Childbirth in the United States is far riskier for women than it ought to be. In a yearlong investigative series, NPR and ProPublica looked into why a woman in America is three times more likely to die in childbirth than a Canadian woman and six times more likely as a Scandinavian. If the nation wants to improve, it should look to California.
The reasons for the U.S. deaths appear to include complacency and a shift in focus from maternal health to fetal health.
“Into the late ’60s and really through the ’70s, the technology of being able to care for the fetus became huge,” said William Callaghan, chief of the Maternal and Infant Health Branch in the Division of Reproductive Health at the Centers for Disease Control and Prevention in a recent article in the series. “People became really enchanted with the ability to do ultrasound, and then high-resolution ultrasound, to do invasive procedures, to stick needles in the amniotic cavity, and everything did revolve around the baby.”
As a result, infant mortality is at an all-time low while maternal mortality rates have climbed. But California may have found a way to reverse the maternal mortality trend. A concerted effort begun in 2006 has cut the mortality rate of women in childbirth by more than half.
The key was a statewide campaign to bring together medical personnel, hospital administrators and public health officials to find solutions. The committee reviewed the details of every maternal death case for the previous five years.
It found that two common and very treatable complications — hemorrhaging and preeclampsia, pregnancy-induced high blood pressure — were responsible for many preventable deaths. The collaborative worked to develop standard training and care procedures for these complications.
Instead of going into a delivery with the assumption that the mother will be fine, medical professionals now go into a delivery with the notion that every woman is at risk and with a clear set of procedures, toolkits and intensive training on how to deal with complications that might arise.
The result has been a 55 percent decline in the maternal death rate in seven years.
Across the nation, more than 700 women die every year from pregnancy- and childbirth-related causes, and 50,000 to 80,000 deal with life-threatening complications. The United States has the highest maternity death rate in the industrialized world. This is unacceptable.
The American College of Obstetricians and Gynecologists released a proposal earlier this year for revamping pregnancy and postpartum care. Obviously, this needs to be done, and California’s approach should become a model for the nation. If its results could be achieved nationwide, hundreds of lives would be saved, and thousands of women would be spared life-threatening complications every single year.
Not that everything falls on physicians. Patients have a role in ensuring a successful, healthy childbirth. Expecting mothers need to take care of themselves in line with their physicians’ recommendations before, during and after pregnancy. Obesity, not eating well, or consuming alcohol or other drugs are all factors that can cause complications for a fetus or infant.
The United States’ maternal death rate is shameful. There is no reason that giving birth in Sweden or Canada should be so much safer.
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