June 4, 2009

The US Has One Of The Worst Maternal Mortality Rates In The World. Why?

FACT: The United States ranks 42nd in the WORLD for maternal mortality rates

FACT: The Centers for Disease Control (CDC) report that there has been no improvement in the maternal death rate in the United States since 1982.

FACT: The CDC estimates that more than half of the reported maternal deaths in the United States could have been prevented by early diagnosis and treatment. (1)

The difficult part of this information to digest is that the US is also one of the highest cost-per-birth countries in the world. I am dumbfounded and saddened by the statistics I continue to uncover while researching for this blog. My original idea was to focus on Ina May Gaskin’s “The Safe Motherhood Quilt Project”. Ina May’s quilt is a reaction to a growing problem in this country, a traveling and virtual quilt representing mothers that have died from pregnancy-related causes since 1982. Each square in the quilt represents the story of the mother that has died. It is similar to the AIDS Memorial Quilt. Currently the quilt has over 125 pieces.

Even with a ranking of 42nd in the world for maternal mortality rates, we still do not have a complete picture of what the damage really is. In 1998, the CDC estimated that the US maternal death rate is actually between 1.3 and 3 times what is typically reported in vital statistics records because of under-reporting of such deaths. There are potentially many more pregnancy-related deaths than those reported and accounted for. Ina May Gaskin points out that :”Reporting of maternal deaths in the United States is done via an honor system. There are no statutes providing for penalties for misreporting or failing to report maternal deaths.

What is maternal mortality rate? According to the World Health Organization: “A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental cause.”

Why is this happening? Well, the answer is complicated; there are several ideas about what might play a role in this issue. Many arrows continue to point back to the growing number of cesarean births as a cause of our embarrassing ranking. If we begin by considering medically unnecessary inductions, we follow a cascade effecting leading to a greater chance of a c-section. With each cesarean a woman has, her chance of complication grows. It is also important to look at the defensive practice of medicine. In the movie, “The Business of Being Born” Dr Eden Fromberg says “There was a doctor who trained me that says “They can never fault you if you just section ’em.” Several doctors in the movie concur that it is a growing problem and litigation plays a role into the decision to perform a cesarean. The maternal mortality rate for cesarean section is 4 times higher than for vaginal birth and is still twice as high when it is a routine repeat cesarean section without any emergency.

Other factors to consider are the quality of care one receives (especially considering the large disparities in health care among different racial/socioeconomic groups) and obesity. The maternal mortality rate among black women is at least three times higher than among white women. Black women also are more susceptible to hypertension and other complications, and they tend to receive inadequate prenatal care. 3 studies have shown that at least 40% of maternal deaths could have been prevented with improved quality of care. Obesity plays a role since there is a higher chance of diabetes and other pregnancy related complications. A doctor I worked with once told me the fat upholstering the inside of the pelvis reduces the space available which may lead to a cesarean birth.

Here is a chart that further breaks down the causes of maternal death in the US.
pie chart of causes of maternal death in US

A 2005 WHO (World Heath Organization) report titled “Make Every Mother and Child Count” identifies the following causes of maternal death: severe bleeding/hemorrhage (25%), infections (13%), unsafe abortions (13%), eclampsia (12%), obstructed labour (8%), other direct causes (8%), and indirect causes (20%). Indirect causes such as malaria, anemia, HIV/AIDS, anesthesia complications and cardiovascular disease can complicate pregnancy or are aggravated by it. If you compare the findings of the WHO’s recent findings in 2005 and compare it to the pie chart from 1990, there is very little difference in the statistics.

While many of the complications listed above are rare, the chance of a cesarean birth is not. Please do not interpret my strong stance against cesareans to mean that they should never be done, or that you will have problems should you need one. The cesarean is a valuable intervention when used appropriately. However, much research supports that our misuse of this surgical procedure leads to complications and, in some rare cases, maternal death.

If you are interested in learning more this subject, there is a very intriguing, detailed 20 minute video called Birth by the Numbers. Eugene R. Declercq, PhD, Professor of Maternal and Child Health, Boston University School of Public Health, presents the sobering statistics of birth in the United States today. Click here for a direct link.

***Please note, that this blog entry is not meant to scare pregnant moms. I am just shedding some light on a growing problem in our society when it comes to wellness of moms and babies.




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