7 ms·

Why are so many new and expectant mothers dying in the US?

54 points by chermanowicz 9y ago

anythingnonidin 9y ago
Does anyone have a summary?
- Consultant32452 9y ago
  Sure, the reason why is women are older, fatter, and have more chronic problems like diabetes when they're choosing to give birth. In some countries there aren't as many women dying because their doctors apparently aren't as sexist as American doctors, but equally importantly in the US it's more difficult to spread the costs of your health decisions to others. Also, the US is kinda shit with mental health problems, which are among the most common problems experienced during pregnancy.
  - phyzome 9y ago
    You're repeating the first subheading, but that subheading is setup partly as a strawman in the article. Read further.
    - Consultant32452 9y ago
      I read it. They never denied that the root causes of the problems were obesity, age, etc. All they did was blame the state for not paying to mitigate it and call American doctors sexist.
      - joe_the_user 9y ago
        They gave a fairly plausible argument that other nations had dealt with obesity effectively and thus that America's failure was a failure rather than just tough luck.
        Consultant32452 9y ago
        Yes, that's precisely what I said. The state didn't mitigate the results of their bad health decisions. Are we having a discussion about why maternal mortality has risen, or are we having a discussions about whether or not it's the state's responsibility to mitigate the poor health decisions of the individual? I assumed we were having the former.
    - revelation 9y ago
      Well, it is and it isn't. It is hard to take an article entirely serious when in passing it makes crass statements like It’s certainly representative of a bigger problem, that women in the US are not getting the medical attention they need.
      - SolaceQuantum 9y ago
        Is that untrue when the mortality rate for birth is so high?
        jquery 9y ago
        It could be. You have to think critically about hard problems. Solving them isn't easier with wishy-washy thinking.
  - kaitai 9y ago
    I don't think this is accurate. First, "choosing to give birth" is a little biased. In a state like Texas, 96% of Texas counties have no clinics that provided abortions. 43% of Texas women lived in those counties in 2014. Abortion rates are down there. Maternal mortality in Texas is the worst in the US. You'd be better off, as a mom, giving birth in Iran. South Dakota has one, maybe two clinics that do abortions, and they fly in docs from Minnesota. Abortions aren't that common there either. So "choice" is, well, not really there. Anyhow. Sexism certainly plays a role but it's not really the main thing. You can be a sexist pig doctor and still practice evidence-based care! OB/GYN in the US is often not evidence-based, does not use standardized protocols, and concentrates on the day of birth rather than pre- and post-natal care. In the US we are extraordinarily good at getting babies out alive. We are not good at getting babies to stay alive or keeping moms healthy/alive, because those goals don't involve one day of technical genius, they require sustained care and social services (good nutrition, access to mental health care, maternity leave including prenatal maternity leave, etc). Weird fun fact: some studies indicate that giving maternity leave the 2 weeks before giving birth has more positive influence on maternal and infant survival and health than increasing maternity leave from 6 months to 12 months. Just two weeks! And yet pre-birth maternity leave isn't standard at all in the US.
    - Consultant32452 9y ago
      >First, "choosing to give birth" is a little biased. Oh boy, I can already tell where this is headed. Okay, "choosing to get pregnant." >Abortions aren't that common there either. Cool, since abortions are so rare then the distinction between "choosing to get pregnant" and "choosing to give birth" is basically meaningless. >So "choice" is, well, not really there. TIL: the only way to "choose not to give birth" is an abortion. And the over half million abortions in the US each year are "not that common" and also "not a choice" due to the fact that abortion availability varies by region. >Sexism certainly plays a role but it's not really the main thing. That may be true, but I think the article is clearly suggesting that sexism plays a role. It refers to women as second class citizens. It also chastises the medical consensus that the maternal mortality rate is caused by: obesity, age, and chronic illness like diabetes is problematic because it places the fault on the people who are obese, unhealthy, and "choosing to get pregnant" later in life. >and social services Yes, we're in agreement there, that the article does suggest that the solution to the problem should be spreading the costs of the decisions of women across all of society in the form of social services. >And yet pre-birth maternity leave isn't standard at all in the US. Weird fun fact: some studies indicate that single motherhood significantly increases infant and maternal mortality, and yet we keep increasing the state incentives towards single motherhood.
- phyzome 9y ago
  Some bullet points: - US health care is shit overall (people are less healthy as a baseline) - Sexism in various ways: "Whether they are pregnant or not, women are second-class citizens when it comes to health care" - vs. men, and vs. their fetuses or babies when pregnant; maternal care not being prioritized in health care - Excessively invasive/interventionist healthcare practices - "With its uniquely fragmented health system, straddling states and federal government in a complex web of public and private, for-profit and nonprofit, it is nearly impossible to effectively tackle complex issues."
- kaitai 9y ago
  In an order that does not correspond with the article: Very high C-section rates, born out of OB/GYN training that concentrates on the abnormal and generally emphasizes an interventionist approach, shift mortality burden to mothers from children. Lack of standardization of care means OB/GYNs follow idiosyncratic rather than evidence-based protocols. This is particularly striking when it comes to maternal death from pre-eclampsia or HELLP. These are complications that are easy to treat in an algorithmic fashion if you care to bother. Anti-coagulants after C-section -- another boring, algorithmic treatment that would decrease mortality a bunch. Moms are getting a older and less healthy. This is also true in other countries and they do a lot better, because other countries make it a priority to deliver low-cost prenatal and maternal care. US emphasis on personal responsibility leads to an attitude that moms should treat themselves/advocate for themselves/blah blah. Prenatal care is not as easy to access as it should be, postnatal care is almost nonexistent (both medical and mental health). Inequality in the US, ranging from economic to straightforwardly racial, leads to poorer outcomes for many groups.
- tareqak 9y ago
  I'll give it a shot by quoting verbatim from the article. To be perfectly fair though, the article is very information dense and has a lot of supporting links as evidence: it's a worthwhile read in my opinion especially if this topic is important to you. >> Overall summary (last paragraph before the first subtitle) Through the course of reporting this story, it quickly became apparent that there is no single reason, but instead a complex brew of factors that, together, point to deep-rooted, systemic problems that run through the entire social and health care system of the country. Gender, class, race—and across all, a fragmented, mainly private health system—conspire to work against maternal health. >> Older, fatter, sicker: The fault of the mothers (first subtitle) In certain parts of the world—Scandinavia and Western Europe, in particular—a focus on more dedicated care, before, during, and after birth leads to dramatically different results. Instead, we need to understand why American women are fatter and sicker in the first place, and why manageable conditions end in women dying. >> Priority matters (second subtitle) When it comes to pregnant women, this manifests itself in a focus on the child, at the cost of a focus on the mother, as highlighted in a recent investigation by NPR and ProPublica into the issue. American women typically have three to five ultrasounds of their fetus, for instance, compared to the two or three British (and most other European) women have. Many other countries (including the UK) provide support from nurses and doulas after a woman has left the hospital, while that’s rarer in the US. Meanwhile, the US is the only rich country that doesn’t mandate maternity leave. This marked a big step forward given that suicide is the second leading cause of death among postpartum mothers. But a pregnant or postpartum woman who finds herself in need of mental health support still has to navigate a complex process of getting treatment, including waiting lists and screenings, said Joy Burkhard, who leads 2020 Mom, an organization focused on improving maternal mental health care in the US. Once the baby is born, new mothers in the US generally have to wait six weeks for their first post-delivery obstetrician-gynecologist (OB-GYN) appointment, so even if their doctor is trained to recognize symptoms of depression (which isn’t common) those first symptoms of depression that can follow delivery will be missed entirely. This contributes to a vast underdiagnosis of postpartum depression (only 50% cases are recognized in the US) and undertreatment of the condition (15% receive treatment). Suicide accounts for 20% of postpartum deaths. According to the CDC, as many as 17% of the pregnancy-related deaths caused by blood clots—like Liz Logelin’s—could be prevented with simple measures such as compression stockings, or anti-coagulants post-surgery. Such precautions are typically employed after other kinds of surgery, yet often aren’t after c-sections. It was only in 2011 that the American College of Obstetricians and Gynecologists (ACOG) postpartum guidelines were updated to recommend anticoagulant therapies following a c-section. >> Birthing while black (third subtitle) But 10 days past her due date, even though neither she nor the baby showed any signs of distress, the personnel at the hospital insisted on inducing labor. Maddy Oden, her mother, remembers her daughter arguing with the staff that she did not want to be induced, but “finally the nurse said ‘well, you don’t want to go home with a dead baby, do you?’” This succeeded in gaining her daughter’s assent. She said it was only later, after both Tatia and baby Zorah had died during an emergency c-section, that the family was told that the drug, misoprostol, could cause severe side effects, including amniotic fluid embolism, a potentially lethal complication of childbirth that occurs when amniotic fluid enters the bloodstream. >> A matter of access (fourth subtitle) “Maternal health doesn’t just begin [and end] at pregnancy,” says Nadia Hussein, an advocate with MomsRising, noting that health care before, in between and after pregnancies is equally important, especially for the 20% of women dependent on Medicaid who suffer from chronic conditions like depression, hypertension, and type 2 diabetes. For example, of the 3,144 counties that make up the US, more than a third—1,263—don’t have an OB-GYN. By 2020, it is estimated the country will be 8,000 to 9,000 OB-GYNs short, largely because the number of OB-GYNs has remained steady since the 1980s, while the population has continued to grow. Financial pressures are, once again, a major reason why. OB-GYNs pay the second-highest malpractice insurance rates after neurosurgeons, reflecting their exposure to a high risk of claims against them. (78% of ACOG fellows have been sued at least once in their career.) Crear-Perry describes the hospital birthing practice as a mix of “efficiency and fear of litigation.” There are, she says, certain delivering techniques, for instance how to turn a baby who’s in an inconvenient position for birth, that are no longer taught to OB-GYNs. They are instead trained to turn to surgical intervention whenever the situation isn’t straightforward, or if delivery isn’t happening within a certain timeframe. >> Too much is not enough (fifth subtitle) C-sections, after all, are far more convenient for a hospital. They are easier to schedule, quicker, and make a lot more money; a US hospital can, on average, bill 50% more for a c-section than a vaginal delivery. Jennie Joseph, a British-trained nurse midwife who has been practicing in the US for the past 26 years and runs Commonsense Childbirth, a birth center which offers midwifery prenatal care in Orlando, Florida, sums it all up effectively: “It’s racism, it’s classism, it’s sexism: All of these things are at play and […] the intersection with capitalism and power,” she told Quartz. “[Women] are dying of a system that’s broken.” >> No country for new mothers (sixth subtitle) If the US was like other rich countries, a health crisis such as this would be met with a flurry of initiatives, spearheaded and mandated at a federal level, to find out why mothers are dying, and to figure out ways to reverse it. But the US isn’t like other rich countries. With its uniquely fragmented health system, straddling states and federal government in a complex web of public and private, for-profit and nonprofit, it is nearly impossible to effectively tackle complex issues. For years, 27 state review groups known as maternal mortality review committees (MMRCs)—some which have sprung from public-health initiatives, others via state OB-GYN societies—have tried to look at available data to assess the causes of maternal death, and if and how they were preventable. Five years ago, the CDC embarked on an effort to coordinate this ad-hoc system of state-by-state analysis of maternal mortality, providing guidance to help individual review committees standardize their findings to make them comparable across states. However, the CDC still isn’t involved directly in the reviews and, so far, the committees continue to operate independently from one another, says Goodman. It’s a leadership void that in the past few years has been filled in part by a private-sector actor. Though the program was built for developing countries with maternal mortality outcomes far worse than the US, Naveen Rao, the doctor who leads it, says Merck for Mothers was expanded to include the US in response to the poor state of childbirth outcomes in the country. >> There is a graph with the title Maternal mortality halved in California while it doubled in the US I hope that helps.
joe_the_user 9y ago
The US' health care statistics generally now put it at "second world status". For example, it's infant mortality put on par with Russia, Eastern Europe, parts of the Mid East and pacific islands [1], At the same, we spend the largest percentage of our GDP on health care of any nation. [1] https://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate https://en.wikipedia.org/wiki/List_of_countries_by_infant_mo...
- Para2016 9y ago
  From the wiki itself: Note that due to differences in reporting, these numbers may not be comparable across countries; while the WHO recommendation is that all children who show signs of life should be recorded as live births, in many countries this standard is not followed, artificially lowering their infant mortality rates relative to countries which follow those standards. -So, how does the US record live births? Does the US count a 22 week old premature birth as a live birth? Does the EU? If it is different, I wonder if it would account for a lot of the difference.
  - joe_the_user 9y ago
    While any given statistic is rather uncertain, a read of the long parent article gives a taste of how the US has essentially abandoned a larger public health approach to the various health problem it faces and those other countries which have instead kept this approach, of dealing with new health threats as they appear, have managed to lower maternal deaths (again for example) while the US has seen an increase in maternal deaths (and so forth).
    - jquery 9y ago
      > a read of the long parent article Sloppy reporting and mixing/matching disparate statistics in an incoherent way isn't improved by length. In fact I'd argue it gets worse and the conclusion can be trusted even less.
      - zaroth 9y ago
bsder 9y ago
Lack of universal healthcare. Next question.
rayiner 9y ago
More quantitatively rigorous analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058. > Considering the comparable sample reported in Panel A of Table 2, one-year infant mortality in the North East is 3.16 deaths per 1000 live births, whereas in the East South Central region (Oklahoma, Arkansas, Louisiana and Texas) this figure is 6.30 per 1000. Both the North East and the Pacific divisions have overall infant mortality rates within the distribution of the European countries considered. If the North East were a country, it would be similar to Austria. > Consistent with this assertion, Almond et al. (2010) analyze the mortality consequences of incremental increases in medical expenditures for at-risk infants (including NICU admission as well as other expenditures), and find that the mortality benefits of additional medical care are concentrated in the first 28 days of life. Our results suggest that if anything the US has a mortality advantage during the neonatal period. > Instead, the facts documented here suggest that, in general, policy attention should focus on either preventing preterm births or on reducing postneonatal mortality. > Notably, in light of our income results, these policies do not focus on alleviating resource constraints per se but rather on providing information and support targeted to mothers and infants.
- kaitai 9y ago
  The US is soooo good at the medical save for babies! Thank you for the cite, rayiner, as it illuminates something done relatively well here. The Finnish baby box system has received a lot of press in the US. Americans think, oh, safe sleep, it'll reduce SIDS/SUID. While that may be true, the whole scam in Finland (since 1949) was that you only got a box if you went to your new free prenatal appointments! Can you imagine the US saying, hey, we'll give all moms & babies cute free stuff if you take advantage of prenatal care! The current situation is rather different.
  - kaitai 9y ago
    I have to say I'm a little surprised at the downvotes. I said much snarkier things elsewhere. US good at medical intervention for neonatal mortality, Finland good at providing consistent prenatal care -- what's the offensive or untrue part?
sirspacey 9y ago
To add a focal point to the context this article provides - the keyword in this article is "cesarean." We presume in the US health system it is normative. It is surgery. The other countries listed all have strong midwifery communities with significant hospital privileged. One of the ways midwives help reduce mortality rates is enable even births with complications to be delivered without surgery. If you have a baby on the way, consider a visit to a midwife. If nothing else, you'll gain access to knowledge, experience and training doctors do not typically receive in the US.
- sabujp 9y ago
  depends on the complication, but sometimes for the health of the baby and mom csection is absolutely necessary
  - QAPereo 9y ago
    You don’t see more than 10%-15% of live births in a large population requiring cesarean for medical reasons. In the US the rate is over 34% of live births via cesarean.
    - rayiner 9y ago
      The statistic is useless without reference to mothers' health and weight. Heavier moms are at higher risk for C sections, and the U.S. rate of obesity is much higher than in Europe.
      - kaitai 9y ago
        In the US, breech babies (4%) are automatic C-sections almost everywhere regardless of maternal condition. This is not true elsewhere. There are also a fair number of purely elective (mother-chosen) C-sections in the US. Obesity is a factor but it does not account for US C-section rates.
- rayiner 9y ago
  My dad spent much of his career in public health trying to figure out how to get women in places like Bangladesh to go visit hospitals instead of midwives. He does not find the midwife trend in America amusing. Relevant: http://www.skepticalob.com/2014/09/awesome-dutch-midwives-kill-just-as-many-babies-in-the-hospital-as-at-home.html http://www.skepticalob.com/2014/09/awesome-dutch-midwives-ki....

54 points by chermanowicz 9y ago

anythingnonidin 9y ago

Does anyone have a summary?

Consultant32452 9y ago
Sure, the reason why is women are older, fatter, and have more chronic problems like diabetes when they're choosing to give birth. In some countries there aren't as many women dying because their doctors apparently aren't as sexist as American doctors, but equally importantly in the US it's more difficult to spread the costs of your health decisions to others. Also, the US is kinda shit with mental health problems, which are among the most common problems experienced during pregnancy.
- phyzome 9y ago
  You're repeating the first subheading, but that subheading is setup partly as a strawman in the article. Read further.
  - Consultant32452 9y ago
    I read it. They never denied that the root causes of the problems were obesity, age, etc. All they did was blame the state for not paying to mitigate it and call American doctors sexist.
    - joe_the_user 9y ago
      They gave a fairly plausible argument that other nations had dealt with obesity effectively and thus that America's failure was a failure rather than just tough luck.
      - Consultant32452 9y ago
        Yes, that's precisely what I said. The state didn't mitigate the results of their bad health decisions. Are we having a discussion about why maternal mortality has risen, or are we having a discussions about whether or not it's the state's responsibility to mitigate the poor health decisions of the individual? I assumed we were having the former.
  - revelation 9y ago
    Well, it is and it isn't. It is hard to take an article entirely serious when in passing it makes crass statements like It’s certainly representative of a bigger problem, that women in the US are not getting the medical attention they need.
    - SolaceQuantum 9y ago
      Is that untrue when the mortality rate for birth is so high?
      - jquery 9y ago
        It could be. You have to think critically about hard problems. Solving them isn't easier with wishy-washy thinking.
- kaitai 9y ago
  I don't think this is accurate. First, "choosing to give birth" is a little biased. In a state like Texas, 96% of Texas counties have no clinics that provided abortions. 43% of Texas women lived in those counties in 2014. Abortion rates are down there. Maternal mortality in Texas is the worst in the US. You'd be better off, as a mom, giving birth in Iran. South Dakota has one, maybe two clinics that do abortions, and they fly in docs from Minnesota. Abortions aren't that common there either. So "choice" is, well, not really there. Anyhow. Sexism certainly plays a role but it's not really the main thing. You can be a sexist pig doctor and still practice evidence-based care! OB/GYN in the US is often not evidence-based, does not use standardized protocols, and concentrates on the day of birth rather than pre- and post-natal care. In the US we are extraordinarily good at getting babies out alive. We are not good at getting babies to stay alive or keeping moms healthy/alive, because those goals don't involve one day of technical genius, they require sustained care and social services (good nutrition, access to mental health care, maternity leave including prenatal maternity leave, etc). Weird fun fact: some studies indicate that giving maternity leave the 2 weeks before giving birth has more positive influence on maternal and infant survival and health than increasing maternity leave from 6 months to 12 months. Just two weeks! And yet pre-birth maternity leave isn't standard at all in the US.
  - Consultant32452 9y ago
    >First, "choosing to give birth" is a little biased. Oh boy, I can already tell where this is headed. Okay, "choosing to get pregnant." >Abortions aren't that common there either. Cool, since abortions are so rare then the distinction between "choosing to get pregnant" and "choosing to give birth" is basically meaningless. >So "choice" is, well, not really there. TIL: the only way to "choose not to give birth" is an abortion. And the over half million abortions in the US each year are "not that common" and also "not a choice" due to the fact that abortion availability varies by region. >Sexism certainly plays a role but it's not really the main thing. That may be true, but I think the article is clearly suggesting that sexism plays a role. It refers to women as second class citizens. It also chastises the medical consensus that the maternal mortality rate is caused by: obesity, age, and chronic illness like diabetes is problematic because it places the fault on the people who are obese, unhealthy, and "choosing to get pregnant" later in life. >and social services Yes, we're in agreement there, that the article does suggest that the solution to the problem should be spreading the costs of the decisions of women across all of society in the form of social services. >And yet pre-birth maternity leave isn't standard at all in the US. Weird fun fact: some studies indicate that single motherhood significantly increases infant and maternal mortality, and yet we keep increasing the state incentives towards single motherhood.
phyzome 9y ago
Some bullet points: - US health care is shit overall (people are less healthy as a baseline) - Sexism in various ways: "Whether they are pregnant or not, women are second-class citizens when it comes to health care" - vs. men, and vs. their fetuses or babies when pregnant; maternal care not being prioritized in health care - Excessively invasive/interventionist healthcare practices - "With its uniquely fragmented health system, straddling states and federal government in a complex web of public and private, for-profit and nonprofit, it is nearly impossible to effectively tackle complex issues."
kaitai 9y ago
In an order that does not correspond with the article: Very high C-section rates, born out of OB/GYN training that concentrates on the abnormal and generally emphasizes an interventionist approach, shift mortality burden to mothers from children. Lack of standardization of care means OB/GYNs follow idiosyncratic rather than evidence-based protocols. This is particularly striking when it comes to maternal death from pre-eclampsia or HELLP. These are complications that are easy to treat in an algorithmic fashion if you care to bother. Anti-coagulants after C-section -- another boring, algorithmic treatment that would decrease mortality a bunch. Moms are getting a older and less healthy. This is also true in other countries and they do a lot better, because other countries make it a priority to deliver low-cost prenatal and maternal care. US emphasis on personal responsibility leads to an attitude that moms should treat themselves/advocate for themselves/blah blah. Prenatal care is not as easy to access as it should be, postnatal care is almost nonexistent (both medical and mental health). Inequality in the US, ranging from economic to straightforwardly racial, leads to poorer outcomes for many groups.
tareqak 9y ago
I'll give it a shot by quoting verbatim from the article. To be perfectly fair though, the article is very information dense and has a lot of supporting links as evidence: it's a worthwhile read in my opinion especially if this topic is important to you. >> Overall summary (last paragraph before the first subtitle) Through the course of reporting this story, it quickly became apparent that there is no single reason, but instead a complex brew of factors that, together, point to deep-rooted, systemic problems that run through the entire social and health care system of the country. Gender, class, race—and across all, a fragmented, mainly private health system—conspire to work against maternal health. >> Older, fatter, sicker: The fault of the mothers (first subtitle) In certain parts of the world—Scandinavia and Western Europe, in particular—a focus on more dedicated care, before, during, and after birth leads to dramatically different results. Instead, we need to understand why American women are fatter and sicker in the first place, and why manageable conditions end in women dying. >> Priority matters (second subtitle) When it comes to pregnant women, this manifests itself in a focus on the child, at the cost of a focus on the mother, as highlighted in a recent investigation by NPR and ProPublica into the issue. American women typically have three to five ultrasounds of their fetus, for instance, compared to the two or three British (and most other European) women have. Many other countries (including the UK) provide support from nurses and doulas after a woman has left the hospital, while that’s rarer in the US. Meanwhile, the US is the only rich country that doesn’t mandate maternity leave. This marked a big step forward given that suicide is the second leading cause of death among postpartum mothers. But a pregnant or postpartum woman who finds herself in need of mental health support still has to navigate a complex process of getting treatment, including waiting lists and screenings, said Joy Burkhard, who leads 2020 Mom, an organization focused on improving maternal mental health care in the US. Once the baby is born, new mothers in the US generally have to wait six weeks for their first post-delivery obstetrician-gynecologist (OB-GYN) appointment, so even if their doctor is trained to recognize symptoms of depression (which isn’t common) those first symptoms of depression that can follow delivery will be missed entirely. This contributes to a vast underdiagnosis of postpartum depression (only 50% cases are recognized in the US) and undertreatment of the condition (15% receive treatment). Suicide accounts for 20% of postpartum deaths. According to the CDC, as many as 17% of the pregnancy-related deaths caused by blood clots—like Liz Logelin’s—could be prevented with simple measures such as compression stockings, or anti-coagulants post-surgery. Such precautions are typically employed after other kinds of surgery, yet often aren’t after c-sections. It was only in 2011 that the American College of Obstetricians and Gynecologists (ACOG) postpartum guidelines were updated to recommend anticoagulant therapies following a c-section. >> Birthing while black (third subtitle) But 10 days past her due date, even though neither she nor the baby showed any signs of distress, the personnel at the hospital insisted on inducing labor. Maddy Oden, her mother, remembers her daughter arguing with the staff that she did not want to be induced, but “finally the nurse said ‘well, you don’t want to go home with a dead baby, do you?’” This succeeded in gaining her daughter’s assent. She said it was only later, after both Tatia and baby Zorah had died during an emergency c-section, that the family was told that the drug, misoprostol, could cause severe side effects, including amniotic fluid embolism, a potentially lethal complication of childbirth that occurs when amniotic fluid enters the bloodstream. >> A matter of access (fourth subtitle) “Maternal health doesn’t just begin [and end] at pregnancy,” says Nadia Hussein, an advocate with MomsRising, noting that health care before, in between and after pregnancies is equally important, especially for the 20% of women dependent on Medicaid who suffer from chronic conditions like depression, hypertension, and type 2 diabetes. For example, of the 3,144 counties that make up the US, more than a third—1,263—don’t have an OB-GYN. By 2020, it is estimated the country will be 8,000 to 9,000 OB-GYNs short, largely because the number of OB-GYNs has remained steady since the 1980s, while the population has continued to grow. Financial pressures are, once again, a major reason why. OB-GYNs pay the second-highest malpractice insurance rates after neurosurgeons, reflecting their exposure to a high risk of claims against them. (78% of ACOG fellows have been sued at least once in their career.) Crear-Perry describes the hospital birthing practice as a mix of “efficiency and fear of litigation.” There are, she says, certain delivering techniques, for instance how to turn a baby who’s in an inconvenient position for birth, that are no longer taught to OB-GYNs. They are instead trained to turn to surgical intervention whenever the situation isn’t straightforward, or if delivery isn’t happening within a certain timeframe. >> Too much is not enough (fifth subtitle) C-sections, after all, are far more convenient for a hospital. They are easier to schedule, quicker, and make a lot more money; a US hospital can, on average, bill 50% more for a c-section than a vaginal delivery. Jennie Joseph, a British-trained nurse midwife who has been practicing in the US for the past 26 years and runs Commonsense Childbirth, a birth center which offers midwifery prenatal care in Orlando, Florida, sums it all up effectively: “It’s racism, it’s classism, it’s sexism: All of these things are at play and […] the intersection with capitalism and power,” she told Quartz. “[Women] are dying of a system that’s broken.” >> No country for new mothers (sixth subtitle) If the US was like other rich countries, a health crisis such as this would be met with a flurry of initiatives, spearheaded and mandated at a federal level, to find out why mothers are dying, and to figure out ways to reverse it. But the US isn’t like other rich countries. With its uniquely fragmented health system, straddling states and federal government in a complex web of public and private, for-profit and nonprofit, it is nearly impossible to effectively tackle complex issues. For years, 27 state review groups known as maternal mortality review committees (MMRCs)—some which have sprung from public-health initiatives, others via state OB-GYN societies—have tried to look at available data to assess the causes of maternal death, and if and how they were preventable. Five years ago, the CDC embarked on an effort to coordinate this ad-hoc system of state-by-state analysis of maternal mortality, providing guidance to help individual review committees standardize their findings to make them comparable across states. However, the CDC still isn’t involved directly in the reviews and, so far, the committees continue to operate independently from one another, says Goodman. It’s a leadership void that in the past few years has been filled in part by a private-sector actor. Though the program was built for developing countries with maternal mortality outcomes far worse than the US, Naveen Rao, the doctor who leads it, says Merck for Mothers was expanded to include the US in response to the poor state of childbirth outcomes in the country. >> There is a graph with the title Maternal mortality halved in California while it doubled in the US I hope that helps.

joe_the_user 9y ago

The US' health care statistics generally now put it at "second world status". For example, it's infant mortality put on par with Russia, Eastern Europe, parts of the Mid East and pacific islands [1], At the same, we spend the largest percentage of our GDP on health care of any nation. [1] https://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate https://en.wikipedia.org/wiki/List_of_countries_by_infant_mo...

Para2016 9y ago
From the wiki itself: Note that due to differences in reporting, these numbers may not be comparable across countries; while the WHO recommendation is that all children who show signs of life should be recorded as live births, in many countries this standard is not followed, artificially lowering their infant mortality rates relative to countries which follow those standards. -So, how does the US record live births? Does the US count a 22 week old premature birth as a live birth? Does the EU? If it is different, I wonder if it would account for a lot of the difference.
- joe_the_user 9y ago
  While any given statistic is rather uncertain, a read of the long parent article gives a taste of how the US has essentially abandoned a larger public health approach to the various health problem it faces and those other countries which have instead kept this approach, of dealing with new health threats as they appear, have managed to lower maternal deaths (again for example) while the US has seen an increase in maternal deaths (and so forth).
  - jquery 9y ago
    > a read of the long parent article Sloppy reporting and mixing/matching disparate statistics in an incoherent way isn't improved by length. In fact I'd argue it gets worse and the conclusion can be trusted even less.
    - zaroth 9y ago

bsder 9y ago

Lack of universal healthcare. Next question.

rayiner 9y ago

More quantitatively rigorous analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058. > Considering the comparable sample reported in Panel A of Table 2, one-year infant mortality in the North East is 3.16 deaths per 1000 live births, whereas in the East South Central region (Oklahoma, Arkansas, Louisiana and Texas) this figure is 6.30 per 1000. Both the North East and the Pacific divisions have overall infant mortality rates within the distribution of the European countries considered. If the North East were a country, it would be similar to Austria. > Consistent with this assertion, Almond et al. (2010) analyze the mortality consequences of incremental increases in medical expenditures for at-risk infants (including NICU admission as well as other expenditures), and find that the mortality benefits of additional medical care are concentrated in the first 28 days of life. Our results suggest that if anything the US has a mortality advantage during the neonatal period. > Instead, the facts documented here suggest that, in general, policy attention should focus on either preventing preterm births or on reducing postneonatal mortality. > Notably, in light of our income results, these policies do not focus on alleviating resource constraints per se but rather on providing information and support targeted to mothers and infants.

kaitai 9y ago
The US is soooo good at the medical save for babies! Thank you for the cite, rayiner, as it illuminates something done relatively well here. The Finnish baby box system has received a lot of press in the US. Americans think, oh, safe sleep, it'll reduce SIDS/SUID. While that may be true, the whole scam in Finland (since 1949) was that you only got a box if you went to your new free prenatal appointments! Can you imagine the US saying, hey, we'll give all moms & babies cute free stuff if you take advantage of prenatal care! The current situation is rather different.
- kaitai 9y ago
  I have to say I'm a little surprised at the downvotes. I said much snarkier things elsewhere. US good at medical intervention for neonatal mortality, Finland good at providing consistent prenatal care -- what's the offensive or untrue part?

sirspacey 9y ago

To add a focal point to the context this article provides - the keyword in this article is "cesarean." We presume in the US health system it is normative. It is surgery. The other countries listed all have strong midwifery communities with significant hospital privileged. One of the ways midwives help reduce mortality rates is enable even births with complications to be delivered without surgery. If you have a baby on the way, consider a visit to a midwife. If nothing else, you'll gain access to knowledge, experience and training doctors do not typically receive in the US.

sabujp 9y ago
depends on the complication, but sometimes for the health of the baby and mom csection is absolutely necessary
- QAPereo 9y ago
  You don’t see more than 10%-15% of live births in a large population requiring cesarean for medical reasons. In the US the rate is over 34% of live births via cesarean.
  - rayiner 9y ago
    The statistic is useless without reference to mothers' health and weight. Heavier moms are at higher risk for C sections, and the U.S. rate of obesity is much higher than in Europe.
    - kaitai 9y ago
      In the US, breech babies (4%) are automatic C-sections almost everywhere regardless of maternal condition. This is not true elsewhere. There are also a fair number of purely elective (mother-chosen) C-sections in the US. Obesity is a factor but it does not account for US C-section rates.
rayiner 9y ago
My dad spent much of his career in public health trying to figure out how to get women in places like Bangladesh to go visit hospitals instead of midwives. He does not find the midwife trend in America amusing. Relevant: http://www.skepticalob.com/2014/09/awesome-dutch-midwives-kill-just-as-many-babies-in-the-hospital-as-at-home.html http://www.skepticalob.com/2014/09/awesome-dutch-midwives-ki....