this is "nightline." >> tonight, inside an epidemic. new mothers dying at an alarming rate here in america. what's going on? and how can we stop it? on the inside with one doctor racing against the clock to save lives. plus "idol" finals. >> i literally feel a little like where are you? >> behind the scenes of a live "american idol" with ryan seacrest. >> the most difficult thing to do is be disciplined enough not to say anything as i see the results. >> how this season is breaking tradition and the remaining three contest stancontestants o show-stopping performance with carrie underwood. first here are the "nightline 5." >> stop fearing your alarm clock. a drug-free plan with botanicals

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tonight we shine a light on a shocking issue that does not often get much attention. the danger facing any woman giving birth. while every other country in the developed world has seen a decrease in maternal deaths, the opposite is true here in the u.s. it's now more than 31 times more dangerous to give birth in america than to skydive.

"nightline" welcomes dr. jenn ashton as she tries to find out why this is happening and how to fix it. >> reporter: 4-month-old moussen just started laughing bringing joy to first-time father mustafa, who swells with pride as he shows off the nursery he and his partner tynesha designed. >> everything was tynesha's idea. the name on the wall, his crib, everything. >> reporter: now all this reminders of the life that could have been. >> mohsin is going to miss out on having a great mother. that's what's so bad about this situation. >> reporter: his partner died giving birth to baby mohsin. tell me about tynesha. >> generous, motivated, dedicated to her family. she was just a caring, loving person. >> reporter: her pregnancy had been going well. she was not high risk and had been regularly going to her prenatal visits.

but during labor, tynesha began having trouble breeting. within minutes, she went into cardiac arrest. doctors performed a bedside emergency c-section to try to save her and the baby. what went through your mind? >> this can't be happening. you know, it's -- it seemed like a dream. i could hear him, trying to bring her back, trying to grab a pulse. >> reporter: for tynesha, it was too late. >> the o.b., she came out and told me, i'm sorry, she didn't make it. i broke down. i witnessed her take her last breath in front of me. >> reporter: she died of an amniotic fluid embolism, an often-fatal complication that occurs in 1 out of every 10,000 pregnancies. we don't know why it happens or how to prevent it. >> as a mom you can be as healthy as can be, you can have the best prenail care in the world. in spite of all that, things can still go wrong because the system that's set up to take care of you isn't reliable.

>> reporter: dr. neil shah is not talking about tynesha's hospital, but the entire medical care system built around women. before, during, and after pregnancy. deficiencies in the entire system that will result in an estimated 700 women dying in the u.s. this year. and 60% of those deaths potentially preventible. shah says potential life-it there ning complications in pregnancy and labor are not being recognized soon enough or being acted on fast enough. >> the man walks into an emergency room with pain, a cardiologist would have to see that person within a defined amount of time. it's common for a woman to go into an emergency room and not see an obstetrician for many, many hours. >> gender discrimination in medicine? >> i think there's no other way to put it, yeah. >> reporter: when quality of care varies tremendously from hospital to hospital, and half the counties in the u.s. don't have a qualified midwife or obs

strigs, you get a crisis that has ballooned out of control. who in control is being affected the most? >> if you're an african-american mother, your risks of dying in childbirth are three to four times higher than if you're white. african-american women are less believed when they express that they have concerns about their symptoms. particularly around pain. >> reporter: dr. shah has taken it upon himself to find solutions inside the hospitals so they can be applied on a national level. we spent over 24 hours with him and his team at with israel in boston, massachusetts, to see how they do things differently. it starts with communication. a moment like this, called the huddle. >> she's currently 5 to 6, 80, and minus 2 -- >> reporter: all the doctors and nurses meet to discuss every patient on the delivery floor. >> she's pretty benign -- >> reporter: so everyone is accountable for everyone's care. >> it's been shown across the country to make a really big difference in patient safety. >> any allergies to medications?

great. >> reporter: down the hall, wendy and her husband john have just arrived. >> you're a champion. >> you are doing awesome. >> reporter: in labor with her first baby, wendy has decided to try to go without an epidural. >> deep breaths, deep breaths. >> reporter: something only 10% of women choose. and she's given the time to explore this option. time another tenet of dr. shah's approach to fixing the system. >> just keep what you're doing, deep breaths. >> reporter: knowing when to wait, when to act swiftly. >> i think my water just broke. >> oh, good, all right. >> reporter: eventually her contractions become more painful. >> it's not a cop-out to get an epidur epidural. if that's what you want to do, where 100% behind you and support you in doing that. >> okay, epidural. >> give the order. you're doing so good. you got this. >> reporter: four hours later -- >> three, two, one -- air out of

your mouth -- >> reporter: she starts pushing. >> deep breath in through your nose. >> everything you got, come on. keep pushing, keep pushing. deep breath. push, push, push. >> there she goes. >> more, more, more, more, that's it, that's it. take a breath. one, great job. oh, what a baby. hi, little one. hi, we were waiting for you. >> we're going to have a baby. >> oh my gosh. >> reporter: but in that moment of joy -- >> would you like to cut the cord? >> reporter: wendy is unaware she's started to lose a lot of blood. >> you have a higher than average amount of bleeding right now. we have a resident? >> reporter: for dr. shah, it's time to act swiftly. >> there's two places you can have extra bleeding. one from the tear, one from the uterus. we gave you some medicine to help with the uterus, i'm going to do the repair for the tear.

>> reporter: she's lost a liter of blood in minutes which qualifies as postpartum hemmorage. >> there's something pumping that i think is probably vaginal. i think we're okay. >> thank you so much. >> one big family. >> fist bumps all around. >> thank you very much, thank you. >> reporter: you may think that once a mother reaches this point that she's in the clear. but that's far from the truth. >> one of the things i'm actually worried about is our whole health care system unplugs after the mom goes home, until about six weeks later. the plurality of american women experience some form of postpartum blues or depression. >> reporter: something eric dykes and his five children experienced firsthand. today they're on a familiar drive. >> we're going to see mommy? >> yeah. she's right over here. >> reporter: their mom, 39-year-old emily dykes, died in 2016. >> mommy!

>> reporter: she had been struggling with postpartum depression. >> the most difficult thing i've ever had to do is to tell my kids their mom wasn't coming home. >> reporter: childhood sweethearts, emily and eric already had four children. jace, colby, nacy, addie. >> your presence i miss, your memory i treasure, loving you always -- >> reporter: in 2015 they welcomed fifth child trey. but things were different this time. >> she would get anxious and agitated quite easily. had a difficult time sleeping. >> reporter: they saw her o.b., who prescribed an antidepress t antidepressant. for a while things got better. but soon emily was struggling again. >> we sought help from psychiatrists, we sought help through therapists. we were doing everything that at the time i knew that i could do to help her. >> reporter: growing more desperate, emily went to an inpatient psychiatric facility where she was treated for 11

days. >> she came home feeling a little bit better. but in hindsight, it was -- it was a two-week respite. >> reporter: shortly thereafter, in the car with her father, the unimaginable happened. >> i happened to be on the phone with him at the time. i can her her in the background, hear the panic building. then i heard -- i heard her exit the vehicle. and at that point the phone dropped. >> reporter: emily ran into traffic and was killed. >> it's my belief that the panic caused her to lose all spatial awareness and drive her to a place that she thought might be safe. that ultimately wasn't. >> reporter: eric has channeled his grief into action. he started the emily effect, a foundation that provides resources and support to women suffering from pregnancy-related mood disorders. >> i think it's time now that we

shine the light on what a mother goes through. and we step up those resources to ensure that our mothers have the care that they need. >> reporter: these changes bring some small comfort to emily's children. >> i love this boy so much. >> reporter: but there's nothing that can bring back their mom. >> give mommy a kiss! do you want to give mommy a kiss? how come your don't wipe mommy's kisses off? >> reporter: for "nightline," i'm dr. jennifer ashton in utah. >> our thanks to dr. jenn ashton for her extraordinary reporting. one more note, to address this crisis, the american college of obs stri obstetricians and gynecologists have created guidelines for safer delivery and postpartum care, now implemented in 18 states. next we'll switch gears

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like you've never seen it before. >> this is master control. this is the control room. dim the lights and here we go. >> reporter: it's just hours before "idol" goes live, and we're behind the scenes with host ryan seacrest. >> wow, i've never been to this set. >> reporter: with millions tuning in each week, the show has launched star after star. ♪ >> kelly clarkson. >> carrie underwood! >> legitimate stars. >> reporter: shattered dreams as well. >> oh, christ, that was terrible. i mean, seriously terrible. >> reporter: but this season -- >> you couldn't get it any better. >> reporter: the show is taking a very different approach, embracing positivity. >> kind of evolved. we're artists. so we need encouragement. we don't need to be scared to death. when you're standing there in front of the three of us, give me a break, that's enough

pressure to just shut you down. >> take a deep breath and take a bow. >> i think it's really, you know about positivity. but even with that positivity, we still have a responsibility to tell the truth. >> you should develop a little bit more before you get into the ring. >> that's really important because if you lie to someone, tell them they're great when they're not yet ready, that's worse. >> reporter: on this night, there's a buzz in the air. knowing one of their biggest talents, carrie underwood, whom they discovered a decade ago from a tiny town in oklahoma -- ♪ because i can't make you love me ♪ >> reporter: is back. >> i said to her when she first came to hollywood, well, have you seen any stars since you've been here? she looked up at the sky and said, it's been pretty cloudy since i was here. when you meet -- >> i love carrie underwood. >> there's a realness to them. i think that's why they've become so successful. >> reporter: the show ran for 15 years on fox. after a brief hiatus, abc

brought it back. how's the show changed? >> well, i think the show hasn't changed terribly much, which is good. ♪ because its format is the reason it's successful. the fact that it's live in every time zone across the country and truly in realtime, so that adds to the excitement of it. >> reporter: and some calling the talent -- ♪ maybe i'm just like my mother ♪ >> reporter: better than ever. are you surprised year after year that there's still this much talent out there? >> yes. we lose a little sleep every year wondering if we're going to have to lower the bar. but then you get to a city, then once you see magic in one place, then you find it in another. >> reporter: full of highs -- >> mara. >> reporter: and tearful lows. >> a natural-born tale, you understand? >> when we see the contestants in their hometown, we bring them

out here, we see their growth and their evolution, it really sinks in what the promise of this franchise is. >> reporter: on this night, the competitors will be cut from five down to the final three. >> the most difficult thing to do is to be disciplined enough not to say anything when we're on the air as i see the results coming in. >> where can you see that? >> there's a little laptop that shows us how the votes are going. it's watching the graphs go up and down. >> reporter: just like that, ryan rushes off to his trailer, replacing his black hoodie for a blue tailored suit. >> make some noise for your top five! >> reporter: singing with their idol, carrie underwood, caid, gabby, caleb, michael, mattie belt out "see you again." ♪ till i see you again >> reporter: and while they may be friends, they all want to win. >> which three faces will make it into the finale? >> reporter: it's time for ryan

to announce the top three singers. >> caleb, gabby, mattie. >> reporter: but the journey is getting more intense. entering into the last week of the competition. ♪ would you simply laugh at me and say ♪ >> reporter: for mattie, it was a journey that came close to never even beginning. did you ever think, i'm just going to give up trying? >> every day i thought that. i tried out for other shows, didn't work. i never thought i'd do another tv show. >> why did you? >> i just took a chance. i just thought, maybe. i'll try this. maybe this is the way in. >> reporter: now her soulful sound and that girl next door vibe is resonating with fans and judges. >> you're a true artist. and it's just really exciting to witness you. >> reporter: country singer caleb losing 70 pounds since first auditioning for the show. >> i was just at a point in my life where i was very unhappy with the way things were going.

i was very close to 300 pounds. i still don't know my heaviest weight because i didn't want to get on the scale. i've taken hold of my life on all levels. >> reporter: and the youngest of the finalists with possibly the biggest voice. ♪ >> reporter: well, her path wasn't so clear at first either. >> luke bryan, if you recall, he wasn't a big fan of my country singing. >> when you try to sound country, you don't sound country. >> but i wanted to try to convince them that is the type of artist i want to be. >> and you want to win? >> yes, i really do, i truly do. but the other two deserve it absolutely as much. but it is a race. there's one man going to be standing. >> or one woman. >> you're right. one woman's going to be hopefully standing. >> reporter: for "nightline," i'm abbie boudreau in los angeles. next on "nightline," this little boy asked for a police escort to school. but he was surprised with so much more.

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it is national police week. we mark the occasion tonight with this touching scene outside of a school in indiana. after terre haute officer rob pitts was killed in the line of duty, his son, 5-year-old dakota pitts, requested a police escort for his return to school. what he got was an entire department, 70 officers, there to let him know that they will always have his back. incredible story. we want to thank you for watching "nightline" tonight. as always we are online 24/7 on our "nightline" facebook page. thank you again for watching and good night.

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