US ranks 40th in places to give birth. Really?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Its true. It has to do with access to prenatal care. Countries that have government run or subsidized healthcare tend do do a little better on the list.

Yes, and since we've got half our population currently living in poverty or near poverty, MANY women are not getting the prenatal care they need.

I tend to think it can't just be access to prenatal care. There are women all over the world living in worse conditions, and there isn't that much that really needs to be done prenatally. Yes, vitamins, maybe. But, even with poor nutrition, you can have decent maternal survival.

You always hear about women having complications during birth. Vaginal or C-sections. I've had tons of friends who've had issues at birth. How can that be the norm?

This has to be written my a male republican. All that is involved in prenatal care is vitamins? Clueless!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Its true. It has to do with access to prenatal care. Countries that have government run or subsidized healthcare tend do do a little better on the list.

Yes, and since we've got half our population currently living in poverty or near poverty, MANY women are not getting the prenatal care they need.

But, isn't prenatal care more crucial for the health of the baby, versus health of the mom?

I don't know who it's more crucial for, but it's definitely important for both. Prenatal care helped my doctors discover I was at risk of having a stroke while pregnant.

We have a lot of risk factors in America, including poor diet (in the form of obesity), high blood pressure, diabetes, high cholesterol, sedentary lifestyles, etc. Some pregnant women have anemia, syphillis, HIV, and other conditions or diseases that increase the risk of maternal death.

[Anonymous]

Anonymous wrote:
No, this is not accurate at all. These may affect the numbers a little but you're missing the big picture. Do you see the economy? Do you realize that many of us on DCUM live in a complete bubble? There are significant numbers of women who get NO prenatal care in the US. Look at the numbers of uninsured people. There are programs to help but so many people fall through the cracks. Our system is all or nothing. If you have good insurance and you are a savvy consumer, you'll get the best of care. Otherwise, not so much.

I don't really think that's the truth. Those of us with decent insurance might like to think so, but there is so much out of our control.

Having good insurance doesn't guarantee lack of medical errors, or too many interventions.

[Anonymous]

It's lack of access to prenatal care, good nutrition (look up "food deserts", for example), lack of scientifically based childbirth (lots of what hospitals require isn't good science and there can be the old Ina May "cascade of interventions"), we have fairly high rates of c section (not as high as, say, Brazil, but the WHO recommends a rate of about 10%) and there is a much higher degree of complications anytime you introduce surgery, we really don't support mothers, either. It's basically up to a woman to fight for leave, or any other accommodations. There are a whole host of reasons why.

[Anonymous]

Very interesting tidbit. I do wonder if it has to do with our poor health, generally, as people.

But, the percentages are still pretty decent in the U.S. According to the article, in the U.S. you have a .017% chance of dying in childbirth. In Greece, you have a .003% chance of dying in childbirth. Not that I'd want to be a statistic.

[Anonymous]

Anonymous wrote:

Anonymous wrote:If you removed the black and hispanic population from the statistics you would probably find that America ranks higher on the list

this sounds a bit racist to me.

You must have a itchy trigger finger for calling out racism.

I interpreted the remark as a commentary on the lack of quality care for these minority populations. It was an observation about unequal access.

[Anonymous]

Anonymous wrote:I feel like I've also been reading stories like that of the Snyder Twins in NYC where the mom died during the C-section. These are women who had access to prenatal care. I find it a bit scary (especially being AMA myself!).

http://thesnydertwins.com/

Do you think this would not have happened if she delivered in Canada?

[Anonymous]

Anonymous wrote:

Anonymous wrote:
No, this is not accurate at all. These may affect the numbers a little but you're missing the big picture. Do you see the economy? Do you realize that many of us on DCUM live in a complete bubble? There are significant numbers of women who get NO prenatal care in the US. Look at the numbers of uninsured people. There are programs to help but so many people fall through the cracks. Our system is all or nothing. If you have good insurance and you are a savvy consumer, you'll get the best of care. Otherwise, not so much.

I don't really think that's the truth. Those of us with decent insurance might like to think so, but there is so much out of our control.

Having good insurance doesn't guarantee lack of medical errors, or too many interventions.

No, but if we're discussing worldwide healthcare ratings and you bring up medical errors, you've got to make a case that there are more medical errors in the US than abroad. Medical errors are everywhere, human nature. Of course they can be incentivized in the wrong kind of system. I'm not sure we have a worse problem here than abroad, though.

[Anonymous]

Anonymous wrote:If you removed the black and hispanic population from the statistics you would probably find that America ranks higher on the list

Not really, a lot of elderly white women try to have kids late in life. I know a bunch who have had still borns and problems due to waiting past 40.

[Anonymous]

"No, but if we're discussing worldwide healthcare ratings and you bring up medical errors, you've got to make a case that there are more medical errors in the US than abroad. Medical errors are everywhere, human nature. Of course they can be incentivized in the wrong kind of system. I'm not sure we have a worse problem here than abroad, though."

But the difference is that in the U.S. OBs deliver a majority of babies, and they are trained to medicalize birth - go right to a c-section rather than use skill as a midwife would do to get a baby out, for example. In other countries, midwives or nurses deliver a greater number babies (often in a hospital setting) and pain relief (epidurals, etc.) is used much less. I'm talking about Japan, Sweden, the UK - advanced countries.

[Anonymous]

Anonymous wrote:"No, but if we're discussing worldwide healthcare ratings and you bring up medical errors, you've got to make a case that there are more medical errors in the US than abroad. Medical errors are everywhere, human nature. Of course they can be incentivized in the wrong kind of system. I'm not sure we have a worse problem here than abroad, though."

But the difference is that in the U.S. OBs deliver a majority of babies, and they are trained to medicalize birth - go right to a c-section rather than use skill as a midwife would do to get a baby out, for example. In other countries, midwives or nurses deliver a greater number babies (often in a hospital setting) and pain relief (epidurals, etc.) is used much less. I'm talking about Japan, Sweden, the UK - advanced countries.

OK, but you still need to establish that going to a c-section is a medical mistake leading to higher death rates, etc. I'm with you on the overmedicalization but I think there are many other factors at work behind the stats than c-sections. I think the lack of prenatal car is a bigger issue. As PPs have pointed out, prenatal care isn't just vitamins. Think of the complications that arise from undiagnosed/untreated gestational diabetes.

[Anonymous]

Repeat c-sections are an issue though. It seems that OBs here are less likely to want women to have a VBAC, and so there are more repeat c-sections, which lead to hemorraghing (sp?). Infections after c-sections are also an issue.

And then of course women in the US have less maternity leave, which means that they work later into their pregnancies. In many other countries women stop working at 36 weeks.

[Anonymous]

My answer is overtreatment/too much unnecessary medical interventions/ is a big problem in this country. This is what you get when a society is too litigous and doctor's have to play defensive medicine. Defensive medicine=overtreatment and that sometimes leads to bad outcomes because there are risks and side effects to every intervention and medication.

[Anonymous]

The maternal mortality gap between black women and white women in the US is really disturbing.

Another difference between the US and the countries that are doing really well may be our higher teen pregnancy rate. The numbers of young mothers here may be dropping, but they are still much higher than in European countries. I had a NICU baby and I would estimate that at least a third of the other moms in the NICU were under 18.

[Anonymous]

I'm not sure if racial disparities in treatment account for all of our poor maternal mortality rate, but they play a huge role. Black women are 4x as likely to die in childbirth as white women. http://colorlines.com/archives/2010/03/death_by_birth_race_and_maternal_mortality.html