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Shame on you, America: too many women dying in childbirth

Updated on November 30, 2016
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Introduction

America is not the country one associates with dangerous pregnancies and deliveries. Naturally, women die in childbirth, but that only happens in third world countries, where babies are born at home, with a lay midwife, right? After all, American women deliver in state-of-the-art hospitals, with gynecologists, emergency cesareans, electronic fetal monitors, and epidurals. Surely, there is no way this could be happening here, is there? My fellow Americans, yes, it does happen here, and sadly, more often than you could imagine. More American women are dying during pregnancy, labor, and the first 42 days postpartum than there were in the 1980's. While improved reporting and statistical analysis may be a significant factor behind this phenomenon, one fact cannot be denied: maternal mortality in the United States has not decreased. In fact, we are only fiftieth best in the world in terms of maternal mortality (http://digitaljournal.com/life/health/the-usa-ranks-50th-in-maternal-mortality-globally/article/375372). How could this be? After all, we live in one of the richest countries in the world! We spend so much money on healthcare! Yes, my fellow Americans, you are absolutely right. Nevertheless, facts are facts and this hub attempts to investigate why tragedy visits many American families each year.

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Causes of increased maternal mortality

  • Multiple births
  • Obesity
  • Maternal age
  • More Cesareans

Possible causes of increased maternal mortality over time

There are a number of potential reasons for increasing maternal mortality in the United States. One of these reasons is an increasing number of multiple births. "In 2009, 1 in every 30 babies born in the United States was a twin, compared with 1 in every 53 babies in 1980.(http://www.cdc.gov/nchs/data/databriefs/db80.pdf). Twin pregnancies, as well as higher-order multiple pregnancies, carry additional risks to the mother's health, such as an increased risk of gestational diabetes and preeclampsia. (http://www.webmd.com/baby/features/11-things-you-didnt-know-about-twin-pregnancies?page=2) "Preeclampsia is marked by high blood pressure, protein in the urine, and sometimes swelling in the feet, legs, and hands. It is the precursor to the more serious, potentially fatal eclampsia." (ibid).

Another possible reason for rising maternal mortality rate is the increasing prevalence of obesity in the United States. According to Flegal et. al. "In 2009-2010, the prevalence of obesity was... 35.8% among adult women..." (http://jama.jamanetwork.com/article.aspx?articleid=1104933). Obesity can place both the woman and the child at a higher risk of serious complications, such as gestational diabetes, preeclampsia, labor problems, cesarean section, and others. (http://www.mayoclinic.com/health/pregnancy-and-obesity/MY01943).


Increasing maternal age also contributes to higher maternal mortality. More and more American women are choosing to delay mothedhood. In fact, the average age at first birth increased from 21 in 1970 to 25.1 in 2008(http://www.babycenter.com/0_surprising-facts-about-birth-in-the-united-states_1372273.bc).Older mothers are at a higher risk of multiple complications, such as hypertension/preeclampsia, gestational diabetes, multiple pregnancy, and difficult delivery, all of which can jeopardize the mother's survival (http://www.mayoclinic.org/healthy-living/getting-pregnant/in-depth/pregnancy/art-20045756).

Cesareans are on the rise and are also contributing to increasing maternal mortality in the United States. How can this be? Aren't they supposed to save lives? Yes, Cesarean sections can and do save lives everyday. There are many women who would not be alive today had it not been for this procedure, including both my mother and my mother-in-law. However, it is still a major abdominal surgery, with plenty of risks to both the mother and the baby. Would anyone willingly undergo such a procedure unless the benefits outweighed the risks? Probably not. A Cesarean section is no exception. One in every three babies is delivered surgically in the US http://edition.cnn.com/2009/HEALTH/11/11/caesarean.section.risks/index.html?iref=mpstoryview). Some of the increase in the incidence of C-sections is inevitable (http://www.today.com/id/17796664/ns/today-today_health/t/why-so-many-women-have-c-sections/), due to the factors listed above (i.e increasing obesity, maternal age, multiple births), among others, but does every third American woman really need a surgical delivery? Many experts beg to differ ( http://www.nytimes.com/2010/03/24/health/24birth.html?_r=0 a). Also, Cesareans are not as innocuous as some people may be led to believe. The risk of dying during these surgeries is higher than that of a vaginal delivery (http://americanpregnancy.org/labornbirth/cesareanrisks.html).


This list is by no means exhaustive, but these are among the most important factors for increasing maternal mortality in the United States.

Average Cost of Childbirth by Country, 2012

Source

Maternal mortality trends

Source

Maternal mortality ratio in selected countries, Part I (http://data.worldbank.org/indicator/SH.STA.MMRT)

(click column header to sort results)
Country  
Maternal mortality ratio per 100,000 live births  
Country  
Maternal mortality ratio per 100,000 live births  
Australia
7
Iceland
5
Austria
4
Iran
21
Bahrain
20
Ireland
6
Belarus
4
Israel
7
Belgium
8
Italy
4
Bosnia and Herzegovina
8
Japan
5
Brunei
24
Korea, Republic of
16
Bulgaria
11
Kuwait
14
Canada
12
Lebanon
25
Croatia
17
Lithuania
8
Cyprus
10
Luxembourg
20
Czech republic
5
Macedonia
10
Denmark
12
Malta
8
Estonia
2
Montenegro
8
Finland
5
Netherlands
6
France
8
New Zealand
15
Germany
7
Norway
7

Maternal mortality ratio in selected countries, Part II (http://data.worldbank.org/indicator/SH.STA.MMRT)

Country
Maternal mortality ratio per 100,000 live births
 
Poland
5
 
Portugal
8
 
Qatar
7
 
Saudi Arabia
24
 
Serbia
12
 
Singapore
3
 
Slovakia
6
 
Slovenia
12
 
Sweden
4
 
Switzerland
8
 
Turkey
20
 
United Arab Emirates
12
 
United Kingdom
12
 
United States
21
 

Why is American maternal mortality so high?

There are a number of reasons why American mothers are more likely to die in childbirth than their counterparts in other countries. One highly important reason is access to health insurance. According to American pregnancy association, "there are approximately 13% of women who become pregnant each year who are without health insurance, often resulting in inadequate prenatal care."(http://americanpregnancy.org/planningandpreparing/affordablehealthcare.html) Even mothers who have health insurance are not guaranteed that their pregnancy or delivery is covered, because "some insurance plans categorize pregnancy as a pre-existing condition" (ibid). Medicaid is an option, because this program accepts pregnant

mothers, but not everyone is eligible, due to income being too high, etc. (http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Eligibility.html). According to WebMD, "the average cost of prenatal care is about $2,000."(http://www.webmd.com/baby/features/cost-of-having-a-baby). It is small wonder, then, that " In 2009-2010, 17.2 percent of recent mothers in a 30-state area reported that they were not able to access prenatal care as early as they had wanted.", 38.7% of them due to lack of insurance(http://mchb.hrsa.gov/chusa13/health-services-utilization/p/barriers-to-prenatal-care.html). Inadequate prenatal care increases the risk of pregnancy-related "complications will go undetected or won't be dealt with soon enough. That, in turn, can lead to potentially serious consequences for both the mother and her baby." (http://m.kidshealth.org/parent/pregnancy_newborn/medical_care/medical_care_pregnancy.html). ". Poor women and women of colour are by far the hardest hit by this crisis. In 2012, 23 percent of African-American women and 36 percent of Hispanic women had no health insurance." (http://m.aljazeera.com/story/201438161633539780). The consequences are a significant gap in maternal mortality rates, where " women in low-income areas were twice as likely to die a maternal death than women in high-income areas, and black women were four times as likely as white women to die while giving birth to a child." (Ibid). "The United States is one of the few developed countries without universal health coverage (http://m.theatlantic.com/international/archive/2012/06/heres-a-map-of-the-countries-that-provide-universal-health-care-americas-still-not-on-it/259153/). United Kingdom, for example, has National Health Service, and their maternal mortality ratio is 12 per 100,000 live births, compared to 21 in the US (see chart above).

The prevalence of obesity was another important cause of the differences in maternal mortality ratios. In Austria (with a maternal mortality ratio of 4 per 100,000) for example, only eleven percent of adults are obese (have a body mass index, or BMI, of >30), as are 6.9 percent of Singaporean adults (and Singapore's maternal mortality ratio is 3 per 100,000), whereas in the United States, that figure is significantly higher, at 33.9 percent ( http://apps.who.int/bmi/index.jsp). While the correlation is not perfect, with the United Arab Emirates having an obesity prevalence of 33.7percent (ibid) and a significantly lowematernal mortality ratio as the US, overall, countries with lower maternal mortality ratios aslso had lower obesity prevalence indicators.

The quality of care is another important reason for the different maternal mortality ratios in different nations. In the United States, women are typically discharged from the hospital only a couple of days after giving birth and do not see their providers until their six-week postpartum visit, while in France, mothers are hospitalized for a week after giving birth and British midwives visit new mothers at home ( http://m.aljazeera.com/story/201438161633539780).

Interestingly, the cesarean rate, while contributing to the increasing maternal mortality ratio in the US, is not responsible for the differences between the US and other countries. Netherlands has a much lower cesarean rate(14.8% in 2009) and a lower maternal mortality ratio than the US, but Germany and Italy have relatively high cesarean rates (31.4% in 2009 and 38.4% in 2010, respectively), yet German and Italian mothers are still less likely to die in childbirth or in the postpartum period than their American counterparts (http://www.cesareanrates.com/blog/2012/12/8/world-cesarean-rates-oecd-countries.html).

Maternal age does not account for the differences in maternal mortality ratios between the countries. American women actually give birth at a younger age than their counterparts in most other developed nations. While the average American first-time mother is twenty-five years of age, German and British women delay childbearing until an average age of thirty (http://www.oecd.org/els/family/oecdfamilydatabase.htm). Nevertheless, both countries experience lower maternal mortality than the United States.

Birth by the Numbers

Conclusion

In summation, labor and delivery in the United States is nowhere nearly as safe as it appears. In fact, forty-nine countries have lower maternal mortality. This is true even though the US spends more money on healthcare than those countries. Even more concerning is the fact that maternal mortality in the US is on the rise. While some of the increase can be attributed to improved record keeping, other reasons for the trend include increasing maternal age, increasing cesarean rates, increasing prevalence of obesity, and note multiple births. Countries that outperformed the US tend to have lower prevalence of obesity, universal access to prenatal care, and higher quality of care. The US can reduce maternal mortality by improving both access to and quality of prenatal care, especially to women of color and of lower socioeconomic status, reducing obesity, and, even though this factor did not account for the difference between countries, reducing the number of unnecessary cesareans.

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    • kenneth avery profile image

      Kenneth Avery 2 years ago from Hamilton, Alabama

      sakinah,

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