Focus on Infants During Childbirth Leaves US Moms in Danger

[Anonymous]

I had pre-ecamplsia. While everything turned out fine in the end, I am convinced it could have and should have been found earlier.

While my BP wasn't clinically high, it was high for ME and crept up throughout my pregnancy. Also, I had a lot of swelling.

[Anonymous]

Anonymous wrote:Just read this earlier this morning and cried. I had HELLP Syndrome and an emergency c four weeks ago. The doctors at Georgetown recognized 4 days prior that I had slightly elevated labs and slightly elevated BP and may end up in trouble. My BP was never as high as the woman in the article yet the doctors knew when I needed the c section and got my daughter out just before my platelet count dropped close to transfusion level and my liver enzymes went sky high.

I spoke to another NICU mom who had the same symptoms as me but was at another hospital in MD and they sent her to the ER instead of L&D and she was told her intense liver pain (and clear symptom of HELLP Syndrome) was just the baby kicking her ribs and to suck it up and take Tylenol. She suffered for several days before getting the help she needed. It's outrageous.

I was already feeling nervous about prior plans to move out of the region before baby #2 but this article has me terrified to consider another pregnancy at a hospital that may not be as good at recognizing signs of trouble.

Georgetown caught my pre-e and HELLP too and kept my baby cooking for an extra three weeks under close care. They are a really great practice.

[Anonymous]

The mortality/morbity is just ONE aspect of how they don't care about moms.

How about the complete lack of research/medical attention to pelvic floor issues post vaginal birth? PT could help a lot of people with these issues (like prolapse) if they caught it in the months right after giving birth, instead we just have a culture where women laugh about how we'll never sneeze without peeing again for the rest of our lives.

[Anonymous]

Anonymous wrote:I had pre-ecamplsia. While everything turned out fine in the end, I am convinced it could have and should have been found earlier.

While my BP wasn't clinically high, it was high for ME and crept up throughout my pregnancy. Also, I had a lot of swelling.

My exact experience. And I had to fight to get them to take the BP seriously because it wasn't at "crisis" levels but was creeping up starting at around 33 weeks.

[Anonymous]

Anonymous wrote:This is horribly sad. I hope it helps spark a public outcry. Everyone trusts our healthcare system too much, then when the unthinkable happens they think it was just bad luck. If another physician has no option other than to stand by watching his wife die a horrific death, what are the chances for a regular person with no medical background?

ACOG has known about the shameful increase in the rate of maternal death for over 2 years and proposed a solution to it in 2015. It sounds like a pretty damn good start. I wonder if any progress has been made in the past 2 years on this levels of care initiative?

Here it is:
http://www.acog.org/Resources-And-Publications/Obstetric-Care-Consensus-Series/Levels-of-Maternal-Care

Oh, and thank you OP for posting this!

OP here - I admit I was torn about posting this here, because as a pregnant woman this is pretty terrifying. But I think it's important to know so that we can be advocates for improvements in maternity care.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I had pre-ecamplsia. While everything turned out fine in the end, I am convinced it could have and should have been found earlier.

While my BP wasn't clinically high, it was high for ME and crept up throughout my pregnancy. Also, I had a lot of swelling.

My exact experience. And I had to fight to get them to take the BP seriously because it wasn't at "crisis" levels but was creeping up starting at around 33 weeks.

I had the exact same experience with high for me but not clinically high blood pressure, along with swelling. I feel so lucky that my doctor was concerned enough to take it really seriously and even called me in on the weekend one time to come in for more labs, which showed deteriorating results and led to an immediate induction. Looking back, I'm also mad at myself for not taking things seriously enough. I had bought into the idea of "natural birth" and was so against the idea of an induction or c-section that I tried to deny to myself that things could get serious quickly. Ultimately, I would up with an induction and c-section followed by a tranfusion, but luckily baby and I both walked out unscathed.

There's certainly a variety of causes of the increasing maternal death rate, and the most significant factor is surely lack of adequate medical care/ability to afford care. My experience also makes me hope that the trend against medicalization/toward natural birth, doesn't also lead to adverse effects in some cases. If my original midwives (not known as particularly crunchy) hadn't transferred me to OBs, and the OBs hadn't been vigilant, I recognize now I could have been in a much scarier situation.

[Anonymous]

Anonymous wrote:

Anonymous wrote:This is horribly sad. I hope it helps spark a public outcry. Everyone trusts our healthcare system too much, then when the unthinkable happens they think it was just bad luck. If another physician has no option other than to stand by watching his wife die a horrific death, what are the chances for a regular person with no medical background?

ACOG has known about the shameful increase in the rate of maternal death for over 2 years and proposed a solution to it in 2015. It sounds like a pretty damn good start. I wonder if any progress has been made in the past 2 years on this levels of care initiative?

Here it is:
http://www.acog.org/Resources-And-Publications/Obstetric-Care-Consensus-Series/Levels-of-Maternal-Care

Oh, and thank you OP for posting this!

OP here - I admit I was torn about posting this here, because as a pregnant woman this is pretty terrifying. But I think it's important to know so that we can be advocates for improvements in maternity care.

NP - Agreed, and thank you! We need to be informed patients, because even well-meaning medical professionals can miss warning signs or write off problems. It's scary to think about all the things that can go wrong, but being educated about pregnancy complications and childbirth injury (which another PP mentioned) is a net positive for women.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Those countries all have better healthcare, usually universally provided by the goverment, and a much stronger social welfare safety net. We choose higher infant and maternal mortality in this country because we do not want universal healthcare. We could make other choices as a nation if we wanted to.

Exactly. Instead, we elect a despotic charlatan and scumbag Republicans to the hill. Family values indeed.

Agree with all of the above.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yeah, it's not a focus on infants that's the problem. It's our terrible healthcare system.

I'm not so sure. They put a ton of resources into promoting breastfeeding, which has negligible if any benefits. The protocols developed by Canada to prevent pre-eclampsia wouldn't take that much money; just the organization/political will to do it.

I disagree that there are a ton of resources promoting breastfeeding. I'm a new mom struggling with breastfeeding and I'm struggling to get support. The hospital provided minimal service (and before my milk even came in with no follow up) and LCs are expensive. I went to a support group at the hospital but there were too many people there to get any specific guidance. Also, it's really tough to continue breastfeeding with a lack of paid maternity leave. Now Congress wants to get rid of the ACA mandates related to breastfeeding.

Well there's certainly been MUCH more institutional support for breastfeeding compared to maternal health. There's the whole Baby Friendly Hospital accreditation that takes money to organize, political capital to push, and then money and commitment for the hospitals to implement. Resources are also expended on reducing c-sections, which may reduce some morbidity/mortality, but fails to address the main causes of maternal death. And JAHCO's "Perinatal Core Measures" are almost exclusively focused on promoting vaginal birth and breastfeeding, not maternal health. http://www.jointcommission.org/assets/1/6/s11.pdf.

Out of curiosity PP what resources are being expended to reduce c-sections? I'm genuinely curious b/c I ended up having to have one b/c my baby was OP and didn't budge after two hours of pushing. To be honest, I was fucking furious. . .what was the point of all of those visits in the last weeks? I really don't understand why they don't do some imaging in the last week or two to determine positioning beforehand so you can try to do something about it BEFORE you go into labor.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yeah, it's not a focus on infants that's the problem. It's our terrible healthcare system.

I'm not so sure. They put a ton of resources into promoting breastfeeding, which has negligible if any benefits. The protocols developed by Canada to prevent pre-eclampsia wouldn't take that much money; just the organization/political will to do it.

I disagree that there are a ton of resources promoting breastfeeding. I'm a new mom struggling with breastfeeding and I'm struggling to get support. The hospital provided minimal service (and before my milk even came in with no follow up) and LCs are expensive. I went to a support group at the hospital but there were too many people there to get any specific guidance. Also, it's really tough to continue breastfeeding with a lack of paid maternity leave. Now Congress wants to get rid of the ACA mandates related to breastfeeding.

Well there's certainly been MUCH more institutional support for breastfeeding compared to maternal health. There's the whole Baby Friendly Hospital accreditation that takes money to organize, political capital to push, and then money and commitment for the hospitals to implement. Resources are also expended on reducing c-sections, which may reduce some morbidity/mortality, but fails to address the main causes of maternal death. And JAHCO's "Perinatal Core Measures" are almost exclusively focused on promoting vaginal birth and breastfeeding, not maternal health. http://www.jointcommission.org/assets/1/6/s11.pdf.

Out of curiosity PP what resources are being expended to reduce c-sections? I'm genuinely curious b/c I ended up having to have one b/c my baby was OP and didn't budge after two hours of pushing. To be honest, I was fucking furious. . .what was the point of all of those visits in the last weeks? I really don't understand why they don't do some imaging in the last week or two to determine positioning beforehand so you can try to do something about it BEFORE you go into labor.

NP, but I believe that they used to allow for elective c-sections a lot more. I know that in order to book my c-section (which I needed for a medical reason) my OB had to fill out paperwork with the hospital telling them the medical reason/justifying it. So that would be some of the decline in c-section rates. Also, I don't know if this will make you feel any better about your c-section or not, probably not, but babies can turn to a bad position during labor-friend of mine had her kid turn breach at the last minute- so imaging is not necessarily helpful before labor if the kid changes position during the labor.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yeah, it's not a focus on infants that's the problem. It's our terrible healthcare system.

I'm not so sure. They put a ton of resources into promoting breastfeeding, which has negligible if any benefits. The protocols developed by Canada to prevent pre-eclampsia wouldn't take that much money; just the organization/political will to do it.

I disagree that there are a ton of resources promoting breastfeeding. I'm a new mom struggling with breastfeeding and I'm struggling to get support. The hospital provided minimal service (and before my milk even came in with no follow up) and LCs are expensive. I went to a support group at the hospital but there were too many people there to get any specific guidance. Also, it's really tough to continue breastfeeding with a lack of paid maternity leave. Now Congress wants to get rid of the ACA mandates related to breastfeeding.

Well there's certainly been MUCH more institutional support for breastfeeding compared to maternal health. There's the whole Baby Friendly Hospital accreditation that takes money to organize, political capital to push, and then money and commitment for the hospitals to implement. Resources are also expended on reducing c-sections, which may reduce some morbidity/mortality, but fails to address the main causes of maternal death. And JAHCO's "Perinatal Core Measures" are almost exclusively focused on promoting vaginal birth and breastfeeding, not maternal health. http://www.jointcommission.org/assets/1/6/s11.pdf.

Out of curiosity PP what resources are being expended to reduce c-sections? I'm genuinely curious b/c I ended up having to have one b/c my baby was OP and didn't budge after two hours of pushing. To be honest, I was fucking furious. . .what was the point of all of those visits in the last weeks? I really don't understand why they don't do some imaging in the last week or two to determine positioning beforehand so you can try to do something about it BEFORE you go into labor.

I don't think there's really anything you can do about an OP baby to reduce c sections. If anything, maternal-health focused care would develop procedures to identify patients like you where going to c-section sooner rather htan later is the best plan to avoid injury to you. The resources I'm talking about are things like the JAHCO and California efforts to reduce c sections by encouraging operative births, longer pushing, etc (which both increase maternal pelvic injury rates, btw ...)

[Anonymous]

Childbirth and pregnancy have always been dangerous for women and for children. There are two groups who are to blame for the low quality prenatal and labor and delivery care - congress and nazi-style natural birthers.


Both just use a "hope for the best" and "let nature do it's magic" philosophy and the results are the embarrassing statistics you see today.

[Anonymous]

I read this article this morning and immediately thought of how different my experience giving birth at Georgetown was. They were constantly monitoring my vital signs, and they also get prepared to do blood transfusions at the first signs of trouble (I didn't need one, but later found out that everything had been prepared just in case). It's also a baby-friendly hospital with excellent breastfeeding support and a low c-section rate. So glad that I live in this area!

[Anonymous]

Anonymous wrote:Childbirth and pregnancy have always been dangerous for women and for children. There are two groups who are to blame for the low quality prenatal and labor and delivery care - congress and nazi-style natural birthers.


Both just use a "hope for the best" and "let nature do it's magic" philosophy and the results are the embarrassing statistics you see today.

Did you read the article?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yeah, it's not a focus on infants that's the problem. It's our terrible healthcare system.

I'm not so sure. They put a ton of resources into promoting breastfeeding, which has negligible if any benefits. The protocols developed by Canada to prevent pre-eclampsia wouldn't take that much money; just the organization/political will to do it.

I disagree that there are a ton of resources promoting breastfeeding. I'm a new mom struggling with breastfeeding and I'm struggling to get support. The hospital provided minimal service (and before my milk even came in with no follow up) and LCs are expensive. I went to a support group at the hospital but there were too many people there to get any specific guidance. Also, it's really tough to continue breastfeeding with a lack of paid maternity leave. Now Congress wants to get rid of the ACA mandates related to breastfeeding.

Well there's certainly been MUCH more institutional support for breastfeeding compared to maternal health. There's the whole Baby Friendly Hospital accreditation that takes money to organize, political capital to push, and then money and commitment for the hospitals to implement. Resources are also expended on reducing c-sections, which may reduce some morbidity/mortality, but fails to address the main causes of maternal death. And JAHCO's "Perinatal Core Measures" are almost exclusively focused on promoting vaginal birth and breastfeeding, not maternal health. http://www.jointcommission.org/assets/1/6/s11.pdf.

Out of curiosity PP what resources are being expended to reduce c-sections? I'm genuinely curious b/c I ended up having to have one b/c my baby was OP and didn't budge after two hours of pushing. To be honest, I was fucking furious. . .what was the point of all of those visits in the last weeks? I really don't understand why they don't do some imaging in the last week or two to determine positioning beforehand so you can try to do something about it BEFORE you go into labor.

I don't think there's really anything you can do about an OP baby to reduce c sections. If anything, maternal-health focused care would develop procedures to identify patients like you where going to c-section sooner rather htan later is the best plan to avoid injury to you. The resources I'm talking about are things like the JAHCO and California efforts to reduce c sections by encouraging operative births, longer pushing, etc (which both increase maternal pelvic injury rates, btw ...)

Bad positioning can be influenced in the weeks before the birth ... mostly through working with the mother on posture and certain techniques. It's not 100% successful but certainly more than just ignoring it. I had MWs for all 3 of mine and there was a lot of education on what I should do to improve baby's positioning. For an OP baby, there's also a lot you can do in labor to move the baby before its head is fully engaged .. after that you're kind of stuck. Regarding longer pushing, what the recent study showed is that the 1 hr cutoff was an artificial (and capriciously applied) timeline that did not improve outcomes.