Monday, May 24, 2010

Things That Make My Heart Hurt

One of the arguments that kept cropping up during the health care reform debates was that the US has the finest medical care delivery system in the world and we shouldn't tamper with that. Socializing medicine would ruin us and cause total death and destruction. We've got the best and don't need anything else.

Well, I chose not to be in denial then, nor am I so inclined at the present. Still, the news contained in this article hit me like a ton of bricks. When it comes to maternity deaths, the US is a third-world country.

Each day in the U.S., two women die of problems related to pregnancy or childbirth. The numbers have been rising, for reasons that are not entirely clear. After plunging in the 1900s, maternal mortality rates in California tripled between 1996 and 2006, from 5.6 deaths per 100,000 births to 16.9.

Nationally, the rate, defined as deaths from obstetrical causes within one year of giving birth, rose from 7.6 per 100,000 to 13.3 per 100,000.

For each death, experts estimate, there are about 50 instances of complications related to pregnancy or childbirth that are life-threatening or cause permanent damage. According to a study published last year, such "near misses" — including kidney failure, respiratory distress syndrome, shock and the need for blood transfusions and ventilation —rose 25% from the late 1990s to 2005.
[Emphasis added]

Yes, that's right: the maternal death rates have tripled in California and nearly doubled across the US. While the "experts" aren't sure why this sudden surge has occurred, they do have some ideas. Women are having babies later in life, even in their 40s. The rate of potential complications rises with such pregnancies. However, there are other reasons which appear to explain the increase, and these have nothing to do with the age of the mother:

Some experts implicate the rise in rates of cesarean sections, which account for one-third of all births — up from one-fifth in 1997. Although many are done to save the life of a mother and her baby, perhaps half are elective, meaning the surgery is medically unnecessary. After one C-section, cesareans are typically recommended for subsequent pregnancies.

Yet these are major operations and "should not be taken lightly," said Dr. Michael Lu, a UCLA associate professor of obstetrics and gynecology. Each additional cesarean increases the risk of placental complications that threaten the lives of mother and baby.

The induction or prompting of labor by medication, which is sometimes medically advisable but more often performed for the doctor's or patient's convenience, has climbed so steeply — it now occurs in 22% of births — that the American College of Obstetricians and Gynecologists felt compelled to advise its members last year to avoid inductions before 39 weeks' gestation.

When labor is induced a week or so before the due date, the uterus may not be ready, leading to prolonged labor. After delivery, the exhausted muscle may not contract properly to stop bleeding. Blood can no longer clot and becomes the consistency of water.

Staffing of maternity wards is also a serious problem, said Nan Strauss, a senior researcher at Amnesty International and a coauthor of the organization's March report on maternal deaths.

Most of these problems could be corrected. Doctors could delay a round of golf. Mothers and fathers could be more patient. Hospitals could staff appropriately. If these elements are the reasons women are dying in or shortly after childbirth in this country then there is something seriously wrong with this country and with our health care system.

Yes, childbirth is a natural phenomenon and has been going on for a long time, but it's never been easy and it's never been safe. We could do better, obviously, and we'd better do better before more children have to grow up without a mother.

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Anonymous Anonymous said...

Look, these are women that are dying. Women. Since when does are society value them? They work for less money, are promoted less frequently, suffer violence and rape at far higher rates than men. Rand Paul and his ilk would be happy to see the civil rights laws reversed. Millions and millions of Americans think Rand Paul is correct in his views. I'm sure just as many or more would like the clock rolled back to 1850-AD when it comes to women's rights. I've even read of a movement to limit voting to men only again, repealing the suffrage amendment. Our society doesn't care about women dying in maternity wards, or anywhere else for that matter. They're rented mules. When the break down and die just gt another.

10:04 AM  

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