It may come as a surprise to some that the U.S. has an absolutely shameful maternal mortality rate. Per a recent NPR story, we rank highest among developed nations, with 26.4 maternal deaths per 100,000 live births. That abysmal rate was the result of spike in deaths from 2000-2015, (the most recent reporting).
In comparison, the next closest result is from the U.K., with 9.2 deaths/100,000 live births. Finland has the best outcomes, with 3.8 maternal death/100,000 live births.
Take this in and be appalled — about 3 women die each day, (~11,000 births/day), giving birth in the United States!
Leading the way in the U.S., and not in a good way, is Texas. The Guardian covered the state’s results in an August 2016 article…
The rate of Texas women who died from complications related to pregnancy doubled from 2010 to 2014, a new study has found, for an estimated maternal mortality rate that is unmatched in any other state and the rest of the developed world.
In more graphic terms, the Guardian story breaks down the scandalous nature of the Texas results…
But the report singled out Texas for special concern, saying the doubling of mortality rates in a two-year period was hard to explain “in the absence of war, natural disaster, or severe economic upheaval”.
No surprise, health advocates blame the staggering increase on nearly $74m in GOP budget cuts to family planning clinics in the state. More than 80 family planning clinics closed across the state, due to the budget cuts. We should not expect improvement in the results if the GOP desired Medicaid cuts become law.
Fortunately, there is some good news on the subject of maternal mortality rates. The good news hails from California.
Vox published an article this week titled, “California decided it was tired of women bleeding to death in childbirth” The Vox article is both a distressing and hopeful story about the years long project that women’s health care providers embarked on to save more women from preventable deaths during childbirth.
The founding physician, Dr. David Legrew witnessed a mother bleed to death during childbirth, and was determined that more should and could be done to prevent deaths. The mother who died had placenta accreta; the article describes why that condition is particularly problematic and on the increase...
In accreta, which doctors believe is most often caused by scarring from prior cesarean sections, the placenta sticks around and embeds. The condition was exceedingly rare in the 1950s, occurring in only one in 30,000 deliveries in the US. Today, because of the rise in C-sections, it shows up in about one in 500 births. One in 14 American women with accreta die, usually from hemorrhaging too much blood.
The article references another mother’s near fatal experience giving birth. It was only near fatal thanks to the work of the California Maternal Quality Care Collaborative (CMQCC).
Dr. Lagrew, along with other health care professionals, began reviewing maternal mortality data and determined that hemorrhaging and preeclampsia were the two most common, preventable causes of maternal death during childbirth. According to the article, this was no small feat…
It’s difficult to overstate how revolutionary this simple first step was in the arena of maternal health. About half of US states still don’t formally review the causes of maternal death on a regular basis to find out which deaths are preventable and how to stop future similar deaths from occurring. The US National Center for Health Statistics hasn’t even published an official maternal mortality rate since 2007 — that’s how low-priority this issue is.
CMQCC created a simple solution to prevent needless deaths due to hemorrhaging. They created a “toolkit” which include a step-by-step “recipe” for health care providers to follow in cases where hemorrhaging occurs.
The organization also suggested another component...
When CMQCC did their root cause analysis on what was causing moms to die in their state, they found that hospitals typically didn’t have these simple things on hand. So they borrowed the idea from the “code blue cart” that’s common in hospitals to quickly treat patients who go into cardiac arrest.
Additionally, the toolkit advises hospitals to have blood products on hand and to use tools that accurately measure how much blood loss a woman experiences in these situations, so they can calculate how much blood needs to be given.
Since the implementation of these guidelines, California’s maternal mortality rate has dropped significantly. From 2006 to 2013, the rate has dropped by >50%. Good news for women in the state, and hopefully a program that other states, like Texas, will consider implementing.
I highly recommend the VOX article. It goes into depth about the program, it’s results, as well as covering societal reasons why a mother’s health and wellbeing is too often overlooked during pregnancy.
The articles I referenced are linked below:
www.npr.org/…
www.theguardian.com/…
www.vox.com/...