Posted by: emjb | August 31, 2007

Dear OB/Gyns of America…

…remember that part of your medical training about “do no harm”? Might be time to take a refresher course, okay?

The maternal mortality rate in the U.S. is the highest it has been in decades, according to statistics released this week by CDC’s National Center for Health Statistics.

According to the figures, the U.S. maternal mortality rate was 13 deaths per 100,000 live births in 2004. The rate was 12 deaths per 100,000 live births in 2003 — the first year the maternal death rate was more than 10 since 1977 (Stobbe, AP/Washington Post, 8/24). A total of 540 women were reported to have died of maternal causes in 2004, 45 more than were reported in 2003, according to the report (NCHS report, 8/21).

A rise in the number of caesarean sections — which now account for 29% of all births — could be a factor in the increased maternal mortality rate, some experts said. According to a review of maternal deaths in New York, excessive bleeding is one of the primary causes of pregnancy-related death, and women who have undergone several previous c-sections are at particularly high risk of death.

Now while the rising c/section rate and the risks it brings are one of my favorite rants, the other factors mentioned in the article are appalling. African American women are THREE TIMES as likely to die from childbirth as white women. That’s an astonishing statistic. And a sad one. Lack of care pre-and -post partum can be deadly.

Obesity (possibly) and improved reporting may also have increased the stats, which lets OBs off the hook a little bit, but our pitiful health care system not at all.

Universal care cannot possibly come too soon. It won’t take the morbidity rate down to zero, but it will allow us to keep women of childbearing age in a system of care, so that lack of access to care during pregnancy will not be a contributing factor. If how deaths related to pregnancy are reported vary so much now that it’s affecting our stats, then our stats still aren’t good; we need a national system to truly determine the effectiveness of care and the pinpoint the problems. How many of those women who died had no care at all until they showed up in labor, maybe with undiagnosed complications that could have been treated? How many were malnourished (which you can be while being obese), had low-grade infections (even an infected gum can cause premature births), had any number of problems that may not have been fatal if caught early?

Of course, I could say the same about all health issues, which is why I’m a universal care proponent. Preventative care is critical to everyone, but under our current system, will always be sacrificed by people without a lot of ready cash. People die from lack of preventative care every day; I’d be willing to bet a great many of the mothers in this study fall into this category.

So maybe it’s not the OBs I should be hollering at, per se, but a government run by people with lots of money who will always have access to care, but who take every chance they get to deny that access to their fellow citizens. Fellow citizens who work just as hard, who pay their taxes, but who are allowed to die for the sin of being too poor to buy their healthcare.

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