My name is Katie Smith, and I have been unfortunate enough to experience stillbirth of my eldest daughter, Zoey Smith on March 14th, 2019, and the stillbirth of my youngest daughter, Riley Smith, on October 13th, 2022. I am petitioning for insurance companies to start requiring more monitoring of stillbirth mothers while in their care in terms of birth complications, maternal morbidity, and mental health. 

The United States already has one of the highest maternal morbidity rates in the world, as well as stillbirth rates. 1 in 168 babies born in the U.S. today are stillborn. There are currently 23.8 maternal deaths per 100,000 live births; maternal morbidity rates are unknown in medical cases involving stillbirth. Kentucky specifically has 6 stillbirths per 1,000 births. We are also ranked #44 out of 50 in regard to healthcare. What that means for a mother experiencing stillbirth is a high probability of low quality healthcare. Additionally, African American women experience a higher rate of stillbirth than other ethnic groups. Addressing the health care disparities regarding stillbirth can also help address maternal morbidity and health disparities in BIPOC communities. 

Maternal morbidity and stillbirth go hand in hand. Many maternal health advocates agree stillbirth and maternal morbidity are different sides of the same coin. When stillbirth occurs, there is obviously a complication involved, whether the complication has been identified or not. In our situation, a blood clotting disorder was suspected as the cause of Riley's stillbirth, and possibly Zoey's. This means I am still at the same risks of blood clotting, if not more, than a mother who experienced a live birth. A blood clotting disorder is suspected to be the cause of Riley's stillbirth, and may have been undetected during Zoey's birth. Additionally, my blood pressure after Riley's birth was reading in the 150s/100s. It was not identified and treated by physicians until two days after Riley's birth. Discharging a stillbirth mother 6 hours after birth increases the probability of life threatening issues remaining unidentified. 

Throughout these experiences with Zoey and Riley, I have learned our local hospitals in Kentucky do not monitor stillbirth mothers as closely as a mother who gave birth to a live child. The labors are the same in both outcomes. Stillbirth can be a more difficult experience, as the baby is not releasing the oxytocin that aids a live birth- Mom is doing all of the birthing work. Stillbirth mothers are still at risk for the same after birth complications as a mother with a living baby, such as blood clots and elevated blood pressure. Stillbirth mothers are also enduring more emotional trauma during the birth because they are aware their child is deceased. 

Currently, most stillbirth mothers are released from the hospital within 6 hours of birth. Mothers who experience a live birth are monitored for three days. Stillbirth mothers are also not screened for suicidal ideation and are not offered bereavement time with their child. Many stillbirth mothers express the need to hold and take pictures of their baby but are often not able to due to hospitals eagerness to discharge. 

Zoey was born at 10:28am on 3/14/2019. There was no Cuddle Cot (infant mortuary bed) available to me for bereavement care. Zoey's labor was 4 hours with no epidural, and I experienced the same labor pains as a mother with a living baby. Additionally, I had to beg hospital staff to allow me to stay until my mother arrived so she could say hello and goodbye to her first granddaughter. My mother arrived from Alabama at 4pm. The nurses had pestered me so much about leaving that I took a few pictures and had the funeral home pick Zoey up at 5pm. Since then, our family fundraised and donated Zoey's hospital a Cuddle Cot, which arrived by her first birthday at the beginning of the COVID-19 pandemic. 

Riley was born on 10/13/2022. I was induced at 7:30am.  Riley's labor lasted 12 hours. I experienced the same labor pains, tremors, a fever, and diarrhea until she was born at 7:30pm. As soon as she was born, the nurses again started pestering me about discharge. I could barely keep my eyes open. I asked the nurse, "Are you kicking me out of here already?" My husband had picked up the Cuddle Cot we donated to Zoey's hospital in order for us to be able to hold our daughter, take pictures of her, and say our hellos and goodbyes. A functioning Cuddle Cot was not available at Riley's hospital because someone had thrown away the cooling unit, and it was stored in a closet. We were lucky enough to have access to a Cuddle Cot, and if it wasn't for a separate party advocating on my behalf, I may not have had the opportunity to use it to hold Riley or have photos of her. As a mother, I feel it is my right to have time to do those things. 

Fortunately I did have a doula and an advocate available to me when Riley was born, and after speaking with the nurse in charge, I was allowed to stay and utilize the Cuddle Cot we had donated. It was also discovered my blood pressure had skyrocketed to the 150s/100s. After Riley was picked up by the funeral home, the hospital decided to monitor me and do further testing. 

Too often stillbirth mothers are discharged without further monitoring for complication risks. Their mental health needs and risk for suicide are often ignored. Before, during, or after Riley's birth, I was not asked any questions regarding my mental health. 

The concern is to get the stillbirth mother out of the hospital "so insurance will pay." By discharging a stillbirth mother out of the hospital on the same day, hospitals are able to collect even more money from the next patient's insurance. How many issues remain unidentified by doing this? In my situation, I had two different insurance policies that should have provided me quality healthcare when I needed it, and my policies were equal to that of a mother who experienced a live birth.  

The "thanks for your insurance money, now get out" mentality has to change. I'm requesting insurance companies start asking the status of the birth, if mental health care was evaluated, and if bereavement care were offered. I'm asking insurance companies to start holding hospitals to the same standard of care for stillbirth mothers as they would care for a mother during a live birth. I believe a stillbirth mother should be treated with the same dignity and respect as a mother that experienced a live birth. Yet, it is a healthcare disparity no one wants to discuss. 

Please join me in advocating for quality health care in all outcomes. Together, we can reduce the maternal morbidity rate for mothers who experience adverse outcomes. Every mother has the right to fair, equitable, and quality health care, including mothers experiencing stillbirth. 

-Katie Smith, SBD (Birth & Bereavement Doula Supporting Birth Diversity)