By Kerry Klein, KVPR NPR Radio Central California
September 12, 2022
Kern County has one of the highest infant mortality rates in California and mothers die during pregnancy and childbirth in the San Joaquin Valley at a higher rate than in any other region of the state. Simultaneously, research shows that maternal mortality rates are rising among the country’s Latino population.
This story is part of the series Moms and Babies at Risk.
In 2006, Stephanie Calvillo of Bakersfield was 27 years old and pregnant. She was so excited to become a mother that she caught up on reruns of a 1990s-era sitcom about raising kids.
“I was like, ‘I’ve got to watch The Nanny,’” she said, laughing. “I’ve got to order this thing for him, I need to get life insurance from Gerber for him, you know, all this stuff.”
But long before she had reached full term, something went wrong. She began leaking fluid, so much that she needed to change her underwear multiple times a day. And then, on a Friday morning, her water broke. She was in labor at just 33 weeks, nearly two months before her due date.
She rushed to the hospital. When her baby boy finally emerged, she says no one in the delivery room celebrated, and no one handed him to her.
“They said, ‘Honey, they're working on him.’ He wasn't breathing,” she said.
Little Elisha, just 4 pounds, had been whisked off to the hospital’s neonatal intensive care unit. He had no brain activity and his heart could barely beat on its own. Eventually, Calvillo and her partner were given the option to take him off of life support.
“We had no discussion, no question. We knew exactly what we were going to do: Take him off the machines,” she said. “‘And you give him whatever you need to give him so he won't feel a thing,’” she recalls telling the doctor.
Elisha was less than eight hours old.
Childbirth is safer in California than in most of the country. But some parts of the state—namely the San Joaquin Valley—lag behind. In 2019, Kern County’s infant mortality rate was 57% higher than the state average, according to data from the research and advocacy organization March of Dimes. It’s one of the highest rates in California.
Mothers, too, die too often here. From 2017 to 2019, the maternal mortality rate in the southern Central Valley – which extends from Stanislaus County south to Kern County – was 34% higher than the state average, the highest of any region in California, according to state data.
Simultaneously, new national data show a recent rise in maternal mortality in the Latino community, which now makes up 56% of Kern County’s population. All this amounts to an urgent problem, said Michele Monserratt-Ramos, a patient advocate with the non-profit Consumer Watchdog.
“I work with families across the state of California, but there’s nowhere, anywhere in California, where I found a crisis like I did here in Kern County,” she said at a county meeting earlier this spring.
So why are these deaths converging here, in the sun-baked, agricultural heart of California? Health officials with the California Department of Public Health (CDPH) aren’t sure.
“CDPH does not have data to determine what might be driving a higher rate of pregnancy-related deaths in this particular region,” an agency spokesperson said in an email statement, though he said that the state has begun examining this issue in some areas of Southern California. “We hope to do similar regionalized efforts in the Central Valley.”
The pregnancy-related mortality ratio is a measure of maternal mortality. The California Department of Public Health defines the ratio as the number of pregnancy-related deaths per 100,000 live births up to one year after the end of pregnancy.
Kimberly Hernandez, director of health services at the Kern County Public Health Services Department, doesn’t know why, either. She points out, however, that many other disparities here trace back to the region’s high poverty and environmental challenges like air pollution and unsafe drinking water.
“There are lots of barriers that we all have to overcome, and so that's something that we know affects our community in particular,” she said. “Those outcomes are something we need to talk more about, we need to put more resources towards.”
Then there’s the disparity in access to health care for urban and rural populations. More than half of the county’s population lives outside of Bakersfield, and yet four of Kern County’s six birthing hospitals are located in the city, more than an hour away from the county’s furthest reaches.
Dr. Elliott Main, a professor of obstetrics and gynecology at Stanford University, doesn’t have an explanation for this region’s higher rates of pregnancy-related mortality, but he says elevated deaths sometimes point to a lacking healthcare system.
“Generally rates are higher when you don’t have comprehensive prenatal care, and you don’t have hospitals that are following standard emergency protocols,” he said.
Main’s other job involves trying to solve these problems. He’s the medical director of the California Maternal Quality Care Collaborative (CMQCC), which since 2006 has partnered with hospitals around the state to try to make childbirth safer.
One of CMQCC’s big pushes was to better train and equip doctors for responding to the most common causes of pregnancy-related deaths, including hemorrhage and the severe blood-pressure condition preeclampsia.
“When you think about other emergencies such as, say, cardiac arrest, you have a code blue. Everybody knows what to do. There are standardized meds, standardized protocols,” he said. “We strove to do the same for obstetric emergencies.”
Almost every birthing hospital in the state is now a member of the CMQCC. State data show that since the collaborative ramped up, California has remained safer for mothers than the U.S. as a whole, though our progress tackling specific life-threatening, pregnancy-related conditions has varied. And although the Valley remains the most dangerous region in the state for pregnancy-related mortality, the gap in mortality rates between us and other regions has narrowed.
All of Kern County’s birthing hospitals are CMQCC members as well. In the last five years, the results have been mixed, according to CalHospitalCompare, a nonprofit that compiles hospital ratings from publicly available data. According to the ratings, which do not include mortality or injury data, all of the county’s hospitals have reduced their use of intrusive incisions known as episiotomies, while only half have reduced their use of C-sections. Both procedures can lead to complications during a mother’s recovery, and the fallout from C-sections in particular has been associated with other severe and sometimes-fatal conditions in later pregnancies.
Experts and advocates both step up to solve the problem
Outside of the CMQCC, health officials in Kern County have developed their own initiatives to try to improve local infant and maternal mortality rates, including home visits and support groups for expecting mothers. Many specifically target Black women, who have been shown to be three times as likely as white women to die of pregnancy-related causes.
Kern County offers home visits and other perinatal services to expecting mothers.
Patient advocate Monserratt-Ramos, however, argues some of the county’s programs contain critical gaps. For instance, many enroll mothers very early in pregnancy before it’s clear who’ll be at highest risk for injury or death during childbirth.
“There didn’t seem to be that type of outreach or help later on in the pregnancy when the complications become evident,” she said.
That’s why, for years, Monserratt-Ramos has been running an awareness campaign in Bakersfield around these issues. For instance, she encourages mothers to advocate for their own health by telling them the questions they’re entitled to ask, and reminds them that they can change doctors if they feel dissatisfied with their care.
Monserratt-Ramos said she got the idea after joining local online parenting groups.
“You’ll find mothers that are reaching out to these groups… And they're all reaching out for help,” she said. “They're all saying that their doctors are ignoring them when they're scared. And they're asking for recommendations for [obstetricians] or asking for recommendations for hospitals. This is daily,” she said.
One patient who could have benefited from more outreach is Stephanie Calvillo. She can’t ever know if her son’s death could have been prevented, but she wonders what would have been different if she’d known the questions to ask when her problems arose in the third trimester.
“It’s been 15 years and it hurts so bad,” she said. “He was my first child…He was my world.”
Kerry Klein is an award-winning reporter whose coverage of public health, air pollution, drinking water access and wildfires in the San Joaquin Valley has been featured on NPR, KQED, Science Friday and Kaiser Health News. Her work has earned numerous regional Edward R. Murrow and Golden Mike Awards and has been recognized by the Association of Health Care Journalists and Society of Environmental Journalists. Her podcast Escape From Mammoth Pool was named a podcast “listeners couldn’t get enough of in 2021” by the radio aggregator NPR One.