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Giving birth in the US is more dangerous than you think
01:37 - Source: CNN

Editor’s Note: Adeline Chen is a senior producer at CNN. The views expressed here are her own. Read more opinion on CNN.

CNN  — 

As I lay on the exam table, squeezing the life out of my husband’s hand, I heard the doctor’s calming voice say, “You’re doing great. Just a little more.”

The last time I heard these words, I was giving birth to my daughter, now three. This time, I was undergoing a procedure to scrape the insides of my uterus, known as an endometrial biopsy, in hopes of resolving a miscarriage that began nearly three months earlier.

Adeline Chen

For nearly every day of 2022, I’ve become all too aware of the emotional and physical cost of bearing this loss. What I had never considered and was appalled to discover were the financial costs, a literal reminder of the steep price of pregnancy in America.

Though not every miscarriage requires medical care, many often do. Most major insurance companies say they cover miscarriage costs, but nothing is covered until the deductible is reached. What results is a monetary guessing game amid a period of deep grief that often becomes another barrier that keeps women from seeking necessary medical care.

The day after I miscarried, the doctor confirmed what my gut had already told me was true. An ultrasound and quick debrief confirmed the news.

I remember sitting there feeling both devastated and numb while questions like “Why?” and “What should I do with the physical remains? What is fitting?” and “Can I be this sad if it was only 7-8 weeks into the pregnancy?” ran through my head, quickly mixing with, “Will insurance cover a pathology report that might provide some answers?” Part of me is ashamed to say I deferred the pathology report for fear of cost, a decision that would complicate the resolution of my miscarriage in ways I couldn’t have fathomed months down the line.

A couple of weeks later, a bill arrived in the mail. While I am lucky I picked the best plan and have good insurance (by US standards) through my job, the doctor’s consult and ultrasound still cost me nearly $500.

However, my body didn’t follow the typical script. For four months, my world was inundated with ultrasounds, near weekly lab draws to measure hormone levels, a hysteroscopy and ultimately a dilation and curettage (D&C) procedure and subsequent consultation with a gynecologic oncologist and reproductive endocrinologist.

Before I went in for my D&C, the hospital billing department called and asked for an upfront payment of hundreds of dollars to cover my portion of the procedure. Without insurance, the fees for the hysteroscopy and D&C alone would have amounted to over $30,000.

I’ve since paid over $1,000 after losing a pregnancy that I wanted dearly. I’m still not sure if other unforeseen bills will pop up. I am beyond privileged that I can shoulder that cost without it becoming a choice between my physical and mental health, or paying rent and putting food on the table. It infuriates me that this is not the same reality facing many others women in this country.

To this day, society still perpetuates a stigma when it comes to miscarriages. Pregnancies during the first trimester are shrouded in secrecy, with public declarations made in later weeks, after the chances of miscarriage drops. Yet an estimated 10 to 20% of pregnancies end in miscarriage; it’s an unspoken statistic and trauma that countless women carry silently.

My ordeal is one of many that exemplify the stark fact that women will always bear the undue burden of reproduction: physical, mental and financial. Even when reproduction is a choice, no woman can magically avoid or skip the toll pregnancy, pregnancy loss or infertility will inevitably take.

Among developed nations, the United States has the highest maternal mortality rates, rates that have only continued to climb throughout the last decade. In 2020, for every 100,000 live births in the US, 23+ women died, up from 20 in 2019 and 17 in 2018.

Women who develop high blood pressure or gestational diabetes during their pregnancy raise their chances of developing heart disease and diabetes later on in life. Moreover, the crucial “fourth trimester,” which consists of the weeks after a baby is born, is just as pivotal for the mother’s future health as it is the newborn. While newborns have an endless number of appointments in the first few weeks, new mothers are largely left to fend for themselves and manage pain, even while their bodies are undergoing extreme physical and hormonal changes. Medical guidelines for new moms as recent as early 2018 only designated one postpartum check-up within six weeks of delivery. Even though the American College of Obstetricians and Gynecologists now “recommends that postpartum care should be an ongoing process, rather than a single encounter,” that guidance doesn’t ensure that every woman gets the care she deserves, since it’s up to doctors to change their longstanding practices.

Then there’s the mental health element. A study published in 2011 showed that 15% of women who had healthy pregnancies following a miscarriage suffered from anxiety and depression. What happens to women solely based on her ability to reproduce life is so often out of her control, even if that choice to pursue pregnancy is intentional.

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    As I write this in May, when Americans celebrate Mother’s Day, I can’t help but see the dichotomy between a holiday that purportedly celebrates the women in our lives and the heated discussion over the leaked Supreme Court draft opinion overturning Roe v. Wade. This decision, if formally handed down as it stands, sets the framework to make reproductive health care infinitely more expensive and tricky for women.

    I am not alone in feeling like we’re screaming into a void, one in which our value as women lies solely as empty vessels worthy of carrying life. If we talk about all the nuances that come with reproductive health and ask for help when it’s genuinely needed, it’s seen as a personal problem. It makes me wonder if the US will ever provide equitable reproductive health care for women.

    On this Mother’s Day, women deserve more than a bouquet bought last minute or empty platitudes of how strong we are. Instead, we need and rightfully should demand a complete legislative overhaul to support all aspects of reproductive health.