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

[Anonymous]

way, way too many c/s and other interventions brought on by a fear of litigation. Countries with lower maternal and infant mortality have MUCH lower rates of medical litigation across the board. The interventions may lead to complications but they also protect practitioners from being sued. A woman may die from hemorrhage from a c/s (because by it's very nature there are risks) but unless there was a gross error the physician will be fine (as he should be--even a c/s performed perfectly has risks! it's MAJOR abdominal surgery). However, had he not done the c/s in the first place and something went wrong with the pregnancy he would be held liable for not doing c/s. And so if there is any question, he does the c/s. And so the cycle continues and continues and leads to the 50% c/s rate in many hospitals.

Also, it is REALLY difficult to get young, poor women to seek prenatal care. Mostly because they have no support at home--no one to drive them to the doctor, no one to take care of other children, etc. Way too many other life issues that take precedent over getting weighed and measured every 1-4 weeks in pregnancy. Most (if not all) states make it INCREDIBLY easy for women to get state insurance for prenatal care. In fact, they have very liberal income limits (much higher than for traditional Medicaid) and will back pay providers who start care before the woman is insured. Plus they pay providers better than traditional Medicaid pays for other medical issues. In Maryland (where I worked as a midwife), they actually pay BETTER than most private insurance plans. However, it's just REALLY, REALLY hard to get the inner-city teenage population to go to the doctor/midwife. Health departments dream up all sorts of intervention programs using nurses in school, etc, etc. but none of it really works. It's to the point where it's ingrained in the culture.

[Anonymous]

Combination of things.

1. lack of access to / interest / ability to get to / etc in prenatal care (even where it's free, many women can't get to the doctors, others are not motivated to go for a variety of factors, others still are so dependent on wage-earning they cannot take time off to get to the appointments without risking jobs, etc etc).
2. c-section epidemic and related aggressive medicalization of birth. This is a controversial topic on these boards but the simple fact is that 40 percent c-section rate is crazy. Certainly a contributing factor
3. greater numbers of parents with high risk pregnancies. this has subsets:
a. teen pregnancies (are actually just as risky as AMA pregnancies, and there are more of them, sadly)
b. obesity, diabetes, sedentary lifestyle, hypertension, undiagnosed heart problems, etc
c. poor diet / nutritional deficiencies
d. older mom pregnancies (especially first time pregnancies over age 35). (NOTE: I am such a mother - no insult intended)
4. Premature babies, etc.

I don't think you can really discount any of these factors, and obviously each factor probably has about 30 unstated related subfactors (c sections are an epidemic for SO many reasons, from everything from doctor fear of lawsuits and doctor convenience, to parental convenience, misinformation about risks, management of labor, and yes, patient's own choices).

In any case, it is appalling and simply must be addressed.

[Anonymous]

Anonymous wrote:way, way too many c/s and other interventions brought on by a fear of litigation. Countries with lower maternal and infant mortality have MUCH lower rates of medical litigation across the board. The interventions may lead to complications but they also protect practitioners from being sued. A woman may die from hemorrhage from a c/s (because by it's very nature there are risks) but unless there was a gross error the physician will be fine (as he should be--even a c/s performed perfectly has risks! it's MAJOR abdominal surgery). However, had he not done the c/s in the first place and something went wrong with the pregnancy he would be held liable for not doing c/s. And so if there is any question, he does the c/s. And so the cycle continues and continues and leads to the 50% c/s rate in many hospitals.

Also, it is REALLY difficult to get young, poor women to seek prenatal care. Mostly because they have no support at home--no one to drive them to the doctor, no one to take care of other children, etc. Way too many other life issues that take precedent over getting weighed and measured every 1-4 weeks in pregnancy. Most (if not all) states make it INCREDIBLY easy for women to get state insurance for prenatal care. In fact, they have very liberal income limits (much higher than for traditional Medicaid) and will back pay providers who start care before the woman is insured. Plus they pay providers better than traditional Medicaid pays for other medical issues. In Maryland (where I worked as a midwife), they actually pay BETTER than most private insurance plans. However, it's just REALLY, REALLY hard to get the inner-city teenage population to go to the doctor/midwife. Health departments dream up all sorts of intervention programs using nurses in school, etc, etc. but none of it really works. It's to the point where it's ingrained in the culture.

This is absolutely true, and so very sad. Some states are considering programs to pay expecting mothers to go to the doctor. Sounds absurd, until you consider that maybe you make a difference not for the parent, but for her child. Maybe that makes it easier for her to pay someone to take her there, or to offset the lost wages she gets hit with while going to the doctor. But, where these programs are being implemented (I think Louisiana is one state) they're struggling with follow up nonetheless.

[Anonymous]

Anonymous wrote: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.

This. In certain countries women stop working at 30 weeks. Lack of paid maternity leave in this country is truly an abomination.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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.

This. In certain countries women stop working at 30 weeks. Lack of paid maternity leave in this country is truly an abomination.

In other countries Women of child bearing age don't get hired because of this and everyone has to pay for it. It doesn't happen out of thin air. The best bet would be to save money before taking time off.

[Anonymous]

women of child bearing age do get hired

[Anonymous]

Health, education, internet and technology, we are second world on many indicators now...provincial Americans are in denial though.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

This. In certain countries women stop working at 30 weeks. Lack of paid maternity leave in this country is truly an abomination.

In other countries Women of child bearing age don't get hired because of this and everyone has to pay for it. It doesn't happen out of thin air. The best bet would be to save money before taking time off.

Have you ever lived in 'other countries'? I have, and let me tell you, there's no shortage of working women in France.

[Anonymous]

Oh, don't forget infrastructure and transportation in general! High speed trains between cities? Not here! Airports that aren't dirty and embarrassing? Try Asia. Airlines that aren't abusive with filthy planes and rude staff? Elsewhere. Things have changed.

[Anonymous]

Check out the documentary: 'The Business of Being Born'.

[Anonymous]

Anonymous wrote:Fertility treatments and NICU's skew our numbers. More women die here than in other developed countries because more women get pregnant here that wouldn't get pregnant in other countries. The only woman I know personally who has died in birth died due to complications of a triplet pregnancy. She was 43.

The infant death rates are higher because we actually try to save micropremies. Babies that are given up on in other countries are treated here and some make it and some don't.

I don't think so.

Do you know how many women give birth in underprivileged countries everyday and have no means to eat to produce enough breastmilk for their child? And they have no access to clean water and the children end up dying of dehydration from throwing up and diarrhea.

I doubt the numbers here are as significant as the numbers there.

[Anonymous]

Anonymous wrote:
What is it about our health care system that gives us such abysmal numbers?

Well, in a nutshell, not everyone gets health care. I know lots of PPs have made great points about birth and pregnancy specifically, but how does this ranking compare to other health indicators? I mean, the US has poor health care in general, and an extremely inequitable system. What sort of ranking does the US get in other indicators like (I'm not sure what's relevant or comparable, so I'm kind of picking things at random) care of heart disease, cancer, mental illness, diabetes ... etc?

[Anonymous]

The US health care system consistently ranks as one of the most expensive and less effective in the world.

Look at the list. We need a national health plan.