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I just had a disheartening conversation with someone involved in healthcare data AI, not a doctor rather a technologist. The topic of maternal death came up, me

I just had a disheartening conversation with someone involved in healthcare data AI, not a doctor rather a technologist. The topic of maternal death came up, mentioned that the US was going backwards, and holy smokes it was an eye opener. 1 - they did not believe the maternal mortality data capturing methods in other countries was on par with US so failed to see the backwards trends in the US alone. 2 - called my interest in pointing out maternal death rates "noble" but misguided as hospitals will pay attention to their "pain points" such as out of control costs, readmission rates. 3 - after pointing out that pregnancy is the 6th highest reason for death women 15-34, said we should focus on the top 5 because that would have more impact on women's health. There was more but those were main points. I ended my debate with this message: pregnancy is the one "illness" where the patient was likely relatively healthy to begin, and once over, will likely have similar health after with 100% guaranteed remission upon menopause. Hospitals just need to keep them alive. What other medical condition can have such positive outcomes over the long term? The whole conversation just kept reinforcing the point that maternal outcomes are indeed affected by society / medical professionals not caring enough.

cbanek 9y ago
Pregnancy at least used to be one of the things insurance companies were excited to cover you for. It means you aren't sick, and the more money they spend (and labor is pretty cheap, compared to a lot of health care), the more likely they'll save it in the future by having a healthy mom and a healthy baby. Unhealthy/premature babies can be a huge ongoing expense.
- sjg007 9y ago
  No. Before the ACA pregnant women were specifically excluded without a rider.
- just4themoney 9y ago
  Not at all, pre-ACA it was impossible to purchase an individual plan that covered prenatal care and childbirth, they just weren't available. Couple self employed friends had babies during that time and they had to pay for everything out of pocket, tens of thousands of dollars. Also, being pregnant does not mean you "aren't sick," not sure what gave you that idea.
  - cbanek 9y ago
    My bad, I was thinking of employer sponsored healthcare, and I think they usually didn't count labor under the deductible. But yes, buying any kind of healthcare on the public market pre-ACA was terrible. And I meant that being pregnant is a normal healthy condition, that happens to normal healthy people. Sick people can be pregnant, of course, and sickness can be precipitated by being pregnant (like gestational diabetes), but in general it's something that happens normally, unlike illnesses.
    - taxicabjesus 9y ago
      > And I meant that being pregnant is a normal healthy condition, that happens to normal healthy people. It was normal, until early 20th century doctors (mostly male) decided that the midwives (mostly female) didn't actually know anything about childbirth. To protect women from the "incompetent" midwives, the doctor guild successfully exterminated their competition. Midwives used to have little tricks for normal pregnancy problems, like how to get a breech baby to turn. Much of the institution's knowledge was lost in the Purge. I realized a while back that there are two books called The American Way of Birth [1]. The local science library had a copy of the earlier one. This book examines the "medicalization" of normal female experiences. [1] https://news.ycombinator.com/item?id=13742782 https://news.ycombinator.com/item?id=13742782 This 2013 NY Times article [2] has a nice summary of the effects of the medicalization of childbirth on the costs thereof: [...] Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute the single biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion. [...] Those payment incentives for providers also mean that American women with normal pregnancies tend to get more of everything, necessary or not, from blood tests to ultrasound scans, said Katy Kozhimannil, a professor at the University of Minnesota School of Public Health who studies the cost of women’s health care. [2] American Way of Birth, Costliest in the World - http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html?pagewanted=all#h[] http://www.nytimes.com/2013/07/01/health/american-way-of-bir... (this article was probably not directly inspired by either book of the same name) [minor edits - formatting, etc]
yjftsjthsd-h 9y ago
> we should focus on the top 5 because that would have more impact on women's health Eh, sorry if I'm missing something obvious, but isn't this true? Obviously it's best to pursue everything possible at once, but with limited resources it is optimal to hit them in order of magnitude.
- joatmon-snoo 9y ago
  Not if your first question is "why do so many pregnant mothers die during childbirth?" - GP's point is that it's a disheartening realization. That being said, it's not necessarily true - after all, if X resources would be more effective mitigating cause of death A than cause of death B, then presumably you would want to (from a utilitarian calculus) direct them to A, irrespective of whether A or B causes more deaths.
- rabboRubble 9y ago
  It's not that the person was wrong, it's that the person saw no difference between an accidental death (#1 cause) and death from pregnancy. Look at these causes, and you tell me which type of death a hospital can best actively prevent as a part of the treatment plan and those measures have the most impact: #1 Unintentional injuries #2 Cancer #3 Suicide #4 Heart disease #5 Chronic lower respiratory diseases #6 Pregnancy complications Think about which type of young patient comes to them with at minimum of 6 to 9 months of warning, so much time to prepare for the "event". Think about which type of patient can leave the hospital well with a completely normal life expectancy. Out of those #6 death options, pregnancy is the only type of event where, if you survive, you have a completely normal life & life expectancy. Given that, why wouldn't a hospital invest the resource? https://www.cdc.gov/women/lcod/2014/all-females/index.htm https://www.cdc.gov/women/lcod/2014/all-females/index.htm
sjg007 9y ago
This is a protocol issue. The United Kingdom and a few States follow a specific programme which dramatically improves maternal outcomes. The US needs to do two things: capture the data and implement the protocols.

cbanek 9y ago

Pregnancy at least used to be one of the things insurance companies were excited to cover you for. It means you aren't sick, and the more money they spend (and labor is pretty cheap, compared to a lot of health care), the more likely they'll save it in the future by having a healthy mom and a healthy baby. Unhealthy/premature babies can be a huge ongoing expense.

sjg007 9y ago
No. Before the ACA pregnant women were specifically excluded without a rider.
just4themoney 9y ago
Not at all, pre-ACA it was impossible to purchase an individual plan that covered prenatal care and childbirth, they just weren't available. Couple self employed friends had babies during that time and they had to pay for everything out of pocket, tens of thousands of dollars. Also, being pregnant does not mean you "aren't sick," not sure what gave you that idea.
- cbanek 9y ago
  My bad, I was thinking of employer sponsored healthcare, and I think they usually didn't count labor under the deductible. But yes, buying any kind of healthcare on the public market pre-ACA was terrible. And I meant that being pregnant is a normal healthy condition, that happens to normal healthy people. Sick people can be pregnant, of course, and sickness can be precipitated by being pregnant (like gestational diabetes), but in general it's something that happens normally, unlike illnesses.
  - taxicabjesus 9y ago
    > And I meant that being pregnant is a normal healthy condition, that happens to normal healthy people. It was normal, until early 20th century doctors (mostly male) decided that the midwives (mostly female) didn't actually know anything about childbirth. To protect women from the "incompetent" midwives, the doctor guild successfully exterminated their competition. Midwives used to have little tricks for normal pregnancy problems, like how to get a breech baby to turn. Much of the institution's knowledge was lost in the Purge. I realized a while back that there are two books called The American Way of Birth [1]. The local science library had a copy of the earlier one. This book examines the "medicalization" of normal female experiences. [1] https://news.ycombinator.com/item?id=13742782 https://news.ycombinator.com/item?id=13742782 This 2013 NY Times article [2] has a nice summary of the effects of the medicalization of childbirth on the costs thereof: [...] Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute the single biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion. [...] Those payment incentives for providers also mean that American women with normal pregnancies tend to get more of everything, necessary or not, from blood tests to ultrasound scans, said Katy Kozhimannil, a professor at the University of Minnesota School of Public Health who studies the cost of women’s health care. [2] American Way of Birth, Costliest in the World - http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html?pagewanted=all#h[] http://www.nytimes.com/2013/07/01/health/american-way-of-bir... (this article was probably not directly inspired by either book of the same name) [minor edits - formatting, etc]

yjftsjthsd-h 9y ago

> we should focus on the top 5 because that would have more impact on women's health Eh, sorry if I'm missing something obvious, but isn't this true? Obviously it's best to pursue everything possible at once, but with limited resources it is optimal to hit them in order of magnitude.

joatmon-snoo 9y ago
Not if your first question is "why do so many pregnant mothers die during childbirth?" - GP's point is that it's a disheartening realization. That being said, it's not necessarily true - after all, if X resources would be more effective mitigating cause of death A than cause of death B, then presumably you would want to (from a utilitarian calculus) direct them to A, irrespective of whether A or B causes more deaths.
rabboRubble 9y ago
It's not that the person was wrong, it's that the person saw no difference between an accidental death (#1 cause) and death from pregnancy. Look at these causes, and you tell me which type of death a hospital can best actively prevent as a part of the treatment plan and those measures have the most impact: #1 Unintentional injuries #2 Cancer #3 Suicide #4 Heart disease #5 Chronic lower respiratory diseases #6 Pregnancy complications Think about which type of young patient comes to them with at minimum of 6 to 9 months of warning, so much time to prepare for the "event". Think about which type of patient can leave the hospital well with a completely normal life expectancy. Out of those #6 death options, pregnancy is the only type of event where, if you survive, you have a completely normal life & life expectancy. Given that, why wouldn't a hospital invest the resource? https://www.cdc.gov/women/lcod/2014/all-females/index.htm https://www.cdc.gov/women/lcod/2014/all-females/index.htm

sjg007 9y ago

This is a protocol issue. The United Kingdom and a few States follow a specific programme which dramatically improves maternal outcomes. The US needs to do two things: capture the data and implement the protocols.