Maternal Mortality in the USA

As I'm sure everyone has heard the heartbreaking news about our AZ Treasurer who lost his wife and newborn son due to complications during her delivery. My heart goes out to him and his family. While Kerry Martin's complications were very rare, I feel that this has definitely drawn attention to the subject of maternal mortality. I found a link to the following information from the most recent post at NursingBirth. This fact sheet originally came from The Safe Motherhood Quilt Project which aims at bringing awareness to the high maternal mortality rate in the US, as well as remembering those mothers who have died due to pregnancy related causes. I found this information to be very eye opening.

Maternal Mortality in the USA
A Fact Sheet

• The World Health Organization reported in 2007 that 40 other countries
have lower maternal death rates than the United States.

• The Centers for Disease Control (CDC) report that there has been no
improvement in the maternal death rate in the United States since 1982.

• The CDC estimated in 1998 that the US maternal death rate is actually 1.3
to three times that reported in vital statistics records because of
underreporting of such deaths. (1)

• The CDC reported in 1995 that the “magnitude of the pregnancy-related
mortality problem is grossly understated.” (2)

• The rate of maternal death directly related to pregnancy or birth appears
to be rising in the United States. In 1982, the rate was approximately 7.5
deaths per 100,000 live births. By 2004, that rate had risen to 13.1 deaths
per 100,000 births. By 2005, the rate was 15.1 deaths.

• The CDC estimates that more than half of the reported maternal deaths
in the United States could have been prevented by early diagnosis and
treatment. (1)

• Autopsies should be performed on all women of childbearing age who die
if there is to be complete ascertainment of maternal deaths.

• Numerous studies have found that in 25 to 40 percent of cases in which an
autopsy is done, it reveals an undiagnosed cause of death.

• In the 1960s, autopsies were performed on almost half of deaths.

.• The United States now does autopsies on fewer than 5 percent of hospital
deaths.

• Reporting of maternal deaths in the United States is done via an honor
system. There are no statutes providing for penalties for misreporting or
failing to report maternal deaths.

• In the United States, the risk of maternal death among black women is
about 4 times higher than among white women. For 2005, the rate was 36.5
deaths per 100,000 live births.

• Most countries with lower maternal death rates than the United States use
a different definition of “maternal death”, which, unlike the United States’
definition, includes those deaths directly related to pregnancy or birth
which take place during the period between six weeks postpartum and
one year after the end of pregnancy.

• Complete and correct ascertainment of all maternal deaths is key to
preventing maternal deaths.

• The Confidential Enquiry into Maternal Deaths in the United Kingdom
(England, Scotland, Wales, Northern Ireland), which has functioned since
1952, is the system believed to have achieved the most complete
ascertainment of maternal deaths while guaranteeing utmost
confidentiality. See http://www.cemach.org.uk/

• The maternal mortality rate for cesarean section is four times higher than
for vaginal birth and is still twice as high when it is a routine repeat
cesarean section without any emergency. (3,4)

• There is currently no federal legislation mandating maternal mortality
review at a state level.

• Fewer than half of the states conduct state-wide maternal mortality
review.

• Hospitals do not release reports of maternal deaths to the public; hospital
employees are required to keep such information to themselves.

• The Healthy People 2010 Goal is no more than 3.3 maternal deaths per
100,000 births. This is a goal that other nations have achieved.

Notes
1. Morbidity and Mortality Weekly Report, September 4, 1998, Vol. 47, No. 34.
2. Atrash HK, Alexander S, Berg CJ. Maternal mortality in developed
countries: Not just a concern of the past. Obstet Gynecol 1995;86:700-5.
3. Petitti D et al. In hospital maternal mortality in the United States. Obstet
Gynecol, Vol 59, pp. 6-11, 1982.
4. Petitti D. Maternal mortality and morbidity in cesarean section. Clin Obstet
Gynecol, Vol. 28, pp. 763-768, 1985.
5. The Confidential Enquiry into Maternal Deaths in the United Kingdom
www.cemach.org.uk
Prepared by Ina May Gaskin, MA, CPM
Coordinator for the Safe Motherhood Quilt Project
149 Apple Orchard Lane
Summertown, TN 38483
www.rememberthemothers.net
http://www.inamay.com/

For a great list of 10 ways to reduce your risk for complications in pregnancy and childbirth check out this post at NursingBirth.

Article from Time Magazine

Here is an article that was featured in Time Magazine back in February. I ran across it again today and wanted to share. I think it does a good job of shedding light on some of the challenges women are faced with when wanting a vbac in America, along with some of the reasons why there is so much resistance from doctors and hospitals.

(I highlighted some parts that really stood out to me)

The Trouble With Repeat Cesareans
By Pamela Paul Thursday, Feb. 19, 2009

To avoid another C-section, Barton has to drive 100 miles to deliver in Los Angeles.

For many pregnant women in America, it is easier today to walk into a hospital and request major abdominal surgery than it is to give birth as nature intended. Jessica Barton knows this all too well. At 33, the curriculum developer in Santa Barbara, Calif., is expecting her second child in June. But since her first child ended up being delivered by cesarean section, she can't find an obstetrician in her county who will let her even try to push this go-round. And she could locate only one doctor in nearby Ventura County who allows the option of vaginal birth after cesarean (VBAC). But what if he's not on call the day she goes into labor? That's why, in order to give birth the old-fashioned way, Barton is planning to go to UCLA Medical Center in Los Angeles. "One of my biggest worries is the 100-mile drive to the hospital," she says. "It can take from 2 to 3 1/2 hours. I know it will be uncomfortable, and I worry about waiting too long and giving birth in the car."

Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them. More than 9 out of 10 births following a C-section are now surgical deliveries, proving that "once a cesarean, always a cesarean"--an axiom thought to be outmoded in the 1990s--is alive and kicking. Indeed, the International Cesarean Awareness Network (ICAN), a grass-roots group, recently called 2,850 hospitals that have labor and delivery wards and found that 28% of them don't allow VBACs, up from 10% in its previous survey, in 2004. ICAN's latest findings note that another 21% of hospitals have what it calls "de facto bans," i.e., the hospitals have no official policies against VBAC, but no obstetricians will perform them. (Read "The Year in Medicine 2008: From A to Z.")

Why the VBAC-lash? Not so long ago, doctors were actually encouraging women to have VBACs, which cost less than cesareans and allow mothers to heal more quickly. The risk of uterine rupture during VBAC is real--and can be fatal to both mom and baby--but rupture occurs in just 0.7% of cases. That's not an insignificant statistic, but the number of catastrophic cases is low; only 1 in 2,000 babies die or suffer brain damage as a result of oxygen deprivation.
After 1980, when the National Institutes of Health (NIH) held a conference on skyrocketing cesarean rates, more women began having VBACs. By 1996, they accounted for 28% of births among C-section veterans, and in 2000, the Federal Government issued its Healthy People 2010 report proposing a target VBAC rate of 37%. Yet as of 2006, only about 8% of births were VBACs, and the numbers continue to fall--even though 73% of women who go this route successfully deliver without needing an emergency cesarean.

So what happened? In 1999, after several high-profile cases in which women undergoing VBAC ruptured their uterus, the American College of Obstetricians and Gynecologists (ACOG) changed its guidelines from stipulating that surgeons and anesthesiologists should be "readily available" during a VBAC to "immediately available." "Our goal wasn't to narrow the scope of patients who would be eligible, but to make it safe," says Dr. Carolyn Zelop, co-author of ACOG's most recent VBAC guidelines.But many interpreted the revision to mean that surgical staff must be present the entire time a VBAC patient is in labor. While major medical centers and hospitals with residents are staffed to provide this level of round-the-clock care, smaller hospitals typically rely on anesthesiologists on call. Among obstetricians, many solo practitioners are unable to stay for what could end up being a 24-hour delivery; others calculate the loss of unseen patients during that time and instead opt to do hour-long cesareans, which are now the most commonly performed surgeries on women in the U.S.

Some doctors, however, argue that any facility ill equipped for VBACs shouldn't do labor and delivery at all. "How can a hospital say it can handle an emergency C-section due to fetal distress yet not be able to do a VBAC?" asks Dr. Mark Landon, a maternal-fetal-medicine specialist at the Ohio State University Medical Center and lead investigator of the NIH's largest prospective VBAC study. (See 9 kid foods to avoid.)

Part of the answer has to do with malpractice insurance. Following a few major lawsuits stemming from VBAC cases, many insurers started jacking up the price of malpractice coverage for ob-gyns who perform such births. In a 2006 ACOG survey of 10,659 ob-gyns nationwide, 26% said they had given up on VBACs because insurance was unaffordable or unavailable; 33% said they had dropped VBACs out of fear of litigation. "It's a numbers thing," says Dr. Shelley Binkley, an ob-gyn in private practice in Colorado Springs who stopped offering VBACs in 2003. "You don't get sued for doing a C-section. You get sued for not doing a C-section."

Of course, the alternative to a VBAC isn't risk-free either. With each repeat cesarean, a mother's risk of heavy bleeding, infection and infertility, among other complications, goes up. Perhaps most alarming, repeat C-sections increase a woman's chances of developing life-threatening placental abnormalities that can cause hemorrhaging during childbirth. The rate of placenta accreta--in which the placenta attaches abnormally to the uterine wall--has increased thirtyfold in the past 30 years. "The problem is only beginning to mushroom," says ACOG's Zelop.

"The decline in VBACs is driven both by patient preference and by provider preference," says Dr. Hyagriv Simhan, medical director of the maternal-fetal-medicine department of Magee-Womens Hospital of the University of Pittsburgh Medical Center. But while many obstetricians say fewer patients are requesting VBACs, others counter that the medical profession has been too discouraging of them. Dr. Stuart Fischbein, an ob-gyn whose Camarillo, Calif., hospital won't allow the procedure, is concerned that women are getting "skewed" information about the risks of a VBAC "that leads them down the path that the doctor or hospital wants them to follow, as opposed to medical information that helps them make the best decision." According to a nationwide survey by Childbirth Connection, a 91-year-old maternal-care advocacy group based in New York City, 57% of C-section veterans who gave birth in 2005 were interested in a VBAC but were denied the option of having one.

Zelop is among those who worry that "the pendulum has swung too far the other way," but, she says, "I don't know whether we can get back to a higher number of VBACs, because doctors are afraid and hospitals are afraid." So how to reverse the trend? For one thing, patients and doctors need to be as aware of the risks of multiple cesareans as they are of those of VBACs. That is certain to be on the agenda when the NIH holds its first conference on VBACs next year. But Zelop fears that the obstetrical C-change may come too late: "When the problems with multiple C-sections start to mount, we're going to look back and say, 'Oh, does anyone still know how to do VBAC?'"

On Being Prepared

A few weeks ago I began questioning myself as to why I was preparing so much ahead of time for my vbac and taking the time to blog about it. I'm not pregnant, and I'm not 100% sure when I will be pregnant again. Why do all this without a due date in sight? After breaking down and talking to my husband about it, I was able to reconfirm my true intentions.

1st- When I do see those two pink lines confirming that I am pregnant, I don't want to immediately feel dread thinking that I am going to relive my last birth experience. I don't want there to be any feelings of negativity or fear in sight. I want to feel happy, happy to be pregnant and happy because I know this time will be better no matter what. Even if I end up truly needing a cesarean section it will be better. Even if I have to be in the hospital again it will be better. It will be better because I took the time to prepare myself. This doesn't mean that my need to prepare will end once I am pregnant.
2nd- I want to get the word out on the high statistics of cesarean sections in the US, along with resources and support for those wishing to VBAC. I've been through one cesarean section and honestly I would love to help prevent an unnecessary one from happening to any woman out there. I know so many who have had unnecessary cesarean sections and I can't help but want to warn others of this is a major issue. I have also found that a lot of pregnant women out there were a lot like me and didn't know all their birthing options and rights. I didn't know anything about the effects of certain medical interventions and unfortunately these tend to lead to cesarean sections. Knowlegde=power and can ultimately lead to a better birth experience.

3rd- Preparing yourself for a birth experience takes a good amount of time. Just as finding a new home, purchasing a car or any other big life change, there is a lot of planning involved. The birth of your child can be the most life changing event, thus it should require even more careful thought and research. This includes researching ones birth options, interviewing care providers and deciding on ultimately where one wants to birth. Eating well and exercising to promote good health should be practiced before becoming pregnant so your body is more physically prepared. Another essential part is working past the previous experiences and conquering those fears that could inhibit a woman from being successful in her future birth. Some might be able to do all this in 9 months time and that is wonderful. I'm the type that likes to have things planned out far in advance because it gives me more peace of mind.

For those of you who are pregnant or not yet pregnant and wanting a VBAC here is a great resource from VBAC Facts that can help you on your way.