'Nurse Hailey' Okula was a healthy, happy 33-year-old. We need to talk about how she died.
'Nurse Hailey' Okula was a healthy, happy 33-year-old. We need to talk about how she died.
Standing outside the hospital elevator doors, Matthew Okula faced an impossible decision.
Doctors and nurses were wheeling his wife, 33-year-old Hailey Okula, to the intensive care unit shortly after giving birth to their son, Crew, by cesarean section at Orange Coast Medical Center in Fountain Valley, California.
As the elevator doors began to shut, the doctor asked Matthew: Would he stay with his newborn son in the delivery room or follow his wife to the intensive care unit?
It took a split second for him to decide. Still donned in the blue scrubs he wore to the operating room, Matthew raced up the stairs toward the ICU and watched through the room's glass window as doctors performed chest compressions on is wife.
Not long after, Hailey, known as 'Nurse Hailey' on Instagram and TikTok, died March 29 from a rare complication known as amniotic fluid embolism, or AFE. The unfathomable loss followed a two-year fertility journey that included in vitro fertilization, or IVF.
"I stood at the foot of the bed the entire time until it was all done," Matthew said. He recalled asking himself repeatedly, "How is this even possible?"
It's a question that too many U.S. families have asked themselves as hundreds of women die each year during or soon after pregnancy. While technology has progressed enough to help women grow their families despite older age and fertility issues, the U.S. healthcare system hasn't kept the same pace in protecting women once they're pregnant.
Maternal mortality improved for the first time in 2023, dropping from 22.3 deaths per 100,000 live births in 2022 to 18.6, according to provisional data from the Centers for Disease Control and Prevention.
However, that improvement doesn't hold for everyone, with rates among Black women 3.5 times higher than their white counterparts. It also still puts the U.S. behind other wealthy countries like the United Kingdom, which reports 5.5 deaths per 100,000 live births, and Canada at 8.4 deaths, according to a Commonwealth Fund study based on 2022 data.
Childbirth 'is not a fear that we should have,' said Dr. Kisha Davis, chief health officer for Montgomery County, Maryland, and a board director of the American Academy of Family Physicians.
'I'm worried as a black woman, and my friends are worried about having babies,' she said 'We shouldn't still be dealing with those challenges that we were dealing with health-wise 100 years ago.'
Most maternal deaths are preventable
Even though little can be done to avoid certain rare conditions, like AFE, the CDC says about 80% of maternal deaths are preventable.
Obstetricians and fertility specialists say access to adequate prenatal care, insurance coverage and nutritious foods during pregnancy can help shape maternal outcomes. Chronic diseases, such as heart disease and diabetes, and advanced maternal age, which is considered 35 and older, also increase the risk of maternal complications, Davis said.
Research shows rates of chronic diseases in the U.S. have skyrocketed over recent years, according to the CDC. The agency says 6 in 10 Americans have at least one chronic condition and 4 in 10 have two or more.
The risk of developing a chronic condition also increases with age, Davis said, which could partly explain maternal mortality rates as more women have children later in life. A CDC report published in March found babies born to women 30 to 35 increased by 90% from 1990 to 2023, while those 40 and older saw a 193% increase during the same period.
What is preeclampsia? Here's why it remains one of the most worrisome pregnancy-related health conditions
'The older we are when we become pregnant, the greater the risk of complications,' she said. The combination of older age and high prevalence of disease is what contributed to maternal deaths in the U.S.
Apart from developing chronic conditions, age itself also increases the risk of miscarriage and stillbirth, according to the Mayo Clinic. Older age also carries a higher risk of gestational diabetes, high blood pressure and chromosomal conditions during pregnancy. Patients are also more likely to undergo a C-section at older ages.
"Vaginal delivery, when that's possible, is associated with fewer complications and a quicker recovery," said Dr. Jeffrey Ecker, department chair emeritus of obstetrics and gynecology at Massachusetts General Hospital. "As one is pregnant again and a C-section is repeated, that's when we see complications related to scarring left from C-sections."
Are there risks linked to in vitro fertilization, or IVF?
Hailey and Matthew were excited to start their family when they married in September 2022 but sought help after eight months. Their IVF journey was complicated, full of genetic testing, and required double the time and cost of the average family, Matthew said.
But Hailey finally announced their pregnancy, a baby boy, to her hundreds of thousands of followers in September 2024.
'It was a pretty special moment,' Matthew said. He thought, 'we did it. We're finally going to be able to start the family we've always been talking about.'
More women are relying on IVF and other assisted reproductive technologies to grow their families. The babies born from this technology increased from about 91,700 in 2022 to over 95,800 in 2023, according to new data from the American Society of Reproductive Medicine.
IVF and other assisted reproductive technologies can increase the risk of multiple births and placental abnormalities linked to frozen embryos, said ASRM president Dr. Elizabeth Ginsburg.
Carrying more than one baby carries a higher risk of other pregnancy complications, such as gestational hypertension, anemia, birth defects and postpartum hemorrhage, according to Johns Hopkins Medicine. That's why fertility clinics should try to prevent multiple pregnancies by limiting the number of embryos transferred, Ginsburg said.
But risks typically associated with IVF heavily depend on patients' medical conditions before they embark on the process, she said.
'We want babies to have a healthy start and babies have the healthiest start when their mother is also healthy and can be there to take care of them,' Davis said.
There's no evidence to suggest that IVF and other assisted reproductive technologies contribute to maternal mortality rates, fertility experts said. The main drivers of these outcomes are access to proper prenatal care, insurance coverage and nutritious foods; management of chronic diseases and advanced maternal age.
Yet Hailey had access to great care, and she was healthy. Obstetricians say, at the end of the day, AFE is really just a product of bad luck, and there's little that can be done to prevent it. But Matthew hopes telling his wife's story will bring more general awareness to maternal health.
And talking about Hailey helps him cope.
On April 9, he took his son, Crew, to the park for the first time. It was the same park Matthew visited a million times with Hailey during his days off, where they enjoyed taking their dog, Brodie.
As he watched the little black dog run around, he told Crew how much his mom loved the park, how she always wanted to stay longer and how she would have to coax Brodie to stop playing so he could drink some water.
Every quiet moment with his son is an opportunity for Matthew to talk about Hailey. Even though Crew may not understand what he's saying yet, Matthew says it helps keep her memory alive.
"It's my way of making sure I remember the little details of things she used to say to me. If I don't say them to Crew, then maybe I'll forget them," he said. "I don't want to forget them."
Adrianna Rodriguez can be reached at adrodriguez@usatoday.com.
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