ST. LOUIS — Preeclampsia can get worse before it gets better, Marie-Laure Firebaugh remembered her doctor telling her when she left the hospital after having a stillbirth.
Firebaugh couldn’t imagine how it could get any worse. She had just lost her baby, Juliette, at 25 weeks gestation.
Severe preeclampsia — persistent high blood pressure — had come on suddenly and was breaking down Firebaugh’s red blood cells and damaging her liver. Her placenta had failed to provide the nutrients and oxygen Juliette needed to grow.
During her pregnancy, Firebaugh began to experience swollen legs, shortness of breath, nausea and rapid weight gain — symptoms medical office staff dismissed as the summer heat or a need to exercise more.
Firebaugh now knows they were warning signs of preeclampsia, a condition dangerous to pregnant women and their fetuses.
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“I wish they would educate pregnant women about this disease and these complications before it happens to us,†said Firebaugh, 37, of St. Louis. “If I had known what signs were and what to look out for, maybe I could’ve advocated for myself.â€
Marie-Laure Firebaugh holds her daughter Juliette, who died during labor in July 2020. “During labor, we knew Juliette would not survive birth,†said Firebaugh, who experienced severe preeclampsia during the pregnancy.
The care team at BJC Healthcare’s Barnes-Jewish Hospital sent Firebaugh home with a blood pressure kit that sent testing reminders and relayed results to a nurse. Firebaugh said this protocol ended up saving her life.
A persistent cough, swelling and high blood pressure that wasn’t responding to medication had the nurse ordering Firebaugh to go to the emergency room four days later. An echocardiogram revealed Firebaugh was having pregnancy-induced heart failure, a complication from her preeclampsia.
“I was also lucky because we were at BJC, who had a cardiologist who specialized in this type of heart failure,†she said.
Firebaugh’s story is echoed in Missouri’s latest annual maternal mortality report, released in July. It shows that cardiovascular disease and mental-health conditions have stubbornly remained the top two causes of pregnancy-related deaths since the state began publishing the detailed multi-year reports in 2022.
This year’s maternal mortality report found a lack of knowledge of warning signs that require immediate follow-up, like cardiovascular conditions, among some providers. Symptoms were chalked up as “normal for pregnancy†or anxiety.
That was the experience for Kelly Gorgas McCormac, 39, of St. Louis. During her pregnancy three years ago, she experienced carpal tunnel syndrome, pain on one side of her ribs, swollen feet, shortness of breath, headaches and slightly elevated blood pressure — all dismissed as normal pregnancy symptoms.
“Looking back, it was like writing on the wall,†McCormac said. “Those were all warning signs.â€
When McCormac was 26 weeks pregnant, she began throwing up and her blood pressure spiked dangerously one night. Luckily, her husband had a blood pressure cuff at home.
McCormac had to undergo an emergency c-section. She had nearly died. Her baby, Robert, died after five days.
Firebaugh and McCormac decided to take action and educate women about preeclampsia, which affects 5 to 8% of all pregnancies.
So last year, Firebraugh and McCormac brought the first nationwide Promise Walk for Preeclampsia to St. Louis to raise funds for research and increase awareness about the signs and risks of preeclampsia and other hypertensive pregnancy disorders.
This year’s 1.5-mile walk will be held Sunday, Sept. 14, at Tower Grover Park. The event will include speakers, kids’ activities and reading of names of mothers and babies who have lost their lives from the disorders.
“I am still grateful to my medical team for saving my life twice,†said Firebaugh, who went on to give birth to a boy, now 2. “But I know so many more women didn’t get the care they deserved.â€
Making slow progress
The numbers of maternal deaths have remained relatively stagnant since the first report. In Missouri, an average of 70 women a year die while pregnant or within a year after their pregnancy, which is about 32 maternal deaths for every 100,000 live births.
Deep disparities remain. Black women are 2.5 times more likely than white women to die of pregnancy-related causes.
And perhaps most telling, the latest report continued to find that most deaths — 80% — could have been prevented with better care, more check-ups and stronger support from family and friends.
“That’s our big takeaway, is that there is opportunity to implement changes,†said Sarah Erhard Reid, the Missouri health department’s head of the office on women’s health.
Reid said she expects that future reports on Missouri’s maternal mortality rate, which has been among the worst in the country, will improve. State officials, researchers and health-care providers have made strides in prevention efforts, she said.
The latest report studied deaths between 2018 and 2022, Reid said, and the state has instituted a long list of improvement initiatives since.
Major state efforts include extending Medicaid coverage for women to one year after giving birth — which covers 40% of new moms in Missouri — and creating a system that virtually connects primary care providers such as obstetricians and family doctors to mental health experts for help with patients at a moment’s notice.
The years studied also include the start of the COVID-19 pandemic, which drove up the third-leading cause of death in the past two reports: infection. The year 2020, when the pandemic hit, saw 85 maternal deaths, the highest since 2017.
“I think what we’ll see is that going forward, is that our number are going to drop,†Reid said.
In 2023, then-Missouri Gov. Mike Parson led an effort to invest $4.3 million in steps to improve the quality and access of health care for pregnant and postpartum women. Actions included developing and teaching providers quality protocols, standardizing mental-health screening, expanding access to doulas and improving the quality and accessibility of data.
Soon to come is Medicaid coverage for blood pressure cuffs at home, Reid added. State health officials also developed new training for providers on how to screen patients for intimate partner violence and offer help, as homicide has landed as high as the third leading cause of maternal deaths in Missouri.
The latest report recommends continuing the initiatives and recommends polices that prioritize housing for pregnant and postpartum women, investing in urban infrastructure, such as grocery stores and playgrounds, and creating violence intervention programs that focus on reducing deadly violence against pregnant women and new moms.
Dr. Heather Campbell, a Washington University obstetrician who specializes in complicated pregnancies for BJC Healthcare, said forming a statewide panel of experts to study and produce annual reports on pregnancy-related deaths was a key first step in identifying the causes and solutions.
The lates report shows that most deaths — 82% — occur after delivery, and she praised work by insurance companies, legislators and providers to make sure new moms are supported at this critical time.
Campbell said she has seen BJC Healthcare, where she works, make sure all patients are assessed for mental health conditions and history of violence, as well as institute methods to accurately estimate blood loss at delivery, react to signs of infection and monitor patients at home.
“I think that we have made strides forward in improving care for patients both during and after pregnancy, recognizing what the causes are of these terrible events that happened to patients, and really tailoring our follow-up and our approach to try to recognize and provide treatment,†Campbell said.
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