I'll... start with the bad news: severe complications during childbirth -- including stokes and heart attacks -- are up 75% (!) from a decade ago, as of statistics from 2009, and complications taking place during moms' post-delivery hospital stays are up 114%. Meanwhile, the American matertnal mortality rate has doubled in the last 25 years, and minority mamas are most at risk, with African American maternal death rates clocking in at four times higher than those for caucasians. The numbers have been climbing -- and available -- for quite some time, but a recent US government study has confirmed the facts: that complications and death during childbirth are on the rise in the United States. Mainstream news coverage has followed (finally -- that's the good news), but the experts' explanations are missing the target completely.
In this Reuters article, which was reproduced on the Chicago Tribune website, the unsettling news is tempered by reminders that, overall, the incidence of serious complications, and maternal death during hospital birth, remain rare. "Over four million women give birth each year," its author writes, "and this study, which appeared in Obstetrics & Gynecology, found about 590,000 cases of severe complications over 11 years." But 590,000 is not a small number, and the sharp increase in maternal death and post-natal complications is shocking. (As are the dramatically higher rates among minorities.) William Callahan of the CDC, who led the study, cites health conditions among a "changing" pregnant population -- including obesity, heart conditions and advanced maternal age -- as the logical cause behind both phenomenons; this, I believe, places the blame on mothers (particularly disadvantaged mothers) and displaces attention from an American hospital birthing system that spends more than any other in the world, and yet trails behind an astounding forty other nations when it comes to its maternal death tolls. Certainly, Americans suffer from the trademark illnesses borne of a culture built on high stress, fast food and limited access to health care. But that moms are dying at crazy high rates during childbirth does not mean that American women are failing within a working health care system. These numbers mean that our health care system is failing women.
A Consumer Reports article published in May shed light on the ways in which this system "has developed into a highly profitable labor-and-delivery machine, operating according to its own timetable rather than the less predictable schedule of mothers and babies. Childbirth is the leading reason for hospital admission, and the system is set up to make the most of the opportunity. Keeping things chugging along are technological interventions that can be lifesaving in some situations but also interfere with healthy, natural processes and increase risk when used inappropriately." C-sections, which now account for a third of US births -- triple the World Health Organization recommendation -- are a notable example of the inappropriate use of interventions once reserved for emergencies. (Btw, intervention 101: more interventions equals more complications.) Carol Sakala, Ph.D., director of programs at Childbirth Connection, a nonprofit organization that promotes evidence-based maternity care, told the CR reporter, “We see rates going up across all birthing groups, including all ages, races, and classes… What we are seeing is a change in practice standards, a lowering of the bar for what’s an acceptable indication for medical interventions.”
The article goes on to list ten interventions to avoid -- unless they're medically necessary -- during childbirth. They are: c-sections for low risk first births, automatic second c-sections, elective early deliveries, induced labor, ultrasounds after 24 weeks, continuous electronic fetal monitoring, early epidurals (if you do get one, the article advises to ask the anesthesiologist for a lighter block), routine rupturing of amniotic membranes, routine episiotomies and sending newborns to the nursery. Included in the list of things TO do when pregnant are: have a plan, consider using a midwife, and listen to yourself. Several of the medicalized interventions that women are recommended to avoid have become so ingrained in our childbirth culture that we tend to feel more safe with them -- like lots of ultrasounds and monitoring -- and others have become truly routine, and often go unquestioned, like episiotomies. (I wasn't even consulted before I'd been cut.) But the skyrocketing maternal death and complication rates, combined with mainstream, objective publications like Consumer Reports turning out advice like this indicate that it's time we questioned hospital birth SOP and opt for more natural means. Doctors and hospitals aren't "bad" -- as some of the 'success stories' included in the Consumer Reports piece indicate, carefully choosing one's hospital can make for a much improved birth experience overall -- but the steep, steady rise in maternal death and complications definitely isn't good. I firmly believe access to quality health care that's free of profit-driving special interests is a human right. America also trails behind other developed (and many not-so-developed) nations in not fulfilling this right for its citizens. Predictably, this harms women, children, and minorities most disastrously. I think we need to pay attention -- instead of blaming the victims -- and push for positive, effective changes in the way we approach childbirth in America, from within the mainstream health care system, and without.
What do you think? Has the "changing" pregnant population (and its poor general health) caused maternal death and complication numbers to rise by 75% and 114%, respectively, over the last decade? Or is this a failing of our medical system? Some combination of the two? What are the solutions? Does it surprise you that Consumer Reports recommends moms consider delivering with midwives? Do you think natural, midwife-assisted and home birth will ultimately make their way into the mainstream in the US? (They're pretty darn mainstream in Japan, and that country has a 60% lower infant mortality rate than the United States does…) Share your thoughts!