BY COLLEEN MORLEY, DNP, RN, CCM, CMAC, CMCN, ACM-RN, FCM
The headline read “Olympic Gold Medalist, 32, dies in labor.”
Tori Bowie was an American track and field athlete who primarily competed in the long jump, 100 meters and 200 meters. She won the silver medal in the 100 m and bronze in the 200 m at the 2016 Rio Olympics, bronze and gold in the 100 m at the 2015 and 2017 World Championships, respectively, and also earned gold medals as part of U.S. women’s 4 × 100 m relays at both the 2016 Olympic Games and 2017 World Championships.
She died from complications during childbirth, reportedly eclampsia. Eclampsia is the onset of seizures (convulsions) in a woman with pre-eclampsia. Pre-eclampsia is a hypertensive disorder of pregnancy that presents with three main features: new onset of high blood pressure, large amounts of protein in the urine or other organ dysfunction, and edema. If left untreated, pre-eclampsia can result in long-term consequences for the mother, namely increased risk of cardiovascular diseases and associated complications. In more severe cases, it may be fatal for both the mother and the fetus. And in this case, it was.
Incredibly, of the four women who competed for the United States in the 4×100 meter relay race at the Rio de Janeiro Olympics in 2016 and went on to win gold for the feat, three members of that elite team faced life-threatening pregnancy complications.
Maternal mortality rates in the United States have been a concern in recent years. According to data from the Centers for Disease Control and Prevention (CDC), the maternal mortality rate in the United States was 20.1 deaths per 100,000 live births in 2018, the most recent year for which data is available.
It’s important to note that the maternal mortality rate in the United States has been rising over the past few decades. In 1990, the rate was 12.4 deaths per 100,000 live births, indicating a significant increase over time. The reasons for this increase are complex and multifaceted, involving factors such as access to healthcare, socioeconomic disparities, racial and ethnic disparities, and medical complications during pregnancy and childbirth.
One notable aspect of maternal mortality in the United States is the disparity between different racial and ethnic groups. Black and Indigenous women experience significantly higher maternal mortality rates compared to white women. According to the CDC, in 2018, the maternal mortality rate for Black women was 37.1 deaths per 100,000 live births, more than double the rate for white women (14.7 deaths per 100,000 live births). This racial disparity has sparked attention and efforts to address the underlying factors contributing to these disparities, such as systemic racism, implicit bias and unequal access to quality healthcare.
Reducing maternal mortality rates in the United States is a priority for public health agencies, healthcare providers and policymakers. Efforts are underway to improve access to prenatal care, ensure timely and appropriate interventions during childbirth, enhance postpartum care, address social determinants of health and promote equitable healthcare services.
Continued monitoring of maternal mortality rates, understanding the underlying causes and implementing evidence-based interventions are crucial steps in reducing maternal mortality and improving maternal health outcomes in the United States. This month, we explore issues surrounding maternal/child health and pediatric case management practice. And I dedicate this to Tori, her baby and all the mothers and babies we have lost and who are at high risk. We have work to do.
Centers for Disease Prevention and Control. (2022). Maternal Mortality Rates in the United States, 2021. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm#:~:text=In%202021%2C%201%2C205%20women%20died,20.1%20in%202019%20(Table).
Kaiser Family Foundation (2022). Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/.
Mayo Clinic. (2022) Pre-eclampsia. https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745.
Wikipedia. (2022). Tori Bowie. https://en.wikipedia.org/wiki/Tori_Bowie.
Dr. Colleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RN, FCM, is the associate chief clinical operations officer, care continuum for University of Illinois Health System and the current president of the Case Management Society of America National Board of Directors. She has held positions in acute care as director of case management at several acute care facilities and managed care entities in Illinois, overseeing utilization review, case management and social services for over 14 years; piloting quality improvement initiatives focused on readmission reduction, care coordination through better communication and population health management.
Her current passion is in the area of improving health literacy. She is the recipient of the CMSA Foundation Practice Improvement Award (2020) and ANA Illinois Practice Improvement Award (2020) for her work in this area. Dr. Morley also received the AAMCN Managed Care Nurse Leader of the Year in 2010 and the CMSA Fellow of Case Management designation in 2022. Her first book, A Practical Guide to Acute Care Case Management, published by Blue Bayou Press, was released in February 2022.
Dr. Morley has over 20 years of nursing experience. Her clinical specialties include med/surg, oncology and pediatric nursing. She received her ADN at South Suburban College in South Holland, Illinois, BSN at Jacksonville University in Jacksonville, Florida, MSN from Norwich University in Northfield, Vermont and her DNP at Chamberlain College of Nursing.
IMAGE CREDIT: ISTOCK.COM/XIJIAN