The News-Register released an article the other morning titled, “Danger in delivery: Despite technology, U.S. trails entire western world in saving mothers”. I thought it was interesting follow up in light of my recent post highlighting the severity of the infant mortality rates in the U.S. It’s interesting that not only are our infants suffering, but our mother’s too. The article opens by stating the following:

Women in the United States are more likely to die during or shortly after childbirth than women in nearly all countries in Europe and many in Asia and the Middle East, according to the United Nations.

While maternal mortality declined in most countries over the past 20 years, it has not just increased, but nearly doubled, in the United States.

Experts blame the high death rate partly on the heavy reliance the United States places on technological intervention, particularly when it results, as it so often does, in surgical delivery via cesarean section. They say motivators include both convenience and fear of litigation in the event of a less-than-perfect outcome.

Originally meant to be strictly an emergency action to save a struggling baby, it has become all but routine in the U.S. It is now used in almost one-third of all American births. 

The article goes on to highlight the fact that despite the obvious increases in medical interventions, there are no studies proving a respective improvement in outcome. In fact, the findings are quite the contrary. 

In March, “Contraception: An International Reproductive Health Journal,” a peer-reviewed medical journal published by the Association of Reproductive Health Professionals, published a landmark editorial on the subject. Titled, “Maternal Mortality in the United States: A Human Rights Failure,” it was authored by Francine Coeytaux of WomanCare Global, Debra Bingham of the Association of Women’s Health, Obstetric and Neonatal Nurses, and Nan Strauss of Amnesty International USA.

The editorial states:

“In contrast to many countries where women lack access to life-saving medical interventions, women and infants (in the U.S.) are often exposed to more procedures than are medically necessary or beneficial. This overuse of medical procedures increases injuries as well as costs.

“Indeed, we are unaware of any study indicating that the 56 percent increase in the rate of surgical births from 1996 to 2008 has improved outcomes. However, there are data to show that the overuse of medical procedures has increased both infant and maternal morbidity.”

Performance of a Cesarean section in one pregnancy also leads to increase the risks in the next. Consequently, doctors have historically discouraged women from attempting to deliver subsequent babies vaginally, a trend that also has helped to increase the national rate of Cesarian sections.

 Yet another finding linking increased medical interventions with poorer outcomes. In my own research, I’ve come across several studies that have found fetal monitoring alone to lead to more interventions but not improved outcomes. This article also touched on fetal monitoring and it’s role in the snow ball effect. I was required to be on a fetal monitor when I gave birth to Hooper and found it incredibly distracting. Instead of concentrating on my body and what it was doing, my eyes were glued to that monitor. I think the monitor alone was a huge source of anxiety especially for Willy. Labor is a stress to the baby even in the best of circumstances and the monitor is always going to reflect that. With that said, the monitor is never calming or reassuring, rather I believe it to be a constant source of worry and concern. Anyway, this is what the article had to say about it:

Hedges, who is retiring from practice to teach and write, said reasons for the nation’s extraordinarily high Cesarean rate are as complex as the American health care system. It starts, he said, with pervasive fetal monitoring in hospitals.

The practice is intended to let doctors monitor the baby’s health continuously throughout the birthing process. But he said, “Studies show that continuous monitoring doesn’t change anything, except to increase the C-section rate.”

That is, it doesn’t change anything in a positive direction. It does change one thing in a negative direction — it costs some mothers their lives. 

That’s because it leads to more C-sections, and a woman is three times more likely to die from a C-section than a vaginal delivery. C-sections also cause substantially more medical complications not resulting in fatality.

If doctors see an abnormality in the readings, Hedges said, they are more likely to perform a C-section, just to be on the safe side in a notoriously litigious area of practice. But he said, “In the vast majority of cases, those babies are fine,” despite the abnormal readings. In many cases, Hedges said, doctors simply don’t know what causes the abnormal readings.

Obstetrician/gynocologyst Dr. John Neeld of the Willamette Valley Medical Center agreed that fear of giant lawsuits is often the driver in such cases.

For example, he said, the fetal heartrate tracing patterns might be slightly elevated, but not necessarily indicative of a baby in trouble. But the combination of a doctor worried about possible lawsuits if his interpretation turns out wrong, and a patient afraid for her baby, and determined to take any action necessary to ensure its safety, often leads to a C-section that, in hindsight, was probably not necessary, he said.

“Those are not small lawsuits,” he said. “I personally have not been sued, but if I get sued for $10 million, I know I’m out of business, because my insurance willl be so high that I won’t be able to continue practicing.”

The problem here seems to be twofold. For one you have doctors making decisions based on fear for their own licenses and welfare. But, the problem is really larger than that. The fact is we live in a very lawsuit friendly nation and the reality therefore is that doctors have to make decisions based on fear for their own licenses and welfare. You can’t really fault them for this. It’s always been my complaint as a nurse that we spend more time charting about patient care than spending time with our patients. Again, we’re a litigious nation. This needs to be fixed before the system of providing medical care can be changed. 

I’ve touched on infant mortality rate, but this article goes on to state the maternal mortality rate. And the results are shocking. 

The United Nations releases a new report every five years. The United States ranked 41st in child mortality in the 2005 report, but had slipped nine spots to 50th by 2010.

The United States averaged 12.7 deaths per 100,000 live births in 2009, up from 7.1 a decade earlier. Nearly every industrialized nation in the world does better than that, as do several developing nations, according to the U.N.

Callaghan noted the U.S. had once set a goal of bringing its rate of maternal deaths down to 3.3 per 100,000 live births by 2010. The country has made no progress toward reaching that goal, he said.

In fact, the government has now given up on it. Now, it proposes to reduce maternal deaths to 11.4 per 100,000 live births by 2020.

Looks like we have quite a ways to go to reach our goal. 

The article touches on other factors that additionally affect maternal mortality such as age, obesity, and access to health care. Woman in the U.S. are statistically older when compared to other nations, and with age comes a higher rate of complications. Same with obesity. More fat, more complications. And whereas other nations have national health care, many in the U.S. are without insurance and therefore do not receive proper prenatal or postpartum care. 

Being that I’m relatively young, not obese, and insured, looks like the only thing I have to worry about is unnecessary medical interventions. Yet again, all signs point to a birth at home.

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