Maternal mortality is a long-running concern in the United States. With heart disease the leading cause of maternal deaths, women’s healthcare advocacy for the past few decades has increasingly focused on raising awareness of pregnancy-related heart conditions and the cardiac risks that can accompany pregnancy and childbirth. These awareness-raising initiatives have been directed not just at expectant mothers and their partners and communities, but at healthcare providers themselves – tragically, many preventable deaths continue to occur in delivery rooms and among women sent home with pregnancy-related heart conditions because of a tendency among otherwise knowledgeable professionals to underestimate cardiac risks in women, especially the younger women who comprise the majority of pregnant patients. To learn more about your options if your family is suffering from the results of medical malpractice, contact the experienced Albuquerque legal team at Erin Marshall Law. Schedule an appointment today by calling 505-218-9949.
Normal Cardiovascular Changes During Pregnancy
Often women may find it difficult to determine whether the symptoms they are experiencing during their pregnancies are normal vs. indications of a potentially serious problem. This uncertainty can be especially stressful for first-time mothers, but even individuals who have been through pregnancy multiple times without issue may have questions about the range of their current symptoms and when to call a doctor.
The Cleveland Clinic identifies a few common cardiovascular changes that are a normal part of pregnancy. These changes can produce symptoms such as fatigue, minor edema (swelling of the extremities, most often feet and ankles), and sometimes shortness of breath, but in general they are not associated with an increase in maternal mortality or immediate cardiac risks:
- Changes in heart rate: Increases of 10-20 beats per minute during pregnancy are considered normal. More extreme changes, or unexplained tachycardia (sometimes called a “racing” heart rate, not associated with strenuous physical activity) may be an early warning sign of some pregnancy-related heart conditions.
- Changes in cardiac output: In addition to increasing the frequency of heart beats, a pregnant person’s heart will often increase the total volume of blood pumped with each beat. This particular change is usually not something you will feel as a distinct symptom, but it can interact with other changes that are more directly noticeable.
- Changes in blood volume: One reason for the increase in cardiac output is that, by the end of her pregnancy, a woman’s blood volume has usually increased by over 40% compared to baseline. During the final trimester, a woman’s heart has significantly more blood to move than would have been true prior to pregnancy. After delivery, however, a woman’s blood volume gradually returns to pre-pregnancy levels.
If you have concerns about whether the symptoms you are experiencing are normal, you may want to speak with a medical professional. If you come away from that conversation wondering whether your concerns have been heard and taken seriously, never hesitate to seek a second opinion.
Heart Conditions and Pregnancy
The Cleveland Clinic explains two main pathways by which heart conditions can cause problems during pregnancy. The first way, and the expectant mothers sometimes find the most alarming because it involves so much uncertainty, happens when new heart problems develop while a woman is pregnant. Preeclampsia is one of the most common, affecting 5-8% of pregnancies in the United States and contributing to roughly 15% of premature deliveries (also according to the Cleveland Clinic). The second way occurs when a woman’s existing heart conditions worse, or cause additional complications, during her pregnancy, delivery, or recovery.
Maternal Care & Pre-existing Heart Conditions
In some ways, women who have a known heart condition that is already under treatment by a trusted medical professional may sometimes have an advantage over those who develop pregnancy-related cardiac complications during the course of their pregnancies. One of the major barriers to cardiac care for women is simply getting a diagnosis and an appropriate treatment plan, so if these elements are already in place before a woman gets pregnant, then maintaining continuity of care can sometimes be easier than seeking a first-time diagnosis while also dealing with all of the other stressors that often accompany a pregnancy.
There can still be risks, however – particularly if a woman’s cardiac care provider (whether this is her primary care physician or a cardiac specialist) and maternal care provider (often but not always an obstetrician) do not work together effectively to coordinate a plan for managing the heart problems during pregnancy and through the postpartum recovery period. Occasionally a medical professional not specializing in obstetrics who is concerned about the possibility of being accused of malpractice if anything goes wrong during a woman’s pregnancy may actually hesitate to recommend or administer treatments that would otherwise be the standard of care for her heart condition – potentially contributing to the excess of preventable maternal deaths. If you have a known heart condition, and are pregnant or planning to become pregnant, you may want to take proactive steps by ensuring that all of the medical professionals involved with your cardiac care regimen as well as your maternity care have access to your information about potential complicating factors. Do not hesitate to specifically request that these teams coordinate with each other to help prevent unnecessary cardiac risks during your pregnancy.
Common Heart Problems During Pregnancy
While there are a number of heart problems that can develop during pregnancy, some are much more common than others. Becoming familiar with the hallmarks of some of these conditions can help you to prepare for a conversation with your healthcare provider.
Pregnancy-Related Hypertension
“Hypertension” is a medical term for high blood pressure. Increased blood pressure is very common during pregnancy, owing to multiple factors (including the sharp increase in blood volume as a pregnancy progresses). In most cases, high blood pressure during pregnancy can be managed with an appropriate treatment regimen (usually similar to the recommendations that are commonly made for managing hypertension in patients who are not pregnant, although you and your maternity care team may need to make some adjustments, depending on how your pregnancy is progressing). Hypertension is also one characteristic of a multifaceted pregnancy complication called preeclampsia.
Preeclampsia
One of the most obvious symptoms of preeclampsia is high blood pressure. However, in preeclampsia the hypertension is accompanied by additional symptoms, particularly protein in the urine (a common sign of organ damage), according to Medline Plus. Estimates from John Hopkins Medicine suggest that preeclampsia affects about 5-8% of pregnancies in the United States.
Preeclampsia does not typically develop until after the 20th week of pregnancy – although unusual, it may even have an onset during or just after delivery, in which case the condition is known as postpartum preeclampsia. Preeclampsia is generally treatable, but careful monitoring for elevated blood pressure, signs of protein in the urine, and other potential indicators of preeclampsia is recommended because not all cases of preeclampsia are symptomatic – meaning that a woman may have preeclampsia without realizing it, increasing her risk of uncontrolled blood pressure and possible stroke.
Gestational Diabetes
Gestational diabetes occurs when pregnancy causes an increase in blood sugar levels. The condition is more common in expectant mothers who have elevated (i.e., “pre-diabetic”) blood sugar prior to becoming pregnant. Women in some racial and ethnic groups are at greater risk of developing gestational diabetes than others, but the condition is so common overall that the Centers for Disease Control and Prevention (CDC) recommends routine screening between the 24th and 28th weeks of a pregnancy. If your healthcare provider failed to perform or recommend the standard gestational diabetes screening, you may want to have a conversation with a maternity care advocate at Erin Marshall Law to discuss a possible case of medical negligence.
Arrhythmias
A cardiac arrhythmia is a condition in which the heart’s beats do not “keep time” consistently. In pregnancy, one of the most common types of arrhythmias is supraventricular arrhythmia, which occurs when the heart’s upper chambers suddenly speed up, typically creating a “lag” between the two upper and two lower chambers.
Supraventricular arrhythmia may or may not need treatment, depending on the circumstances. A healthcare professional may want to consider any arrhythmias you develop during pregnancy in light of your overall health, and you can usually expect your medical team to review your personal case history for any indications that your heart might be a concern.
Peripartum cardiomyopathy
Technically any illness of the heart muscle could be called a “cardiomyopathy” – but in practice the term is generally reserved for conditions in which the heart is weakened. “Peripartum” simply means “near the time of birth,” so peripartum cardiomyopathy is a condition in which the heart muscle weakens – often for reasons that are not fully clear, although the total physical stresses of pregnancy and childbirth are thought to play a role – in the final stages of pregnancy or in the period just after delivery.
While peripartum cardiomyopathy can have several symptoms and a range of outcomes, the major cardiac risks associated with this condition are strongly correlated to the degree of weakening in the heart muscle. The more severe the peripartum cardiomyopathy is, the more the heart will struggle to pump enough blood to fully oxygenate the body. Peripartum is not particularly common – especially by comparison to some widespread pregnancy-related heart conditions, such as preeclampsia – but it is serious: The Cleveland Clinic explains that cardiomyopathies are the leading cause of maternal deaths. Any indications of potential cardiomyopathy, particularly within a few weeks before or after the baby’s due date, should be thoroughly investigated without delay.
Cardiac Risks and Preventable Deaths Due to Pregnancy-Related Heart Conditions
The tragic reality of America’s high maternal mortality rate raises serious questions, year by year, about when the well-documented gender disparity in heart disease diagnosis and treatment tips over from a systemic inequity that needs to be addressed into an instance of medical negligence by a specific healthcare professional. While precise legal definitions may vary by state and context, in layman’s terms medical negligence can generally be said to occur when a healthcare provider’s actions or inactions fall below the established medical standard of care, and that failure to meet the medical standard of care results in patient harm. The most horrifying cases are of course those that end in preventable deaths, but medical negligence can also result in non-fatal patient outcomes that are nonetheless worse than the patient could have been expected to achieve, had they received timely, appropriate treatment for their condition.
Professional Duty and Standard of Care
In the context of medical injury discussions, a healthcare professional is typically taken to owe his or her patients not just the standard of care, but a professional duty of care, representing the level of skill and care that a reasonably competent healthcare professional would provide in similar circumstances. Usually, the professional duty is considered fulfilled when the professional delivers the “standard of care” to each patient – and may be considered breached when the patient does not receive treatment commensurate with the medically accepted standard of care. Legally, a breach in an established duty of care is one of the crucial elements that must be proven to show negligence (the others are the duty of care itself, then that harm occurred and the harm was a direct result of the breach).
Medical Negligence vs. Medical Malpractice
The terms medical negligence and medical malpractice are sometimes used interchangeably, but for legal purposes malpractice is a more specific term than negligence. Anyone can, theoretically, owe another person a duty of care and breach that duty through negligent actions or negligent failures to take action. Generally speaking, the terminology of malpractice is used primarily when speaking of professions that require some form of licensure (such as doctors or attorneys). The term malpractice helps to underscore that the professional is accused of breaching a duty of care that was based on their professional relationship to the person alleging harm (a doctor-patient relationship is the classic example).
In addressing preventable deaths from pregnancy-related heart conditions, using the term malpractice implies an allegation that the death was not the result of an unavoidable risk associated with carrying or giving birth to a child, but rather a direct result of a healthcare provider’s failure to provide appropriate care. Bereaved families might allege medical malpractice if they believe a healthcare professional ignored critical warning signs, inappropriately delayed accepted medical interventions, or made other avoidable errors during the pregnancy or delivery. To succeed in a wrongful death suit, the family would need to prove that these failures led to the mother’s death. Essentially, the family – or their attorney, if they choose to work with professional legal representation – would need to show that the death was the result of a medical error that should have been avoided.
A Plan for Lowering New Mexico’s Maternal Mortality Rate
Pregnancy-related heart conditions are not going anywhere, so lowering the maternal mortality rate in New Mexico – and throughout the United States – has to depend on cooperative efforts from multiple stakeholders and a long-term strategy for identifying and managing cardiac risks, in pregnancy and beyond. The legal profession has a role to play in sustaining advocacy efforts, promoting policy initiatives, and supporting both women who have suffered maternal injuries and the families of those who have succumbed to preventable deaths – but the kind of systemic change that will be needed to make pregnancy a safer and happier time for everyone will also require efforts from families, from communities, and from the healthcare professionals on whom they rely.
Educating the Experts
Improving outcomes also involves enhancing the education and training of healthcare professionals. Too many doctors and other healthcare providers are too willing to dismiss a woman presenting with cardiac symptoms – even during a pregnancy – and send her home without a diagnosis, much less a treatment, according to the National Heart, Lung, and Blood Institute. Medical staff must be able to recognize the signs of pregnancy-related heart complications and be prepared to take appropriate action quickly. This requires ongoing training and education to ensure that healthcare providers are up to date on the latest guidelines and best practices in maternal care, and particularly on managing cardiac risks during pregnancy.
Empowering Women
Community outreach programs play a pivotal role in reducing maternal mortality. Groups like Go Red for Women are already working to educate women on the importance of regular prenatal check-ups, help them identify warning signs of pregnancy-related heart conditions, and connect them to necessary healthcare resources. Empowering women to ask for additional tests, seek second opinions, and take proactive steps toward managing their own cardiac risks can help to reduce the number of preventable deaths that occur among pregnant and postpartum women in the United States each year.
Advocacy
While litigation may provide a form of redress for affected families, it does not solve the systemic issues that contribute to high maternal mortality rates. Addressing these issues requires a coordinated effort from healthcare providers, policymakers, and communities to create a healthcare system that prioritizes maternal health. Improving access to care, especially for underserved populations, and eradicating the gender bias in diagnosing heart disease are both critical components of any long-term plan to reduce the cardiac risks of pregnancy.
Speak With an Albuquerque Maternal Care Lawyer
Women’s healthcare advocacy groups have been raising awareness about cardiac risks in women for several years, but more work remains to be done. Pregnancy-related heart conditions, in particular, contribute to deaths in even young, otherwise healthy women, with heart disease the leading cause of maternal deaths nationwide. Tragically, an underestimation of these risks sometimes leads to preventable maternal deaths. Discuss your medical malpractice concerns with an experienced New Mexico professional at Erin Marshall Law. Call 505-218-9949 to schedule a consultation.
