The number of women dying because of pregnancy and childbirth is going up in the United States. One of the wealthiest nations on earth is now one of only eight countries -- including South Sudan and Afghanistan -- where the mortality rate for American mothers is increasing.
Why is giving birth in the U.S. more dangerous?
First, statistically, in 1987, more than 25 years ago, there were 7.2 deaths of mothers per 100,000 live births in the U.S., according to the Centers for Disease Control and Prevention (CDC). In 2011, the number of deaths has more than doubled to 17.8 deaths per 100,000 childbirths.
According to various experts, there's no singular factor that explains the increase in deaths. However, issues, including a substantial increase in the number of cesarean section births, the lack of access to affordable, quality health care, diabetes, hypertension, and other obesity-related complications, and more women giving birth at older ages, are contributing factors.
"The body is already stressed by obesity and the other accompanying diseases, such as hypertension, diabetes, and things that accompany that and then you put the demands of pregnancy on top of that and it's just very difficult."In addition, Dr. Michael Brodman, chairperson of the department of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai Hospital in New York, says obesity is one of the leading causes of mortality in the OB/GYN field.
"We didn't specifically have protocols for dealing with obese patients. We didn't treat them differently and in reality, you have to treat them differently.After it was revealed that New York had one of the worst maternal mortality rates in the U.S. two years ago, Dr. Brodman and nearly 50 other leaders in the OB/GYN profession came together to try and figure out why more women were dying during pregnancy and after childbirths.
Initially, the group of leaders thought that New York might have more complicated patients than other states due to it having a more diverse population. The professionals reasoned that the difficult patients explain why there is a higher death rate for mothers during pregnancy and childbirth in New York.
However, after further discussion and meetings, Dr. Brodman and his colleagues uncovered a larger issue. Dr. Brodman and his team of professionals suggest that the wide range of health care offered at hospitals across the country offers a valid explanation for the increased deaths during pregnancy and childbirth.
"If you're in Sweden, everybody gets treated the same way. If you are in New York City, you get treated one way. If you're in Buffalo, you get treated another way and if you're in Missouri, you get treated another way. This is that sort of U.S. individualistic kind of thing, 'I know what I'm doing. This is how I'll do it.' In health care, at the end of the day, that doesn't work."Doctors are now coming up with standardized care for pregnancy and childbirth complications. The experts recommend that programs like the American Congress of Obstetrics and Gynecologists' Safe Mother Initiative, and the National Partnership of Maternal Safety should be used in every hospital where all health care personnel would follow the same protocols for dealing with issues such as a postpartum hemorrhage, which can result in death.
Although different procedures and training at hospitals may account for reasons why more women are dying during pregnancy and childbirth, some suggest medical pride and egos play a big part of this life-threatening problem.
In the U.S., Brodman adds that a doctor's mentality becomes an issue, at times.
" 'No one tells me to wear a helmet when I'm riding my motorcycle. I am allowed to do what I want,' that kind of mentality. Well, doctors have that, too, and in reality, it doesn't work in health care."Therefore, standardized guidelines are necessary in every state and they have to be rigid, Dr. Brodman explains.
"We can't allow for individuality because of whatever crazy reason people come up with."Another extenuating factor for the increase death rate for mothers is health disparities. According to the CDC, African-American women are three times more likely to die as a result of pregnancy and childbirth than white women in the U.S. are.
"We know that black women dying from pregnancy-related causes are younger, less educated, more likely to be unmarried, more likely to start prenatal care in the second (or) third trimester of pregnancy or not at all, when compared to white women, but except for that, we don't know a lot."Dr. Creanga suggests that medical and nonmedical factors, such as insurance coverage and poverty, need to be considered as part of the research to figure out reasons why more women are dying from pregnancies and childbirths.
Turner offers a scenario of a pregnant woman waking up in the middle of the night with contractions at 28 weeks. The pregnant woman isn't sure if she's in labor, but she needs to go to the hospital. This cannot be determined over the phone.
In addition, the woman may have private insurance. However, Turner suggests that, "You're still going to have a whopping co-pay for that hospital visit just to make sure you weren't really in preterm labor. So I know that people hesitate to seek care because there is an out-of-pocket expense every time you engage with the health care system."
Another factor that is likely contributing to women dying during pregnancy and childbirths is the substantial increase in C-sections in the United States. Today, about one in three American mothers has a C-section -- up from one in five 20 years ago.
Turner said the decision over whether to perform a C-section is a very difficult one for healthcare providers.
"We, as providers, know that surgery carries more risk for mother and baby. It's such a delicate balance to find that perfect razor's edge of the most benefit with the least risk and for some patients, there is risk in continuing to labor for the mom and for the baby."The rising maternal mortality rate for American women may be due to their age and delaying childbearing, as well. According to the CDC, while less than 15 percent of all births in the U.S. are to women 35 years and older, between 27 percent and 29 percent of all the pregnancy-related deaths are among that same age group.
Dr. Creanga cites that age and chronic diseases increase life-threatening complications for women.
"Because women are delaying childbearing, a larger proportion of them are likely entering pregnancy with a burden of chronic disease conditions. Many studies have shown that an increasing number of pregnant women in the United States have chronic health conditions such as hypertension, diabetes, chronic heart disease and all these conditions can put a pregnant woman at higher risk of pregnancy complications."So what is the solution to saving lives of new mothers?
Better quality care and increased access to more affordable healthcare is one way to bring the maternal mortality rate down and save women's lives in the United States. Turner added, "We need to have quick, easy, 24/7 access to a skilled person that's not burdensome, that's not expensive, that's not difficult, that you don't have to drive an hour and a half to get to."
According to Dr. Creanga of the CDC, more states need to implement evidence-based guidelines and recommended practices for dealing with pregnancy and childbirth complications. These practices and guidelines should be implemented across every hospital in the state in order to reduce the number of deaths.
In addition, Dr. Creanga cites that the guidelines that address the most preventable causes of maternal deaths have been shown to decrease the number of mothers dying, during and after pregnancy, in other parts of the world, such as the United Kingdom. Perhaps, by following tried and true practices and guidelines, the U.S. mortality rate will come down, and more women's lives will be saved.
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