Sunday, March 10, 2024

Why do so many American women die from childbirth?

For most of human history, pregnancy and childbirth was the cause of many women’s deaths. In the modern era, this should be an extremely rare event, and in most of the developed world it is.

About 800 women in the U.S. die every year during pregnancy, delivery or the 6 weeks that follow delivery. Our maternal mortality statistics are our shame. Maternal mortality per 100,000 live births is 4.4 in Sweden, 8.0 in France, 9.2 in the United Kingdom and 7.3 in Canada, while in the U.S. it is 26.4.

Globally, maternal mortality has been steadily falling while in the U.S. it has been rising.

There is a clear racial disparity, with deaths from pregnancy much higher among Black and Native American women than among white, Asian and Hispanic women. For Black women, poorer care compounds their tendency to more of the hypertensive disorders of pregnancy. However, even white women die at a higher rate in the U.S. than in any of our peer developed countries.

Why is this? Doctors here are often too slow to recognize the importance of even mild high blood pressure in a pregnant woman and fail to treat it, leading to the dangerous condition called eclampsia. Because severe complications of pregnancy at any given hospital are rare, most hospitals do not have an organized plan to deal with severe hemorrhage after delivery or embolism of the amniotic fluid (large bubbles of amniotic fluid entering the mother’s circulation).

Experts who study maternal deaths estimate that about 70% of the deaths due to hemorrhage, infection or cardiovascular conditions are preventable. California adopted a comprehensive plan to lower maternal deaths, with “best practice” guidelines widely distributed to every hospital and obstetrician, and was able to cut its death rate in half between 2006 and 2013.

Additionally, many women die from treatable mental health problems, notably depression and suicide, that are missed, often because the new mother is not seen after delivery. While most women bring their infants in for a well-baby visit, many skip their own post-partum check, often because they do not want to take time off from work.

Most western countries provide ample paid time off for new mothers, no matter their occupation, while in the U.S. this tends to be a “luxury” afforded only to highly paid professionals. We should be advocating for 3 months paid maternity leave for ALL women.

Ask your local hospital if it has systems in place to deal with the infrequent but lethal emergencies that occur during pregnancy and delivery. Make sure any friends and relatives who deliver have adequate support. Offer to take them for post-partum checks.

We should be emulating Sweden and Canada, not Afghanistan and Swaziland.

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1 comment:

  1. Excellent piece. Data clear, as is analysis and recommendations.