"Male-dominated funding panels may also explain why we have so few drugs available for uterine failure. Every day 830 women around the world die due to complications during pregnancy and childbirth (in some African countries more women die annually from childbirth than at the height of the Ebola epidemic). Over half of these deaths are explained as being a result of problems with contractions, often because the contractions are too weak for the woman to give birth. The only medical treatment available for women whose contractions aren’t strong enough is the hormone oxytocin, which works about 50% of the time. Those women go on to give birth vaginally. Women who don’t respond to oxytocin are given an emergency caesarean. In the UK weak contractions are the reason given for a majority of the 100,000 emergency caesareans carried out each year.
We currently have no way of knowing which women will respond to oxytocin, which clearly isn’t ideal: all women, including those for whom it will result in a pointless and harrowing delay, have to go through the process. This happened to a friend of mine in 2017. After being in hospital in excruciating pain for two days (on her own for much of it as her partner had been sent home), she was only 4 cm dilated. Eventually she was taken off for a C-section, and she and the baby were fine. But the experience left her traumatised. She had flashbacks for the first few weeks after she gave birth. When she talks about the internal exams and procedures, she describes it as a violent assault. It was, she says, brutal. But what if it didn’t have to be this way? What if they’d known from the beginning that she was going to need a caesarean?
In 2016 Susan Wray, a professor of cellular and molecular physiology at the University of Liverpool, gave a lecture to the Physiological Society. Wray is also the director of the Centre of Better Births in Liverpool Women’s Hospital and she explained that recent research revealed that women with contractions that were too weak to give birth had more acid in their myometrial blood (the blood in the part of the uterus that causes contractions). The higher the levels of acid were, the higher the likelihood a woman would end up needing a caesarean, because oxytocin isn’t, it turns out, that effective on women with an acidic blood pH.
But Wray didn’t simply want to be able to predict the need for a caesarean. She wanted to be able to avoid it. Together with her fellow researcher Eva Wiberg-Itzel, Wray conducted a randomised control trial on women with weak contractions. Half of them were given the usual oxytocin; half were given bicarbonate of soda, and then given the usual oxytocin an hour later. The change was dramatic: 67% of women given just oxytocin went on to give birth vaginally, but this rose to 84% if they were given bicarbonate of soda an hour before. As Wray pointed out, the bicarb dose wasn’t tailored to body weight, it wasn’t tailored to the amount of acid in the blood, and the women weren’t given repeated doses. So the efficacy could turn out to be even higher. This finding could not only be transformative for the tens of thousands of women a year who have what could turn out to be unnecessary surgery (not to mention saving the NHS a substantial amount of money). It could save women’s lives in countries where caesarean sections are risky or not readily available – not that you have to live in a low-income country for a C-section to be risky: you could just be a black woman living in the United States.
The US has the highest maternal mortality rate in the developed world, but the problem is particularly acute for African Americans. The World Health Organization has estimated that the death rate of black expectant and new mothers in the US matches that of women in much lower-income countries like Mexico and Uzbekistan. Black women in America have worse health outcomes overall than white women, but when it comes to pregnancy and childcare the comparisons score off the charts: African American women are 243% more likely than white women to die from pregnancy and childbirth-related issues. And it’s not just because African Americans tend to be poorer: a 2016 analysis of births in New York City found that ‘black college-educated mothers who gave birth in local hospitals were more likely to suffer severe complications of pregnancy or childbirth than white women who never graduated from high school’.
Even global tennis superstar Serena Williams is not immune: in February 2018 she revealed that she had almost died following an emergency C-section. African American women also have higher rates of caesarean section and a 2015 study from Connecticut found that – even when controlling for socio-economic status – black women were more than twice as likely to have to return to hospital in the month following surgery. So Wray’s research could be transformative here. But it looks like we aren’t going to see the fruits of her labour any time soon. When Wray discovered that the British Medical Research Council was offering funding for research that would benefit low- and middle-income countries, she decided to apply. And yet, despite all the data about how dangerous weak contractions can be, she was turned down. The research was ‘not a high enough priority’. So currently we have only one treatment for womenwith weak contractions, and it doesn’t work half the time. Compare this, Wray says, to the around fifty drugs available for heart failure."
— excerpt from Invisible Women: Exposing Data Bias in a World Designed for Men by Caroline Criado Perez
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