Harrop: Looking past surface for cause of maternity deaths

By Froma Harrop

While giving birth at a small hospital in central Tennessee, Whitney Brown developed terrible breathing problems and seizures. The medical staff in McMinnville decided she needed the attention of specialists at a big hospital in Chattanooga. It took nearly two hours to get her there. Despite the new team’s heroic efforts, the 28-year-old died shortly after her arrival.

Brown’s story was the centerpiece of a Wall Street Journal article about maternal death rates in rural areas greatly surpassing those in urban ones. The opposite used to be true.

What we saw was a young white woman, wholesomely described as “an outgoing former high school cheerleader,” who grew up in a town known for its shrub and flower growers. Readers were more than halfway through before learning that Brown had spent early weeks of her pregnancy in jail after an opioid relapse violated her court-ordered treatment for addiction.

Had Brown been an African-American addicted to heroin, this detail might well have gone high up in the story, if not in the lead. Nor would the writers have similarly described the boyfriend — as they did the father of Brown’s baby — as a fiance, implying a more stable family structure than existed.

So what should this story be about? Is it the disparity in quality of care between rural and big-city hospitals or the explosion of drug addiction among rural whites?

It could be about both, but it shouldn’t extend white-kid-glove treatment to a woman who tried to get pregnant while on drugs and, when she succeeded, did not stop taking. So what if Brown, according to her mother, “was just beside herself” with joy upon learning she would have a daughter? From the arrangement of facts, it’s hard to believe that Brown’s death wasn’t afforded an added element of tragedy because she was white.

It’s true that rural hospitals have suffered cutbacks in recent years. It’s true that Brown was ultimately diagnosed with an amniotic fluid embolism, a deadly condition whose causes remain unclear.

It’s also true that expert-heavy medical centers can offer more sophisticated care than the average small-town hospital. But that was the case in 2000, when the rate of maternal deaths was higher in the cities.

Obviously, more women are burdening hospitals in largely white rural areas with drug addictions they pass on to their babies. From 2004 to 2013, the proportion of “drug babies” increased nearly twice as much in rural counties as in urban areas, according to a JAMA Pediatrics study.

What should we do about this calamity affecting all races and city and country alike? Show compassion for those who made bad choices — but equally. Drug treatment programs should be everywhere and free.

But addicted babies deserve compassion, too. That leaves doctors with terrible dilemmas. Some states consider drug use during pregnancy to be child abuse. As a result, many women hide their addictions and don’t seek treatment for them.

Horror stories are legion. A mother in Utah rubbed crushed Suboxone pills into her newborn’s gums to cover the child’s drug withdrawal symptoms. (She and the father were arrested.)

In Ohio, meanwhile, a court put several pregnant addicts behind bars to keep drugs out of their hands. Three of the women reportedly induced labor while in jail so they could get back out and do more heroin.

Many will argue that being hooked on drugs didn’t make Brown evil. Perhaps not. But it also didn’t necessarily make her a victim of inferior hospital care. For her, the mountain ridges standing between McMinnville and Chattanooga may have been just some of the obstacles for a life ended in grief.

Follow Froma Harrop on Twitter @FromaHarrop. Email her at fharrop@gmail.com.

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