I realize as I write this that many of you are pregnant and I am trying to present this information in the gentlest way I can.  Please know that it is not my intention to scare you.  However, the only way the trend will change is if we take back our right to a gentle, safe birth.  We need to once again believe in our bodies abilities and develop confidence in ourselves.  So in the spirit of knowledge and empowerment, I encourage you to read on: 

I just returned from the Midwifery Today Conference, where Dr. Marsden Wagner of the World Health Organization (WHO) gave an update of the state of obstetrics in the US, which seems to have reached a tipping point.  Quite frankly, as an advocate of birth as normal these numbers infuriate me to the point of tears.  Sadly, the United States is falling behind in safe birth.  According to a 2005 WHO report on maternal mortality, 29 countries have lower maternal mortality rates than the US.  These numbers reflect only reported deaths, not actual numbers which are suspected to be much higher. 

In 2007, the maternal mortality rate in the US climbed to 15 per 100,000 births.  To give you an idea of where we stand, here are a few other countries statistics:

Canada:      7/100,000 (2003)

Australia:    4/100,000 (2003)

Czech Republic:     4/100,000 (2005)

Ireland:       1/100,000 (2005)

 

Where has the US gone wrong?  How is it that 29 other countries have lower mortality rates than the US? Is it possible to reverse this trend?  Let's examine these questions.

 

Where have we gone wrong?  This is difficult to know for certain, because death certificates do not always indicate if a woman was pregnant at or near the time of death.  Currently, only 21 states ask if the deceased was pregnant in the weeks or months preceding her death.  Without knowing, it is hard to get a handle on the concrete reasons why.

 

However, it does seem that the increase in maternal death rates correlate with the rise in cesareans, which ACOG seems to agree with.  According to Dr. Marsden Wagner, optimal cesarean rates are somewhere between 10% and 15%.  When cesareans rates are within these numbers, maternal morality is at its lowest, based on historical US data.  Currently the US cesarean rate is 31%.  Dr. Wagner estimates that 60 women a year die as the result of a complication during or after an unnecessary cesarean.  HOW can this happen in the United States?

 

In the recent article "Masking Maternal Mortality" (Mothering, March/April 2008), Ina May Gaskin sites flaws in postpartum care, where moms are sent home from hospitals before some problems can be detected.  She also cites an apparent apathy by the US Center for Disease Control, who publishes very incomplete, inaccurate data.  Compare our single-number statistic of 15 deaths per 100,000 births to a 400-page, highly accurate report entitled Why Mothers Die, published by the UK, and you begin to see how our reporting system is doing an injustice to women.

 

In 2007, an estimated 520 women died at or near the time of birth.  The majority of these deaths were never investigated. Can you imagine what would happen a bridge collapsed, killing 520 people, and it was not investigated?

 

Another factor to consider is the way healthcare is managed in the US, where insurance companies dictate who receives care, and for how long.  Consider the number of under-insured women, or those with no insurance.  According to the US Department of Disease Control, women of color are 3.7 times more likely to suffer maternal mortality than their Caucasian sisters, as more women of color are under-insured. 

 

How is it that other countries have lower mortality rates?  There are probably multiple factors.  One is government-sponsored healthcare in other countries.  Two other factor are greater use of midwives and the way maternal mortality is reported.  As mentioned, the UK deliberately studies maternal mortality to determine what can be done to prevent unnecessary death.  Because US medical reporting occurs at the state level, it is up to each state in the US to set its own reporting statistics.  Sadly, few, if any, states research the reasons for maternal mortality and if there are changes that need to be implemented.  Without knowing what went wrong, how are we to improve?

 

Of the countries with lower death rates, most use midwives as the primary form of care during pregnancy and birth, resulting in less intervention and fewer cesarean births.  OBs are reserved for high-risk pregnancies.  There are of course wonderful OBs that believe in normal birth, and there are midwifes that use more intervention than some OBs.  But, most midwives see birth as normal and do not practice medical management of labor as the standard of care.  This cannot be said for most OBs.  For low-risk moms, midwives have been shown to offer the best outcomes for mom and baby. 

 

I hear from women all the time "What if something happens?"  We have been taught by a broken system that our bodies are broken, that they are poorly designed, and that only with careful medical observation will be make it out the other side alive.  Our numbers show otherwise.  Other countries get this.  In Norway, for example, the maternal death rate is only 2 per 100,000 births.  In Norway, midwifery care and birth centers are the norm.  Obstetricians are reserved for high-risk patients, and home birth is not uncommon. 

Is it possible to reverse this trend?  YES, but it is up to us as women.  Not until the powers-to-be clearly understand that this is an issue will changes begin.  This will require political pressure and more media coverage.  On a more personal level, we need to make well-informed decisions, carefully select our caregivers, and support those midwives who clearly hear the call of birth as normal.  We need to once again realize that we are not broken, our bodies do know how to birth, and we need to be empowered to make choices and to realize the power that lies within us.  Change will come only if women demand it.  

All we need to do is study Germany to see the power of women.  Not so many years ago, the German government decided that it was going to demand that women deliver only in hospitals, and only by OBs.  The backlash was unexpected.  Today, Germany has free-standing birth centers and a large percentage of births are attended by midwives.  Their maternal mortality rates are far below ours at 4 per 100,000 births.  More babies get to have their mommies.  In 2007, the US sat back as 520 mommies left behind their babies.  These deaths generated little media exposure.  Meanwhile, Anna Nicole Smith's death generated massive amounts of media.  How unfair.