua: Yeah.
Sharyn Alfonsi: She questioned whether you were pregnant or not?
Kaitlyn Joshua: Absolutely. And they discharged me maybe within an hour and a half or so after monitoring me. And on the paperwork it literally said, "potential miscarriage" or
"possible miscarriage," but nothing definite.
Sharyn Alfonsi: Knowing what you know now about what your body was going through, could you have died?
Kaitlyn Joshua: When I finally did get care from a midwife on, like, day five, she said that "you certainly could have died." She said, "The amount of blood you lost, the amount of– fluids, that you were passing was a lot for someone in such a short period of time."
Sharyn Alfonsi: Why do you think there was such ferocious pushback from not one, but two hospitals?
Kaitlyn Joshua: I just have to believe that it is just the vagueness of the abortion ban in this state that’s caused so much fear around physicians doing their job.
We reached out to Baton Rouge General, they told us, "every patient is different," and that since the ban they have "not changed the way they manage miscarriage or the options available" to treat them.
The hospital left Joshua with one option – to take Tylenol and monitor for worsening symptoms.
In Louisiana some physicians are now afraid to offer methods typically used to treat miscarriages because those same methods are used in abortion and could be seen as illegal, potentially landing health care providers in jail.
Sharyn Alfonsi: To be clear, you were not seeking abortion.
Kaitlyn Joshua: Uh-huh.
Sharyn Alfonsi: You were trying to have a healthy baby. You needed care and nobody would touch you.
Kaitlyn Joshua: Absolutely. I think a lot of times we fail to realize the intersectionality between maternal health care, reproductive justice and abortion care. Until we understand that all of those things interconnect we probably will not see change any time soon.
Dr. Jennifer Avegno: We take an oath to do no harm, and that’s really our north star as a physician. But when the prospect of doing that might cause you to be brought up on criminal charges, that’s a really difficult place for our physicians to be.
Dr. Jennifer Avegno has been an ER doctor for 22 years and is the current director of the New Orleans Health Department.
Last summer, Attorney General Jeff Landry sent a letter to doctors about the new abortion ban that Avegno says paralyzed maternal health care across the state.
Dr. Jennifer Avegno: The letter was something that I’ve never seen before as a practicing physician. A non-medical layperson inserting themselves into medical care. And there was a direct line about any physician who violates this will lose their liberty and medical license. And so really it was a threat.
Sharyn Alfonsi: What kind of criminal penalties does a doctor face?
Dr. Jennifer Avegno: At least one year and up to 10 years of imprisonment with hard labor.
Sharyn Alfonsi: This is about going to jail –
Dr. Jennifer Avegno: This is about going to jail. Doctors don’t want to be in a war with their own state. They wanna be able to just practice.
As the New Orleans Health Department director, Dr. Avegno has seen how doctors are struggling to interpret the language of Louisiana’s new abortion ban.
Dr. Jennifer Avegno: What they’re being told is, "Well, you can consult with the hospital attorney." But I don’t know of any other disease or process where routinely you’re being told, "We’ll get the hospital attorney involved." That also brings up, what if the attorney advises something that the physician really feels is harmful. So really, what our physicians are facing is a terrible choice– to make decisions that might not be in the best interest of the patient, or risk going to jail.
Sharyn Alfonsi: We reached out to three urban hospitals, rural hospitals, providers. And they said, "We’d love to talk to you, but we’re afraid."
Dr. Jennifer Avegno: Yes. That has been the consistent echo from providers. There are several providers I think that would love to speak out but were told by their hospitals that it’s too risky.
Sharyn Alfonsi: So why are you sitting here today?
Dr. Jennifer Avegno: I am concerned that we are gonna see a worsening of our morbidity and mortality rates. Simply because of access and simply because of fear.
Produced by Ashley Velie. Associate producer, Jaime Woods. Broadcast associate, Elizabeth Germino. Edited by April Wilson.
First published on April 30, 2023 / 7:00 PM
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