Birth Services

Joyce Kimball, CPM

News

The Maternal Mortality Rate in the U.S. is rising in 48 states

In October 2016, The Diane Rehm show discussed a recent study regarding the increasing U.S. maternal mortality rate. //dianerehm.org/audio/#/shows/2016-10-12/whats-behind-increase-in-the-u-s-maternal-death-rate/113757/@00:00"

I listened and took some notes, below, but here’s what shocked and saddened me:

1. The rate of maternal mortality in the U.S. is much higher than in other countries. In Britain the maternal mortality rate is 6.7%/100,000 live births; in Germany 4.1%/100,000 in Japan and Canada 6-8%/100,000. In the U.S. it’s 23.8%/100,000 live births!

2. Of the maternal death rate, 2 out of 3 maternal deaths are associated with cesarean section. 1 out of 3 are associated with childbirth.

We need to stop inducing, augmenting and cutting women.

 

My notes from the Diane Rehm show: In Texas the maternal mortality rate doubled from 2010 and 2012, similar to the rate of a developing country rate. 17.1/100,000 in 2000 to 35.8/100,000 live births in 2014! The overall maternal mortality rate increased 27% for 48 states from 2000 to 2014. However, in California, the maternal mortality rate has declined.

The maternal mortality rate is the number of women who die as result of complications of pregnancy and childbirth; the death is related to pregnancy or childbirth. In U.S. suicide, accidents, and homicide are not included in the maternal mortality rate. In other countries suicide is included due to the impact of postpartum depression and psychosis.

The rate of maternal mortality in the U.S. is much higher than in other countries: in Britain 6.7%/100,000; in Germany 4.1%/100,000 in Japan and Canada 6-8%/100,000 ; in the U.S. it’s 23.8%/100,000 live births.

So why? Reporting differences in the U.S.? No. Population differences? No. Older? No. Higher rates of chronic conditions such as diabetes and hypertension and obesity? No. Higher access to care in other countries? Yes. Increase in medical procedures such as cesarean section, induction and augmentation? Yes. Mandatory review of all maternal mortality cases? Yes, in other countries. Only a few states have a maternal mortality case by case review. California created a mortality task force and decreased their maternal mortality rate by finding root causes, creating protocols and affecting change.

Top 2 reasons why women die: hemorrhage and hypertensive complications like pre-eclampsia. However, hemorrhage and hypertension rates have stayed the same since 2000 and not increased.

There is a surgical expansion in the care of women, most specifically cesarean section. Cesarean rates are high in U.S. Delivery by cesarean section is relatively safe but can result in many complications especially in subsequent pregnancies. Cesarean section has risks of hemorrhage, infection and death. And if a woman has a cesarean section, she has a higher risk of placenta accreta and uterine rupture in subsequent pregnancies. There used to be interest in VBAC but that interest has faded. The new focus is on preventing the first cesarean section. What created the rise in cesarean section? It’s a relatively of low risk surgery if it’s scheduled. It’s more expensive. But it’s longer recovery. And has higher risks in future pregnancies. The cesarean section rate in the U.S. is higher than most European countries. Of maternal death rate, 2 out of 3 maternal deaths are associated with cesarean section. 1 out of 3 are associated with childbirth. Should doctors discourage cesarean sections? Doctors should have a good discussion re: optimal birth method. "For low risk moms and healthy babies, an uncomplicated vaginal delivery is the safest delivery route for mom and baby."