This week, Dr. Marsden Wagner, a well-known perinatologist, perinatal epidemiologist, and birth outcome advocate, addresses the seriousness of maternal mortality in the U.S. He illustrates the crucial need for expectant mothers to know the risks associated with common birth interventions, in order to empower healthier birth outcomes.
Every year, the equivalent of three jumbo jets full of women — that is nearly 1000 of our sisters, daughters and mothers — die before, during or after giving birth. And, around half of these deaths could have been prevented with access to better-quality maternity care, based on information from the Centers for Disease Control (CDC).
Most frightening, data suggests an increase in recent years in the number of women in the U.S. dying during pregnancy and around the time of giving birth. Public health officials have always known maternal mortality in the U.S. to be underreported — but the evidence suggests a recent rise: “The actual pregnancy-related death rate could be more than twice as high as that reported,” cites the CDC.
Why are more American women dying before, during and after giving birth?
It is difficult to pinpoint the causes, because current data provides only the leading or immediate cause of death, and not the underlying causes. But if we look at the six leading causes of pregnancy-related deaths in the U.S., three causes (hemorrhage, anesthesia and infection) are often the result of interventions. So, for example, although the immediate cause of death is frequently given as hemorrhage, in many cases the hemorrhage is associated with cesarean section.
There is strong research, both in the U.S. and in Great Britain, showing that the maternal mortality rate for cesarean section is four times higher than for vaginal birth. And, the rate of women dying is still twice as high when it is a routine or “elective” cesarean section without any emergency. With at least twice as many cesarean sections as are necessary done today in the U.S. — around 30 percent of all births, rather than the World Health Organization’s suggested 15 percent, unnecessary cesarean section is undoubtedly a significant part of the reason for more and more women dying around their childbirth in the U.S. With all of the statistics taken into account, we can calculate that a cesarean section rate of 30 percent means a minimum of 600,000 unnecessary c-sections each year (more than 1640 every day), leading to a minimum of 60 avoidable maternal deaths each year (more than one each week).
Another cause of the rising pregnancy-related deaths of women in the U.S. is the markedly increasing use of epidural block for normal labor pain. Epidural block for normal labor pain carries a scientifically-proven increased risk the woman will die, and “anesthesia complications” is documented by the CDC as one of the leading causes of maternal mortality in the U.S.
There is good reason to believe that other technologies also contribute to the rising number of women dying during childbirth in this country. Data from the Centers for Disease Control (CDC) shows that between 1990 and 2000, the number of women given powerful drugs to induce their labor had gone from 10 percent of all births to 20 percent. During this same 10 years, the drug cytotec became the most popular drug for such inductions of labor — in spite of having never been approved by the FDA for induction of labor, and the best scientific opinion in the world (Cochrane Group) strongly advising against cytotec induction. A more recent survey, completed in 2006, shows that 44 percent of births in the U.S. have pharmacological induction and augmentation. New scientific data shows that for women with a previous cesarean section, cytotec induction causes a marked increase in uterine rupture, a catastrophe that can result in the death of the mother, the baby — or both. Nearly all women who survive will never be able to have another baby.
Is the excessive use of birth interventions and technologies killing more women and babies than it saves?
This possibility has a reasonable scientific explanation, since caesarean section, epidural anesthesia and drugs to induce labor all have been used more and more in the U.S., and scientific evidence proves these interventions can result in the death of a pregnant or birthing woman.
The U.S. spends twice as much as any other country on maternity care, and yet is at least ranked 15th in the world for the pregnancy-related deaths of women. How do they do it in the 14 countries losing fewer pregnant and birthing women than we do? In every industrialized country in Europe (including the countries with the world’s lowest maternal mortality rates), obstetricians are hospital-based specialists who do not attend normal pregnancies and births, but remain in the hospital to “jump in” and treat the serious complications. Meanwhile, it is the midwives who are out in the community giving prenatal and postnatal checkups, and also in hospitals as the only health professional at the births of more than 80 percent of women without serious complications during pregnancy. The U.S. may want to reconsider the required presence of obstetricians at most normal births, as midwives are more than prepared to handle them.
There is an urgent need for careful audit of every single maternal death in the U.S., with a thorough analysis of causes — including underlying causes — with feedback to the doctors and hospital involved in the death, and presentation of overall results (no names of patients or doctors, of course) to scientists and the public. The FAA couldn’t set policies for safe flying if they were unaware of half of the planes falling from the skies, and couldn’t get to the black box of most of those they knew fell. But this is the situation with the Centers for Disease Control and Prevention trying to set policies for safer maternity care when they have limited data on pregnancy-related deaths of women.
Whether it is because of bureaucratic red tape, political motivations, or some other reason, federal bureaucratic orders prohibit the CDC from making surveys of what is happening in all states with maternal deaths. And at the state level, there are enormous pressures from medical societies to prevent adequate investigation of all maternal deaths. Regardless, it is imperative that practitioners and scientists concerned about the safety of women during pregnancy and childbirth have access to complete information on every case in which a woman dies from pregnancy-related causes. In addition to professionals, American women need to know that their chance of dying around the time of birth is increasing — and they have a right to know why.
Marsden Wagner, MD, is a perinatologist and perinatal epidemiologist, and an outspoken supporter of midwifery. He was director of Women’s and Children’s Health in the World Health Organization for 15 years. Marsden travels the world to talk about improving maternity care — including addressing the appropriate use of technology in birth and utilizing midwives for the best outcomes. His books, “Born in the USA,” “Creating Your Birth Plan,” and “Pursuing the Birth Machine,” are invaluable for anyone involved in birth. Marsden also raised four children as a single father.
Do you feel the risks associated with birth interventions are made clear to expectant mothers?
Mother’s Advocate wants to facilitate a safe and supportive community for birth advocates, educators, and expectant mothers. You’re welcome to share any thoughts about or experiences with maternal mortality.
This is the kind of thing I try to teach people. Can we count on a sequel?
[…] This post was mentioned on Twitter by BirthDoulaTara, ®Childbirth Hypnosis. ®Childbirth Hypnosis said: from INJOY video's "Mother's Advocate" blog, "The Ultimate Price of Unnecessary Interventions": http://bit.ly/a7skQY […]
Thank you for this article. It is well stated
So glad you found this post helpful. We just shared our third installment of this series from Ina May Gaskin, and are excited to wrap it up with her! Who knows what 2011 holds, though!
I love this article and I love you! But I do wish they would make more public some very important petitions that are available:
Cytotec Petition:
http://www.petitiononline.com/cytotec/petition.html
and the Petition for the Mandatory Reporting of Maternal Mortality in the U.S.
http://www.tinyurl.com/savemothers
Thanks,
Cassandra
Thank you Marsden for being as always, the champion of mothers and babies. Your words are powerful and eloquent.
I’m sending concerned family members of my home birth clients to this article, so they can see the other side of the story for themselves.
Constance Rock, LM, CPM
http://www.CaliforniaWaterBirth.com
I don’t believe in many cases that they are made clear. It is truly sad. I know that with my first birth, I was not informed of the true risks of cesarean, nor that ACOG doesn’t recommend c-section for suspected big baby unless the weight is thought to be over 11lbs.. I was just told that trying the natural birth I had planned for would risk death to my baby and my provider was not comfortable with that. I only became aware of some of the risks when I later experienced them after my surgery. Then, I became aware of the true risks involved as I researched why this had happened to me and my options for future pregnancies.
Though, I have to admit, I believe our care providers are far over worked. I believe OBs are responsible for too many normal, low risk deliveries that should be in the hands of the midwives, wearing them out. I believe that insurance companies are making things dangerous for women by requiring such high malpractice insurance premiums out of our care providers. Managed birth has become the norm, and things are so far removed from our body’s and our abilities as women, that it is causing these results. It is a system failure. One that desperately needs our attention on all fronts. For all our sakes. Blame isn’t productive, but identifying our problems all around and addressing them all is the way to improve our outcomes, but it will take a lot of work on both political and institutional fronts… along with education.
Thanks for the wonderful article! I had a cesarean with my son after laboring without any medication or intervention. It turned out that his head was turned at an angle and he couldn’t descend no matter how hard I pushed. I am looking to have VBAC with my next child and am amazed at the misinformation out there with regards to pregnancy/delivery safety!
Maternity compression socks are a great way to lower DVT risk after a c-section and help prevent spider and varicose veins. 50% of all women who have had two or more pregnancies will get varicose veins. There was a great article in Fit Pregnancy magazine about wearing compression socks during pregnancy and a few weeks after a c-section to help prevent blood clots. I thinks it’s the dec/Jan issue. The http://www.babyyourlegs.com website has some good information about keeping legs healthy during pregnancy.
Your current post features confirmed necessary to
us. It’s quite educational and you’re certainly extremely well-informed in this region. You have exposed our sight to various opinion of this specific matter using intriguing, notable and solid content material.
You are so interesting! I don’t suppose I have read through something like
that before. So wonderful to find another person with some
genuine thoughts on this topic. Seriously.. thank you for starting
this up. This web site is one thing that is needed on the internet, someone with a little originality!
I seriously love your site.. Great colors & theme. Did you develop this web site yourself?
Please reply back as I’m wanting to create my own site and would like to find out
where you got this from or what the theme is called. Thank you!
An interesting discussion is worth comment. I think that you need to write more on this issue, it might not be a taboo subject but generally people do not speak about such issues.
To the next! Many thanks!!