Sherry Willis-Prater was 2 months old and was about to return to her job at the school cafeteria in Chicago. But one evening, as she climbed the short stairs to the kitchen, she almost fainted, out of breath.

At the hospital, Ms Willis-Prater, aged 42 at the time, was hooked up to a ventilator that pumped air into her lungs. According to doctors, her heart was working at less than 20 percent of its capacity. She developed a rare form of heart failure that occurs after pregnancy.

The diagnosis was the last thing she expected to hear. After giving birth, Ms Willis-Prater thought, “I’ve crossed the finish line,” she recalled in an interview. “I don’t have to worry about anything anymore.”

Most people consider contractions and childbirth to be the most dangerous part of pregnancy. But a new scientific study casts doubt on that assumption, finding that significant risks persist for up to a full year after birth itself. The deadliest time for mothers is actually after the birth of a child.

And for every woman who dies, there are between 50 and 100 women with severe complications that can leave health problems for life. The numbers are rising as more American women get heavier and hypertension and diabetes become more common.

In addition, more women are postponing childbearing until later in life, so they are more likely to start a pregnancy with chronic conditions that can lead to complications.

The new data comes amid an alarming increase in the death rate of pregnant women and new mothers in the United States, which has the highest maternal mortality rate in industrialized countries. During the pandemic, those numbers rose to 32.9 deaths per 100,000 live births in 2021, up from 20.1 per 100,000 live births in 2019. Rates for blacks and Native Americans are two to three times higher than for white women.

But these numbers reflect the traditional definition of maternal mortality, deaths that occur during pregnancy or within six weeks of birth.

The full extent of the problem came to light in September, when the Centers for Disease Control and Prevention took a closer look at maternal mortality, analyzing them throughout the year after childbirth, including deaths due to mental illness.

Based on data provided by 36 states on 1018 pregnancy related deaths from 2017 to 2019, the CDC concluded that about a third of these occurred during pregnancy or on the day of delivery, and about another third before the baby was six weeks old. A full 30 percent occurred from that point until the baby’s first birthday, a period that has not been the focus of studies on maternal mortality.

The data has led to calls for closer follow-up and more support for new mothers during the so-called “fourth trimester”, with a focus on vulnerable women.

“Our approach to birth was that the baby is the candy and the mom is the wrapper, and once the baby comes out of the wrapper, we discard it,” the doctor said. Alison Steube is professor of obstetrics and gynecology at the University of North Carolina School of Medicine. “We have to accept that the wrapper is the person – moms do get sick and die.”

The leading causes of maternal death among white and Hispanic women are mental illness, which leads to suicide or fatal overdose. Among Asian women, bleeding is the leading cause.

Among black women like Ms. Willis-Prater, heart disease were the main cause of death. High blood pressure, a predisposing factor, is more common among black women, and they are more likely to have poor access to health care, a legacy of both poverty and racism.

The risk of later maternal death—six weeks to a year postpartum—is 3.5 times higher in black women than in white women.

Medical practice is often slow to change. But the numbers are accelerating the revision of Medicaid, a health insurance plan that covers low-income Americans, including more than 40 percent of pregnant women in the United States.

Thirty-three states and Washington DC expanded Medicaid coverage for new mothers up to a full year after giving birth, so women are insured during pregnancy recovery, and eight other states are planning to do so, according to the Kaiser Family Foundation.

Three states, including Texas, are expanding only limited coverage, while six, including Arkansas, are expanding highest maternal mortality rates in the country — has no plans to expand Medicaid coverage, according to the foundation.

Other initiatives include a new law in New Jersey that requires emergency room doctors to ask women of childbearing age about their pregnancy history. Some diseases that women bring to the hospital can be diagnosed more quickly if doctors know they are new mothers.

In North Carolina, healthcare providers receive a $150 bonus if a patient comes in for a postnatal visit. Historically, nearly half of new mothers have missed postpartum checkups.

Doctors are now advising to visit new mothers within three weeks of giving birth, rather than waiting for the once-standard six-week checkup.

“Now it’s, ‘See you in two weeks, right? And yes, you will definitely come, ”said the doctor. Tamika Auguste, co-author, with Dr. Stube, Mr. new guide to postpartum care from the American College of Obstetricians and Gynecologists.

Young mothers with conditions such as hypertension should be seen even earlier. Auguste said.

More importantly, however, doctors and other health care providers listen to women who express concerns and pay special attention when black and Native American women say something is wrong.

“No more ‘Oh honey, you’re fine,'” the doctor says. Auguste said. “It won’t happen again. There is “Let’s see if we can invite you to our place today or tomorrow.”

Multiple Risks

Many doctors call pregnancy “natural stress test for the heart.” The condition puts a load on the woman’s heart and circulatory system: blood volume increases by up to 50 percent, the heart works harder, and the pulse quickens.

An increase in blood pressure can affect other vital organs and put a woman at greater risk of heart disease during pregnancy or even decades later. Rachel Bond is a cardiologist and systems director for the women’s heart health program at Dignity Health in Chandler, Arizona.

“We tell women, ‘You passed your first stress test – you either passed it or you didn’t,'” says the doctor. Bond said. “Failure doesn’t necessarily mean you’ll have heart disease, but it does mean that we doctors need to treat you more aggressively.”

After the baby is born, the uterus contracts, and blood pressure may rise, which can trigger a stroke.

New mothers are also more likely to develop life-threatening clots and infections. At the same time, hormonal changes can lead to mood swings. Some of these are transient, but more severe and prolonged postpartum depression can also develop.

Although most women experience pregnancy-related complications after childbirth, prompt medical attention is critical.

Deirdre Winzy, a 28-year-old paramedic from New Orleans, was already suffering from high blood pressure when she became pregnant with her third child. Doctors gave her a blood pressure cuff to use at home, along with a Babyscripts remote monitoring system that sent readings to her midwife.

Ms Winzi was called two and a half weeks early after being diagnosed with pre-eclampsia, a dangerous hypertensive condition. But three weeks after giving birth, she woke up in the middle of the night feeling disoriented and dizzy. She called a friend for help, her speech slurred.

The medics thought she was having a panic attack and were initially reluctant to take her to the hospital. In fact, she had a stroke. “I got there just in time,” Winzy recalls. “If I hadn’t, I could have been paralyzed for the rest of my life.”

Ms. Winzy is currently battling short-term memory loss and weakness, but she can work. However, as a single mother of three, she worries.

“My biggest fear is not being around my children,” Ms Winzi said. “What if I have another stroke and it permanently paralyzes me or kills me? It’s horrible”.

Mental disorders account for 35 percent of pregnancy-related deaths among white women, according to the CDC. Among Hispanic women, the figure is 24 percent. Preexisting anxiety or depression can make women vulnerable to postpartum depression, as can a difficult pregnancy or the birth of a sick child.

The stress of parenting can trigger a relapse in a person recovering from a substance use disorder, said Katayoune Kaeni, a psychologist and chairman of the board of directors. International postpartum support.

Karen Bullock, 39, who lives outside of Peoria, Illinois, went through a difficult pregnancy and traumatic preterm birth and found it difficult to breastfeed.

“Nothing came by itself,” she said. “I was not happy when the baby was born – I was scared. Every time I looked at him, I thought I didn’t know what to do with you.” Eventually, Ms. Bullock was diagnosed with postpartum depression and began taking medication.

Complications can surprise even women who have had a successful pregnancy. After a C-section, Ariana Jacobs, a 34-year-old medical technology analyst in Washington, D.C., was told her blood pressure was fluctuating. At home, Ms. Jacobs tested it with a blood pressure cuff she wore because of a family history of hypertension. Within a few days the reading reached 170/110.

She went to the hospital and was treated for pre-eclampsia, which usually develops during pregnancy, not after.

“I would like every new mother to be sent home with a box of chocolates and a blood pressure cuff to show that you, as a mother, are still a patient,” Ms. Jacobs said. “Your body is recovering from something massive.”