In most of the world, the number of women dying in childbirth is decreasing, but the United States is one of eight countries in the world where the maternal mortality rate is going up, not down, according to the newest figures. In fact, the US is rock bottom of the developing nations of the world in maternal mortality - #60 out of 180 nations included in the statistics. And that is unacceptable.
According to the latest figures from the World Health Organization, the United States has made an alarming jump in the maternal mortality rates. From an average of 12 deaths per 100,000 in the period 1988-1992 up to 28 per 100,000 in the period from 2008-2012. That is a 136% increase over what it was 20 years ago. The rate has more than doubled in the past ten years. The maternal mortality figures are going the wrong way. Here is how the numbers look over that 20 year period:
- 12 deaths per 100,000 1988-1992
- 11 deaths per 100,000 1992-1997
- 13 deaths per 100,000 1998-2002
- 17 deaths per 100,000 2003-2007
- 28 deaths per 100,000 2008-2012
In 2005, there were 27 countries where it was safer to give birth than the USA; now there are 59.
A new report from the Lancet states that the US has a maternal mortality rate of 18.5 for 2013, lower than the WHO figure. However, the Lancet figure is an average from the years 2003 to 2013, a ten-year period. The WHO mortality rate is derived from the past five years, thus the discrepancy. The risk to women giving birth in the "Land of the Free and Home of the Brave" is increasing at a disturbing rate. No other country has increased their maternal mortality rate at such a steep pace.
Babies are at risk as well. The rate of infant mortality is not keeping pace with the rest of the world either. According to the latest figures, the US is at #55 out of 224 nations listed.
Most of the European nations have much better statistics. Canada loses less than half of the mothers that America does. It is safer to have a baby in countries like Iran, Puerto Rico, Hungary, the Czech Republic, or the Republic of Korea, even though the US spends far more for maternal health care than most other countries.
Author and midwife Gail Hart has been attending birthing women for nearly forty years, and she points out that the United States:
"has a profit-based health care system. The US system leaves some women with only emergency care, while others are over treated. Women are harmed when they do not have access to good medical care, but also when they are given inappropriate care. The market based Hospital System puts profit above appropriate care. Unnecessary induction, unnecessary medication, and unnecessary cesarean section can increase the maternal death rate."The most common cause of maternal mortality is hemorrhage, or excessive bleeding. During pregnancy, a woman's blood volume typically expands to half again what it is in the non-pregnant state, so some blood loss is normal. Good nutrition, including adequate iron and protein, make a significant difference in how a mother is able to handle blood loss. Overuse of supplements like fish oil and flaxseed oil can predispose to bleeding and inhibit clotting. Mis-management of third stage in getting the placenta out can contribute to hemorrhage as well.
Hypertensive disorders and infection also contribute to maternal mortality. Six to seven percent of maternal deaths are attributed to complications of abortions. Amniotic fluid embolism is often a direct result of induction of labor with drugs such as pitocin or cytotec, and is another contributor to the mortality rate.
Interestingly, many of the best statistics are found in countries where midwives provide the majority of the maternity care for all but the high risk women. The late Marsden Wagner, former director of Women's and Children's Services for the World Health Organization for 15 years, was a vocal advocate for midwives to attend birthing women. He was dismayed by the increasing infant and maternal mortality rates:
"it may be that the increase in the use of birth technologies is not only not saving more women's lives but it is also killing more women. This possibility has a reasonable scientific explanation: cesarean section and epidural anesthesia have both been used more and more in this country and we know that both cesarean section and epidural block can result in death."Many times the topic of midwives brings up fear in those who have been ingrained with the "1920s myth" - the widely held belief that it was the move of birth to the hospitals away from "uneducated, dangerous" midwives that made all the difference in saving mothers' lives. Some will point to the graveyards of the 1920s and declare that we must not go back to those primitive days when women were dropping like flies and dying in childbirth at home. However, correlation does not equal causation.
Though childbirth had begun to move into hospitals and out of the homes, it was around that era that sanitation was improved and antibiotics came on the scene, making a big difference in saving maternal lives in cases of infection.
It was also around that time that the simple practice of hand-washing by doctors and caregivers became common practice. Before that time, actually for a couple of hundred years, it was the doctors who were spreading infection, specifically puerperal fever, because they didn't understand germ theory and were not washing their hands. Often doctors would go from dissecting a cadaver to attending birthing women, without washing their hands.
So childbirth did become much safer during that time period, but it wasn't due to the elimination of midwives, or to the transfer of birth to doctors and hospitals.
It was in the year 2005 that Carla Hartley, director of Ancient Art Midwifery Institute, founded the Trust Birth Initiative, because the maternal mortality rate had become so high, and the cesarean rate had reached an all-time high of 25%. (Now it is 34%.) Hartley and others are working hard to turn things around for birthing women, through education, conferences, and woman-to-woman support. "Birth is safe; interference is risky," is the motto of Trust Birth, recognizing that often it is unnecessary intervention that disrupts the delicate hormonal balance of birth, creating problems where there were none, as well as recognizing when it is truly appropriate to intervene.
Renowned French Obstetrician Michel Odent, M.D., puts it this way:
"Experiences have clearly shown that an approach which 'de-medicalizes' birth, restores dignity and humanity to the process of childbirth, and returns control to the mother is also the safest approach."The maternal mortality rates are abysmal. This did not happen on the watch or under the care of midwives. According to Marsden Wagner, it happened under a broken medical system of power and control. Suzanne Arms has said that the maternal care system in this country is "a multi-billion dollar, self-regulated industry."
It is obvious that whatever the United States is doing about maternal care, it is not enough. It is quickly going in the opposite direction.
Perhaps it is time for the country as a whole to return to a policy of freedom for pregnant women, to allow women the right to decide for themselves where, how, and with whom to birth their babies, even if it is at home, even if it is with a midwife. Perhaps it is time to return responsibility for choices in childbirth to the place that it always has belonged - with the mother giving birth, for it is she who has the most stake in both infant and maternal mortality rates.
[images via bing]