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Pregnant Women In Texas Death Rate Doubles: US Most Dangerous Developed Country To Give Birth

August 30, 2016

Modern medicine likes to tout its safety standards to pregnant women, telling all of us how women must conform to medical standards in order to make pregnancy “safer,” even prosecuting women who refuse standard medical care, deeming them mentally incompetent; however, what headlines fail to point out is that the United States is one of the most dangerous places in the world to have a baby with standard medical care. The US is actually the worst country in the developed world for women to have a baby:

Pregnancy-related deaths in the U.S. have risen from 7.2 per 100,000 live births in 1987 to 17.8 in 2009 and 2011, according to the CDC.

How is it that the medical industry claims safety, and the statistics show that childbirth in the US gets riskier and riskier?

The U.S. ranking represents a slip from No. 31 last year. This year the U.S. ranked ninth in economic status and 16th in education but 61st on maternal health, 42nd on children’s well-being and 89th in female political status. Women hold less than 20% of Congressional seats in the U.S., the report notes.

How does the US compare? Pretty shabby. And not just mothers are dying, so are the babies. Infant mortality rates in the US match those in Serbia or Bosnia:

The 11 bottom-ranked countries are almost all in West or Central Africa. Somalia ranked worst overall.

As part of the report, Save the Children examined infant mortality rates in the capital cities of wealthy nations. Washington D.C. had by far the highest infant mortality rate of 25 capital cities studied, with 7.9 deaths per 1,000 live births in 2012.

What’s more, many major U.S. cities have an even higher infant mortality rate than Washington D.C. Cleveland and Detroit, for example, reported rates of 14.1 and 12.4 per 1,000 live births, respectively, in 2011. The under-age-5 mortality rate in the United States nationwide is 6.9 per 1,000 live births. According to the report, an American child is just as likely to die before the age of 5 as a child in Bosnia or Serbia. In contrast, Stockholm, Sweden and Oslo, Norway reported infant mortality rates below 2.0.

Infant mortality rates are unsurprisingly linked closely to maternal mortality rates.

A big part of the mortality rate is related to the medical ego model, and in case you didn’t know how dangerous that is, just check out my post on medical malpractice being the third leading cause of death in the United States.

“If you’re in Sweden, everybody gets treated the same way. If you are in New York City, you get treated one way. If you’re in Buffalo, you get treated another way and if you’re in Missouri, you get treated another way,” said Brodman. “This is that sort of U.S. individualistic kind of thing, ‘I know what I’m doing. This is how I’ll do it.’ In health care, at the end of the day, that doesn’t work.”
So now, through programs such as the American Congress of Obstetrics and Gynecologists’ Safe Mother Initiative, and the National Partnership of Maternal Safety, doctors are coming up with standardized care for pregnancy and childbirth complications where every hospital would follow the same protocols for dealing with issues such as a postpartum hemorrhage, which can result in death.
For instance, in New York, they’ve created hemorrhage teams and have done hemorrhage drills so “every little, big, medium-size hospital will all have the same protocol,” said Brodman.
While different training and different procedures at hospitals account for some of the variations in care, medical egos are a big part of the problem too, he said.

How can this be when we

Authors find that many maternal deaths caused by postpartum hemorrhage, between 54 percent and 93 percent, are preventable with improved clinical response.

The two-state AWHONN study confirms and quantifies some observations that nurses and doctors have made since the 1960s about the inaccuracy of visually estimating blood loss.

“We have to admit that for years we were off the mark,” says Renée Byfield, nurse program development specialist at AWHONN and one of the authors of the study.

“It is disturbing. Estimating blood loss, a decision so imperative to save a life, was determined by subjective means.”

 Estimating blood loss as opposed to measuring it, with a 94% possible reduction in maternal deaths is a form of misogyny–no medical institute would claim that estimated rates prostate cancer by simply looking at a patient would constitute responsible medical practices, so why is maternal blood loss estimation even still allowed? Medical egos shouldn’t be allowed to determine whether women die. Egos vs. human lives, should be an easy call, right? Nope, because guess what, doctors say, against all evidence, that they have it under control, their guesstimate is accurate, except hard facts never make it to the ego.

The average blood loss during a vaginal birth is about 500 milliliters (about half a quart) and about 1,000 milliliters during a Caesarian birth. More than that amount is considered a danger sign.

Byfield says PPH treatment decisions are based on the amount of blood lost; so knowing these standard thresholds enables teams to be better prepared with the proper response.

Quantified blood loss, or QBL, requires weighing those pads to calculate a much more accurate amount.

Lashea Wattie is a clinical nurse specialist at Wellstar Kennestone Hospital in Marietta, Georgia, near Atlanta.

“When you realize how much blood loss you have had, many times it is too late,” says Wattie, who coordinated the AWHONN study in Georgia and spoke about the findings by phone. “So by using that quantified blood loss, you are able to stage appropriately where your patient is at, knowing what her status is, and how critical she may be.”

Another disturbing and not fully explained component of postpartum hemorrhage is racial disparity. Of the 4 million women who give birth in the U.S. each year, 125,000 will suffer from postpartum hemorrhage. Black women suffer far more fatalities related to PPH (68.3 per 100,000) versus white women (21.0 per 100,000).

“We are still looking at data,” says Byfield. “What we do know is that, 4-to-1, African American women suffer more postpartum hemorrhage compared to other races. The disparity is not just related to economics. It is a function of access to care. [A lot of ] community hospitals are not prepared.”

So when there is no measured response to postpartum hemorrhage, lack of attention literally means women die, and if egos are more important than women’s lives, how is that not misogyny?

Back in 2011, it became evident that it was safer to give birth in Bosnia than California:

According to a report released by the California Department of Public Health using data from 2002-2003, the rate of women dying from pregnancy-related complications is increasing at a statistically significant rate.  More than a third of these deaths seem to have been preventable.  Deaths related to pregnancy in California have risen from 8.0 deaths per 100,000 live births in 1999 to 14.0 deaths per 100,000 births in 2008.   The statistics show that giving birth in especially dangerous for African-American women, who are four times more likely to die from pregnancy-related causes than women in other racial groups.  Poor women are also at greater risk; more than half the women who died last year were Medi-Cal recipients.

In other words: Bosnia has a better maternal mortality rate than California

Most recently, Texas maternal death rates have doubled, making it similar to California. The US maternal death rate is triple that of the UK maternal death rate:

Deaths from pregnancy-related causes have increased by 26.6 per cent across most of the US in 15 years. The problem is particularly bad in Texas, where the maternal mortality rate nearly doubled in the space of a year, from 2011 to 2012.

These numbers come from a study of health data led by Marian MacDorman at the University of Maryland. The average maternal mortality rate in the US was 23.8 per 100,000 live births in 2014, although the researchers excluded Texas and California from this calculation. In comparison, it was only 9 and 6 deaths per 100,000 live births in the UKand Australia, respectively, in 2015.

In fact, according to a previous analysis, the US is one of only eight countries in the world where the rate of pregnancy-related deaths has gone up in the last few decades, instead of down. The other countries where this has happened are Afghanistan, Belize, El Salvador, Guinea-Bissau, Greece and the Seychelles.  But it’s Texas’s shocking rise that has caught the most attention. MacDorman’s team hasn’t pinned the state’s doubling in maternal mortality to a specific cause, but the team did note that the it has seen “some changes in the provision of women’s health services” since 2011.

Just in case you were wondering, the “Maternal Mortality Ratio” in Bosnia for 2015? 11

The Maternal Mortality Ratio for the US? 23.8

A World Health Organization reports a Maternal Mortality Ratio, or how many women die in childbirth to all childbirths at a whopping 28.

Although considered mainly as problems of the developing world, maternal mortality and morbidity remain a challenge in the United States of America (USA).1 Between 1990 and 2013, the maternal mortality ratio for the USA more than doubled from an estimated 12 to 28 maternal deaths per 100 000 births1 and the country has now a higher ratio than those reported for most high-income countries and the Islamic Republic of Iran, Libya and Turkey.2 About half of all maternal deaths in the USA are preventable.2

Each year an estimated 12001 women in the USA suffer complications during pregnancy or childbirth that prove fatal and 60 0003 suffer complications that are near-fatal – even though costs of maternity care in the USA in 2012 exceeded 60 billion United States dollars.4

15 Minutes of training can help save women’s lives, but the hospitals that need the training and preparation refuse to participate.

The 18-month AWHONN study, completed in February and supported by Merck for Mothers, looked at the presence or absence of 38 PPH preparedness elements. They found less than 50 percent of the hospitals had massive hemorrhage protocols, performed risk assessments and drills or measured blood loss. And while there are standard checklists for dealing with medical emergencies, such as strokes or heart attacks, that’s not always the case for hemorrhage in the delivery room.

Many emergency rooms perform specific readiness drills for high profile crises such as plane crashes or mass shootings; but far fewer do such drills on PPH.

Wattie says more training is needed in many places. Health care staffs at smaller hospitals that don’t have specific labor and delivery rooms, but still deliver babies, need it. So do emergency medical technicians, especially in rural areas.

She says these smaller hospitals “May be able to deal with a normal delivery, but because of the increased risks among those populations they may have to go farther, including a postpartum hemorrhage preparedness course.”

Such drills do require time and commitment from hospital staff. Byfield says that time is well spent. A team can go back and practice more confidently and in a safer environment. She says even a short, 15-minute debriefing after every delivery, routine or complicated, can be valuable.

And, of course, we all know that lack of training and preparedness makes sense: plain crashes are much more common than a human birth, right? Nope, a good ole case of misogyny contributes to women dying, and not much will change unless hospitals are pushed to offer better care. It appears that limiting medical malpractice lawsuits means more women die because medical egos are allowed to make decisions that kill women with no recourse. Hospitals won’t voluntarily provide staff training, 15 minutes worth, to save women’s lives, and if they won’t provide 15 minutes voluntarily, the only way to do that would be to push that through the courts, because it seems nothing else is working.




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