35:18 בראשית
In this week’s Torah there is a moving account of the postpartum death of Rachel.
וַיְהִ֥י בְהַקְשֹׁתָ֖הּ בְּלִדְתָּ֑הּ וַתֹּ֨אמֶר לָ֤הּ הַמְיַלֶּ֙דֶת֙ אַל־תִּ֣ירְאִ֔י כִּֽי־גַם־זֶ֥ה לָ֖ךְ בֵּֽן׃ וַיְהִ֞י בְּצֵ֤את נַפְשָׁהּ֙ כִּ֣י מֵ֔תָה וַתִּקְרָ֥א שְׁמ֖וֹ בֶּן־אוֹנִ֑י וְאָבִ֖יו קָֽרָא־ל֥וֹ בִנְיָמִֽין׃ וַתָּ֖מת רָחֵ֑ל וַתִּקָּבֵר֙ בְּדֶ֣רֶךְ אֶפְרָ֔תָה הִ֖וא בֵּ֥ית לָֽחֶם׃ וַיַּצֵּ֧ב יַעֲקֹ֛ב מַצֵּבָ֖ה עַל־קְבֻרָתָ֑הּ הִ֛וא מַצֶּ֥בֶת קְבֻֽרַת־רָחֵ֖ל עַד־הַיּֽוֹם׃
And it came to pass, when she was in hard labour, that the midwife said to her, Fear not; thou shalt have this son also.And as her soul was departing (for she died), she called his name Ben-oni: but his father called him Binyamin. And Rachel died, and was buried in the way to Efrat, which is Bethlehem.
Rachel died shortly after giving birth. In this, she was unique among the Four Mothers of the Jewish people. But even relatively recently, her death would certainly not have been unusual or unexpected.
MATERNAL DEATH RATES
Maternal deaths are defined as by the World Health Organization as the death of a woman whilst pregnant or within 42 days of delivery or termination of pregnancy, from any cause related to, or aggravated by pregnancy or its management, but excluding deaths from incidental or accidental causes. Worldwide, there are at least 287,000 such deaths each year. A recent study of maternal deaths in 115 countries noted that there are three main causes: Bleeding, high blood pressure (leading to complications like eclampsia) and infection. Here in the US, maternal deaths are among the highest in the developed world. Each year, 700-900 women die from pregnancy or childbirth-related causes, or about 14 per 100,000 live births. By comparison, the rate in Israel is 5 deaths per 100,000 live births.
Semmelweiss and Dirty Hands
Tragic as each of these deaths are, it was once a lot worse, and in the nineteenth century doctors played a major role in causing maternal deaths. In Vienna, Dr. Ignaz Semmelweiss (d. 1865) noted that the death rates in one maternity ward were three or four times higher than in a second ward. He suggested, after much sleuthing, that the cause was the dirty hands of medical students. These students came straight from performing autopsies to examining their pregnant and post-partum patients, with no hand washing in between. In an era before the germ theory of disease, his suggestion that something was carried on the hands of the medical students was widely ignored, but he instituted compulsory hand-washing anyway. And within a year the death rate dropped to zero.
From here.
Over the past century the maternal death rate in the US has declined by over 99%,That is the good news. But the US maternal death rate has actually been increasing over the last few years. In 2018 it was 17.4/100,000 births. In 2020 it had climbed to an astonishing 23.8/100,000 births, and is over twice that in Black mothers.
Maternal Mortality in High Income Countries. Deaths per 100,000 live births
The maternal mortality ratio is defined by the World Health Organization as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. 2015 data for FRA; 2017 data for UK; 2018 data for NZ; 2019 data for SWIZ; 2020 data for AUS, CAN, GER, JAP, KOR, NETH, NOR, SWE, and US.
Data for all countries except US from OECD Health Statistics 2022. Data for US from Donna L. Hoyert, Maternal Mortality Rates in the United States, 2020 (National Center for Health Statistics, Feb. 2022).
Source: Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II, “The U.S. Maternal Mortality Crisis Continues to Worsen: An International Comparison,” To the Point (blog), Commonwealth Fund, Dec. 1, 2022. https://doi.org/10.26099/8vem-fc65.
The racial disparities are startling.
From Fleszar LG, Bryant AS, Johnson CO, et al. Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States. JAMA. 2023;330(1):52–61. doi:10.1001/jama.2023.9043
This week’s parsha is a reminder of the risks that are associated with childbirth, and how fortunate we are to have reduced them substantially. But there is still much more work to do.
אַחֵינוּ כָּל בֵּית יִשְׂרָאֵל
הַנְּתוּנִים בַּצָּרָה וּבַשִּׁבְיָה
הָעוֹמְדִים בֵּין בַּיָּם וּבֵין בַּיַּבָּשָׁה
הַמָּקוֹם יְרַחֵם עֲלֵיהֶם
וְיוֹצִיאֵם מִצָּרָה לִרְוָחָה
וּמֵאֲפֵלָה לְאוֹרָה
וּמִשִּׁעְבּוּד לִגְאֻלָּה
הָשָׁתָא בַּעֲגָלָא וּבִזְמַן קָרִיב
