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8 Aug

Why are so many American women dying from childbirth?
Aug 6th 2015, 13:40 BY E.B. | NEW YORK

CHILDBIRTH was once a reliably dangerous experience. As late as the 1930s, one out of every 100 live births in America cost a woman her life; similar rates were seen around the world. But the 20th century brought tremendous advances in obstetric medicine and widened access to decent care. The maternal-mortality rate plummeted in rich countries by as much as 99%, and now poor countries are starting to catch up. But in America something odd is happening: over the past quarter of a century, the maternal-mortality rate (which counts deaths within 42 days after delivery) has been creeping back up. In 2013 more than 18 women died for every 100,000 live births. America is one of only eight countries, including Afghanistan and South Sudan, where these numbers are moving in the wrong direction. What is going on?
The shortest answer is that no one really knows. Some speculate that it has to do with the fact that American women tend to be both fatter and older when they become pregnant these days. Indeed the risks associated with childbirth rise in tandem with weight and age. But these trends can be seen in plenty of countries where the death rates are still coming down. Others suggest optimistically that America is simply more rigorous about counting these deaths. The problem with this theory is that the system for collecting these records hasn’t changed much over the past decade, while the rate has continued to rise.

Death from childbirth is unusually common in America
The most compelling explanation is that more women are in poorer health when they get pregnant, and then failing to get proper care. Chronic health problems, such as obesity, hypertension, diabetes and heart disease, are increasingly common among pregnant American women, and each of them makes delivery more dangerous. Indeed the traditional causes of pregnancy-related deaths, such as haemorrhage, venous thromboembolism and hypertensive disorders, have been declining in recent years, whereas deaths from cardiovascular conditions and other chronic problems have been on the rise. These conditions are more common among African-American women, which partly explains why they are nearly four times more likely to die from pregnancy-related complications than white women. Poverty is also closely correlated with worse health outcomes, as poor women are less likely to have access to proper health care, including contraception and prenatal care. (Women who become pregnant accidentally are less likely to seek timely prenatal care, which raises the risks of death.) Because African-Americans are more than twice as likely as their non-black peers to live below the poverty line, this also helps to explain the grim racial disparity in maternal mortality rates.

Prenatal health and life outcomes
What is the solution? Many hope the Affordable Care Act (ACA), otherwise known as Obamacare, will widen access to health care, which would ensure that more women are in better shape when they become pregnant. In the 31 states plus Washington, DC, that expanded Medicaid under the ACA, poorer women will have access to contraception and better care before and after childbirth, which should reduce their mortality risks. (After-care is seen as essential for both managing potentially critical problems and putting women back on track for a healthy lifestyle.) Studies of obstetric emergencies have also shown that at least 40% of fatalities are completely avoidable in the moment. Once doctors are trained to spot the signs of haemorrhage, severe hypertension and venous thromboembolism when they arise, they can move more swiftly to protect their patients’ lives. Federal, state and professional organisations, including the Centres for Disease Control and the American College of Obstetricians and Gynaecologists, are working together to make sure that hospitals and childbirth centres know how to handle these emergencies. Hospitals in California—where one in eight American births take place—have put these protocols in place already, and the state has managed to bring its maternal-mortality rate down. The hope is to see a similar transformation on a national scale.
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SheSheAug 8th, 12:54
Poll this: In every poll taken when it come to any type of whose most likely to be affected by a disorder,disease and or death African Americans are always at the top of the poll.
karanti_mariaAug 8th, 10:20
Many of those competent, diligent, efficient, well-educated, high performing Obstetricians and Gynecologists from Europe and Latin America would be eager to immigrate and work in remote areas of the United States, saving women’s lives and ensuring healthy neonates.
Strict exhausting unrealistic long term bureaucratic selection procedures are imposed to “maintain quality”, or better seclude the profession and maintain high wages.
Funny thing is that those who examine for high quality foreign colleagues are the same poorly performing dangerous US Obstetricians!
The only hope for US women is that the forthcoming EU-USA Treaty liberalizes professional services and abolishes seclusion processes and bureaucratic procedures…
kongxiangfei2014@outlook.comAug 8th, 08:56
the article really shocks me a lot….
guest-onosnaeAug 7th, 19:47
If unhealthy = greater chance of death during childbirth (seems reasonable), then would be good to look at different proxies for unhealthy vs healthy (e.g. age, income, geography, etc.) and determine if the birthrate for the unhealthy is growing faster than the healthy. Has to be something like this. Seems like a simple way to test the above hypothesis, no?
eKK25iuTRTAug 7th, 06:47
I was in Silicon Valley and I thought I was getting the most natural and “alternative” birthing experience I could at a hospital. My midwife encouraged me to write a birth plan and hire a doula, so I did. So alternative, so natural! I was warned multiple times about the dangers of epidurals and interventions that quickly spiral into a C-section, which is risky, major surgery. But when the big day arrived, my midwife was too busy to see me. I had a horrible nurse that hounded me every 5 minutes to take an epidural even though I said “No!” several times. My birth plan stated that nobody was to offer me an epidural, but I’m fairly certain she didn’t read it. The only doctor available was a complete stranger, not my regular ob/gyn. I refused to have pitocin but they hounded my doula until I agreed to a tiny dosage which “would not do anything”. Turns out it’s impossible to say no with any authority when you are having contractions every few minutes. Between contractions, I realized I was sold a false bill of goods, so in desperation I locked the bathroom door and allowed them to knock and bang on the door repeatedly. I gave birth on the bathroom floor alone without their “help”. If I hadn’t done so, I’m fairly certain I would have had a C-section and the medical team would have received a nice chunk of cash from my insurance company. When I emerged from the bathroom a new mother, my midwife eventually showed up and had the nerve to be angry with me. I had no idea why she would be upset, but I found out later that whoever “catches” the baby receives extra cash. Moral of the story: the incentive structure ($$) sets up American women for unnecessary major surgery.
umghhhin reply to eKK25iuTRTAug 7th, 07:50
Nice chunk of cash for a routine op is a driving force for apparent increase of C-section. Doctors know it, hospitals know it and mothers to be should know it too.
It is all about not harming the patient while digging a pile of cash.
New Freetraderin reply to eKK25iuTRTAug 8th, 01:39
Well, it is of course your choice to refuse an epidural. Most women prefer to have one – my wife arrived at the hospital for our second in plenty time but by the time the Midnight Shift RNs finished their coffee it was ‘too late’. So she ended up going without.
CA-OxonianAug 7th, 04:16
Data suggests that the “natural” rate of C-sections is about one in a thousand. In the USA approximately one third of all births are by C-section. American women want to be gassed into unconsciousness and wake up only after it’s all over; American doctors want to be able to schedule their golf games without risk of disruption so they regularly induce with oxytocin, leading to complications, leading to an “emergency” C-section. In consequence, a large number of overly-large women undergo invasive surgery that is wholly unnecessary and which puts their lives at risk. But that’s the American Way.
When my two children were born we agreed in advance with the attending physician that short of a real medical emergency they would be natural births. The physician agreed, but when the time came he was unable to contain his urge to use all manner of unnecessary procedures and it was only by threatening actual force that I was able to dissuade him. Our two children were born without complications, while three of the other women on the ward were induced, had C-sections, and so enjoyed the Full American Experience.
Until doctors are not remunerated for creating unnecessary surgeries and until women accept that a certain amount of pain is part of childbirth, the horrific level of unnecessary death will remain a fact of American life.
guest-ljnoawlin reply to CA-OxonianAug 7th, 06:34
All of which misses the article’s main point – that maternal death rates are rising in the US and falling everywhere else. Unnecessary C-sections could theoretically explain the comparative LEVELS of maternal deaths (though I deeply doubt it – else why do black women die so much more than white ones?), but unless these have become far more common in the US and/or far less common in other countries (neither of which are remotely true) then it cannot explain the comparative TRENDS.
A far more likely cause is the intersection of the US’ inefficient and unfair health system with increasing inequality. That explains that white/black differential.
New Freetraderin reply to CA-OxonianAug 8th, 01:42
C sections are not part of the issue; or at least, there is no indication that they are. C sections are used often because doctors (and more frequently – the patients) want to schedule the birth as if it were any other ‘elective’ medical procedure. I’m not sure I have any right to judge anyone who chooses for convenience to have a C section – why the Hell not if that’s what they want – but having one’s abdomen cut open unnecessarily seems like a bad idea to me.
guest-onoiimlAug 7th, 03:07
Why is this a mystery? American Maternity care involves much more “interventions” than all comparable countries. Scheduled c-sections, avoidable c-sections, pitocin and other medical inducements, and an over-use of epidurals. All of these things (when not absolutely necessary) increase the risk for harm of mother and baby.
Just look at the c-section rates in the US compared to European nations. The answer is right there.
A. AndrosAug 7th, 01:46
“These conditions are more common among African-American women, which partly explains why they are nearly four times more likely to die from pregnancy-related complications than white women.”
And,once we control for that there really is no story.
Black women, as observed, live in less prosperous circumstances and more than two-thirds of the time lack a husband or reliable male partner.
They far more likely to drop out of high-school.
As a hypothesis, one can postulate that lack of spousal assistance, little attention at home to prenatal care as a result of limited education and economic distress are the culprits.
Regardless, it is worth any amount of money to mitigate this situation. I do not know the relevant provisions of ACA — at our age my wife is unlikely to become pregnant and if she does we aren’t likely to name the kid after me — but a national health plan that does not contain free and easily obtained care for expectant mothers is a failure.
Visiting nurses . . . visiting dieticians . . neighborhood walk-in maternity clinics in each locale with an above-average loss of mothers and or child. . . well-baby care at community centers . . . extensive daycare for newborns so that an exhausted post-delivery mom can recoup her strength . . . amplified WIC provisions so that formula and diapers are free . . . week-long stays for new, young single-mothers in maternity and recovery wards that not only assist in bonding but give mothers confidence and acquired skills . . . these are a few positive things, some of which may already be in place, but there must be others readers can imagine.
Also . . . kick the ass of every insurance company in America until they stop hassling people with chicken-shit objections and questions to routine claims in the hope they can stiff the consumer. Maternity should be safe, comfortable and without unnecessary stress.
Cost is not a consideration.
BrownPelicanAug 7th, 01:39
They flat out don’t give a shit, as indicated by the continued rise in obesity.
Connect The DotsAug 7th, 00:05
“Indeed the traditional causes of pregnancy-related deaths, such as haemorrhage, venous thromboembolism and hypertensive disorders…These conditions are more common among African-American women, which partly explains why they are nearly four times more likely to die from pregnancy-related complications than white women.”
Ideally White American Women should be subsegmented and compared to White Europeans for health outcomes.
And Black American Women should be subsegmented and compared to Black Africans for health outcomes.
In both cases, American health outcomes are either on par or excel.

The premise is an apples to oranges comparisons, when it should be apples to apples.
Mike Hoyin reply to Connect The DotsAug 7th, 00:21
A less ridiculous comparison would be the pregnancy-related death rates of white and black American women with their white and black European counterparts.
umghhhin reply to Mike HoyAug 7th, 07:58
Actually that would be a nice comparison and I would urge TE to do so. Do a comparative study in which poverty is controlled for so that we can extract that as a factor – I have this hunch that while you take care of poverty in US by giving a chance to rise out of it, the racism apparent from any statistics on social malaise in US will wither enough not to be considered systemic anymore.
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