Allison Stevens Black Maternal Health(WOMENSENEWS)–When I was a kid, my family and I used to make a parlor game out of the question, "What would life have been like if we had lived a century ago?"

It always made for an interesting game, so long as we skipped over the fact that most of us would not have made it into the world in those days.

That’s because my mother and sister most likely would have died in childbirth, preventing my brother from ever even being conceived. The only offspring with decent odds of existing was me, a girl who would have grown up without a mother or any siblings.

Back in the 1970s, my mom was a young healthy woman–she was training to be a physical education teacher–who was pregnant for the first time with twins.

The problem was, she didn’t know she was carrying twins and neither did her doctor. Ultrasound was rudimentary back then and the doctor was hardly an expert sonogram reader. He saw me (and yes, it had to be me!) on that fuzzy black and white screen all those years ago, but missed my sister.

The pregnancy weighed heavily on my mom’s petite frame and she asked her doctor if she could possibly be having twins.

"No dear," he simply said. "You’re just pregnant, Princess."

My mom went into labor and delivered me without a problem. But the doctor was not prepared for the arrival of my sister. There was no second set of neonatal tools; there wasn’t even the realization that she was on her way.

After I was born, the doctor was preparing to sew up my mother’s episiotomy when the medical intern who was holding her legs in place (mom says they didn’t use stirrups then) turned to the doctor and said something to the effect of: "Stop! There’s another one in there!"

Deprived of Oxygen

The doctor reached in and pulled out my sister, who had been deprived of oxygen for two minutes because her umbilical cord, which was separate from but fused to mine, had detached from the uterine wall. Since no one had prepared for a second birth, oxygen was not immediately available for my sister. She spent the first day and a half of her life in the intensive care unit, but made it out alive.

If the intern hadn’t notified the doctor, she probably wouldn’t have survived. My mother’s life might have been jeopardized too and I would have lost my best friend.

Four years later, my mother was having another difficult delivery. My 10ish pound baby brother’s head got stuck in the birth canal and two doctors had to pry him out with forceps. My mom couldn’t have an epidural because the doctors feared it would stop the contractions and further endanger both of their lives. Somehow they both made it through that gruesome delivery.

This modern-day happy ending always left us glad that we were born in the 20th century in the United States.

The surprising reality is that not everyone in modern-day America gets a happy ending.

More than two women die every day–every day–during pregnancy and childbirth in the United States, according to Amnesty International. Low-income, African American and immigrant women suffer disproportionately.

That rate puts us behind 40 other countries, even though we spend more money on health care than any other country in the world. And our maternal mortality rate is rising. It climbed to 13.3 deaths per 100,000 births in 2006 from 6.6 deaths in 1987, according to Amnesty International. Severe pregnancy-related complications that nearly cause death–called "near misses"–are also trending upward.

Shining an International Spotlight

A global conference on maternal mortality held earlier this month in the nation’s capital shined an international spotlight on this global pandemic.

Meanwhile, other activists have pushed the subject of maternal mortality to the middle of the G-8 conference in Canada, which is taking place today and tomorrow.

At the summit, governments will be urging donor governments, developing country partners, nongovernmental organizations and private organizations to reduce maternal, infant and child mortality by strengthening health systems in developing countries and improving access to health care.

As money and concern rises about maternal mortality in other parts of the world, it’s also important to flag problems here at home.

On June 18 the New York Academy of Medicine and the New York City Department of Health and Mental Hygiene issued a study of 161 pregnancy-related maternal deaths between 2001 and 2005.

Black, non-Hispanic women were seven times more likely than white, non-Hispanic women to die during pregnancy in New York City. Women 40 years and older were 2.6 times more likely to have a pregnancy-related death. Nearly 80 percent of the women who died had Cesarean sections. The death rate for women with no insurance was nearly four times higher than for insured women, and nearly half of all women who died from pregnancy-related causes were classified as obese.

Participants at the maternal mortality conference earlier this month repeatedly referred to the need to customize programs based on the differences among countries.

If this New York report is any guide to the overall U.S. situation our marching orders are clear: Focus on women who are black, or over 40, or obese, or uninsured.

Also, curb C-sections. For many women, a C-section can be lifesaving. But as the New York and other data increasingly demonstrate, that’s certainly not always the case.

Allison Stevens is a writer in Washington, D.C.