Serena Williams, who can win a Grand Slam title with ease almost died doing something almost all women can do – give birth. Her story highlights the significant complications that women in the U.S., including our state, New Jersey, have when pregnant, giving birth and recovering postpartum, especially when the birth is accomplished by cesarean section. Here is her story, originally published in Vogue January 2018:
Though she had an enviably easy pregnancy, what followed was the greatest medical ordeal of a life that has been punctuated by them. Olympia was born by emergency C-section after her heart rate dove dangerously low during contractions. The surgery went off without a hitch; Alexis cut the cord, and the wailing newborn fell silent the moment she was laid on her mother’s chest. “That was an amazing feeling,” Serena remembers. “And then everything went bad.”
The next day, while recovering in the hospital, Serena suddenly felt short of breath. Because of her history of blood clots, and because she was off her daily anticoagulant regimen due to the recent surgery, she immediately assumed she was having another pulmonary embolism. (Serena lives in fear of blood clots.) She walked out of the hospital room so her mother wouldn’t worry and told the nearest nurse, between gasps, that she needed a CT scan with contrast and IV heparin (a blood thinner) right away. The nurse thought her pain medicine might be making her confused. But Serena insisted, and soon enough a doctor was performing an ultrasound of her legs. “I was like, a Doppler? I told you, I need a CT scan and a heparin drip,” she remembers telling the team. The ultrasound revealed nothing, so they sent her for the CT, and sure enough, several small blood clots had settled in her lungs. Minutes later she was on the drip. “I was like, listen to Dr. Williams!”
But this was just the first chapter of a six-day drama. Her fresh C-section wound popped open from the intense coughing spells caused by the pulmonary embolism, and when she returned to surgery, they found that a large hematoma had flooded her abdomen, the result of a medical catch-22 in which the potentially lifesaving blood thinner caused hemorrhaging at the site of her C-section. She returned yet again to the OR to have a filter inserted into a major vein, in order to prevent more clots from dislodging and traveling into her lungs (Source).
To read a story about a world-renowned athlete like Serena Williams nearly dying after childbirth is shocking and terrifying. If she cannot escape the risks of cesarean birth, who can?
What Risk Factors Did Serena Williams Have for Such a Scary, Near Death Experience?
- Cesarean Birth. the United States, and especially New Jersey, need to reduce the number of unnecessary cesarean births because they are a direct cause of maternal death. Too few cesareans result in increased neonatal mortality but too many cause increased maternal mortality; a truly unacceptable outcome. Most people believe a reasonable cesarean rate is about 20%. The state of New Jersey has one of the highest section rates in the country at about 37%. The Midwives of New Jersey are happy to report our total cesarean rate for 2017 was 10.7%.
- African-American Heritage. Despite Serena William’s extraordinary health and fitness, she still carries a risk simply because she is African American. In the United States, black women have at least 3x’s the risk of dying in childbirth. This is for many reasons related to the socioeconomics and racism experienced by many African American women in the U.S. but we would like to think that Serena Williams in her wealth and fame has overcome a lot of that. But despite her healthy lifestyle and access to excellent healthcare, she cannot escape the epigenetic impact that racism had on the health of her ancestors. The genetic predisposition to pregnancy and birth complications makes African American women more at risk despite their personal healthy lifestyle. Healthcare professionals must be more diligent in the care of African American women. Especially those without resources and lacking support in pregnancy and postpartum.
- History of Blood Clots. There was nothing to change her personal predisposition to hypercoagulation of her blood but we know that pregnancy and cesarean birth each increase risk for blood clots.
Pregnancy does not cause blood clots, but pregnancy does increase a woman’s chance of developing a blood clot by about fourfold. A woman’s risk is even higher immediately after delivery: in the first six weeks after delivery, a new mother’s chance of developing a blood clot is five times higher than during her pregnancy (Source).
Cesarean section is associated with substantially more severe complications like 4 x’s the risk of blood clots and pulmonary embolism than vaginal birth (Source).
Add a medical history of blood clots to a pregnancy with a surgical birth and you find an amazing athlete incredibly sick after doing something as physiologic as delivering a baby.
Of the 3 things that increased Serena William’s risk factors for developing blood clots, only the cesarean birth was possibly avoidable. We can never fully know which woman’s cesarean was necessary amongst the many unnecessary surgeries performed, but we can be SURE that they were not ALL necessary.
That is the focus of this year’s New Jersey Symposium for Physiologic Birth: 2018 Avoiding Cesarean. We are thrilled to welcome Dr. Neel Shah as our keynote speaker at this conference on November 8th at the Marriott in Bridgewater New Jersey. The Midwives of New Jersey host this annual event in the attempt to Improve Pregnancy and Birth Outcomes in New Jersey.
Please Save the Date and join us on November 8, 2018 for the Symposium as we consider unique perspectives on reducing unnecessary cesarean births and begin to make positive changes for women like Serena Williams and many, many others.