美国国家公共电台 NPR Focus On Infants During Childbirth Leaves U.S. Moms In Danger（在线收听）

DAVID GREENE, HOST:

America is the most dangerous place in the developed world to have a baby. And the rate of women dying from pregnancy complications has been rising. Women here are three times more likely to die in childbirth than women in Canada, and six times more likely than in Scandinavia.

This morning, NPR in partnership with ProPublica and reporter Nina Martin begin a series that unravels why. And just a warning, this story may be hard to hear. Here's NPR special correspondent Renee Montagne.

RENEE MONTAGNE, BYLINE: The sun was just coming up on a winter day in Pensacola, Fla., when Amanda Lauver opened her computer.

AMANDA LAUVER: I enjoy waking up early and drinking coffee and scrolling through Facebook like it's the morning news.

MONTAGNE: Among other things, she was keeping track of her best friend since junior high, Sara Ruiz. Sara was living in Las Vegas and pregnant for the first time. Her age, 36, automatically put her in the category of high risk. Otherwise, healthy and very excited.

LAUVER: There was a post to Sara's Facebook page from her fiance, Ron. And it said something along the lines of, I will miss you, rest in peace. And I just kept thinking no, this can't be true. This can't be true.

MONTAGNE: Amanda's first thought - a car crash.

LAUVER: It took me a few minutes to say, what about the baby? What about the baby?

MONTAGNE: The baby - he had died. Sara's mother later described to us the chaotic hours after Sara began vomiting violently and having contractions. It became so intense her mother called 911. By the time Sara reached the emergency room, she was choking on her own vomit and went into cardiac arrest.

Sara Ruiz's death was unimaginable to everyone who knew her. Yet every day in the U.S., on average, two or three women die of complications related to pregnancy. That's between 700 and 900 a year.

MARY-ANN ETIEBET: A woman is at her most vulnerable at the time of childbirth. And if she dies, it is a sign that our health system has failed to protect her.

MONTAGNE: Mary-Ann Etiebet runs Merck for Mothers, which is a major corporate-funded effort to bring down the maternal death rate in the U.S. These days, American women die giving birth in ways that have figured in history and literature for hundreds of years - infection, hemorrhage, heart failure, blood clots and pre-eclampsia, a condition linked to dangerously high blood pressure. NPR and ProPublica spent six months investigating this surge in maternal deaths at a time when developed countries from Britain to South Korea saw their numbers plunge.

What we found included a hodgepodge of hospital protocols for dealing with potentially fatal complications, allowing treatable conditions to proceed to a lethal level. We discovered hospitals, even those with intensive care units for newborns, woefully unprepared for a maternal emergency. We tracked federal and state funding and found only 6 percent of block grants for maternal and child health actually go for care of the mothers.

We found that in the U.S., some doctors entering the growing specialty of maternal fetal medicine were able to complete that training without ever spending time in a labor delivery unit. And we heard stories of hundreds of women who have died. Among them, Marlene Dominguez-Hicks. A photo taken three days before she died shows her fully pregnant in a cotton sun dress, a garland of flowers encircling her hair. Marlene was the pride of her Filipino-American family, a doctor now on a fellowship in Houston. Her husband, Alex, leans in to kiss their toddler. Their other daughter perches on her knee, and Marlene is the picture of health.

ALYSSA: I'm Alyssa. And I am 5. And this is my sister Alana.

ALEX HICKS: Say Alana.

ALANA: Lana (ph).

MONTAGNE: I visited Alex Hicks and his two little girls in a place he never thought he'd return to - his childhood home in Detroit. His father worked for General Motors. His mother taught school. Bunk beds in every bedroom tell the story of a once full house.

HICKS: Well, there were five boys and two girls, so somebody was always sharing a room (laughter).

MONTAGNE: Sitting amid the moving boxes, Alex happily shares pictures of his life with Marlene.

HICKS: It's mother and daughter both wearing cheetah pants. And there's another one I have where they have their hairstyles the same in a little bun.

MONTAGNE: It's been five, six months now. In their little lives, it's a part of a lifetime.

HICKS: Yeah. It's 159 days to date.

MONTAGNE: And so Alex Hicks begins the story. Marlene was days away from delivering a baby boy upstairs that night, snuggling in bed with the girls.

HICKS: And I just hear two or three just loud thump, you know, rolling down, boom, boom, boom. And I literally race upstairs. And Marlene is laying on the floor unconscious. And I just get under her. And she's, you know, kind of hissing. And I was holding her. And I remember her teeth started clenching. And everything happened so fast, yet so slow.

And watch - watch, like, the paramedics doing CPR on your wife who's 9 months pregnant, it's, I mean, it's like the worst thing in the world, like, just watching her helpless. I mean, you just fast forward in the ambulance. We get into the ER, and I hear them say, we have to deliver the baby. And I knew she was gone. And, you know, that was it.

MONTAGNE: Their baby didn't survive. Marlene died of cardiomyopathy, pregnancy-related heart failure, even though her medical records show normal checked in the box next to heart. As with thousands of others who have died in childbirth, this loss has created an unending pain that radiates through family and friends. It's not clear if Marlene's condition had been detected earlier, she would have lived. But in a recent analysis of maternal deaths, the CDC Foundation found 60 percent were preventable.

And a striking thing about these numbers, it's incredibly difficult to track them through public health records. We found Marlene Dominguez-Hicks on Facebook. We discovered Sara Ruiz on GoFundMe. And Sara's own obituary appears typical - long and loving, it devotes just a single line to the news that she passed away during childbirth. Renee Montagne, NPR News.

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GREENE: And our full investigation with ProPublica is on npr.org.

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