The United States has a very low maternal mortality rate in comparison
with the rest of the world however it has one of the highest rates when just
comparing it to other industrialized countries. It is also higher than most
countries for infant mortality rate. According to the central intelligence
agency the United States has an infant mortality rate of 5.9 per 1,000 live
births and maternal mortality rate of 21 per 100,000 births. Comparing this to
countries such as japan (IMR = 2.17 per 1,000 and MMR = 5 per 100,00) or
Germany ( IMR=3.48 per 1,000 and MMR 3.48 per 100,000) (1) raises the question
as to why the United States’ rates are higher. As we’ve learned in class there
are many factors that can contribute to death rates such as culture and
traditions and these differences can also be seen in birthing practices. There
has always been discussion on the best ways to give to birth whether it’s with
a mid-wife, at home, water birth, c-section, or a traditional birth in a
hospital, if women should get an epidural ect. There are many benefits and
risks for all methods, such as laying down in a hospital allows doctors and
other health professionals to clearly see the birth allowing them to identify any
complications but this is also thought to be more uncomfortable for the mother
and increase pain during delivery. Other methods such as using a stool or
birthing ball are thought to be more comfortable and make birth easier because
of the help of gravity. The mothers and babies comfort is very important but
how much, if any, does one method over another increase or decrease the chances
of maternal or infant death. The World Health Organization has statistics that
show that c sections were used for 17.4% of all births, where .4% was thought
to unnecessary c-sections. C-sections in the United States was 30.3% with 10.8%
thought to be unnecessary and in Germany 27.8% of all births and 1.4%
unnecessary. One study also found that only
6% women needed a c section who received care in mid wife led centers compared
to 24% (2) who gave birth in a traditional hospital. Another source also states
that in Germany it is much more prevalent to use a midwife than it is in the
United States and in Japan painkillers during birth are used less than in the
United States.(3) There are always unpredictable issues and complications that
can arise during birth that a OBGYN would be able to use their expertise,
knowledge and skills to save the mother and/or baby’s life. I am not implying
that one birthing method is better than another, as I mentioned before I think
its most important that the mother, father and baby feel comfortable, confident
and remain safe throughout the entire birthing process. Before I had a women’s
health course I never would have considered using a midwife, birthing ball or
anything other than the traditional method in the United States but I do find
it interesting and unfortunate that the Unites States is one of the worse industrialized
countries in terms of maternal and infant mortality rates, whether birthing
methods contribute to that or not.
Very impressive point, Nicole! We usually overlook infant mortality in the United States, which seems a problem in developing countries. I agree with you that it is important to make the mother and baby feel comfortable and safe no matter which method is used. Except for culture and traditions, which are vital as you mentioned, I think some other factors are also contributing to the higher infant and maternal mortality rates in the United States than other industrialized countries. For example, can most mothers get access to quality prenatal care and actually take advantage of these methods? In addition, Congressional Research Service reported that one of the most common causes of infant mortality in the United States was associated with low birth-weight. Friedman who was a Statistician in Columbia University proposed that low weight birth was at a rate of 13 percent among African Americans and at a rate of only 6.5 percent among Caucasian and Hispanic babies in 2012. Does low birth-weight incidence indicate the existence of inequality, such as lack of social welfare and disparities in health care among some racial and ethnic groups? I always find it interesting comparing the differences between countries' records and practices, because behind the number and phenomenon the underlying determinants in different worlds are so complex and need neverending exploration.
ReplyDeletehttp://www.cbsnews.com/8301-204_162-57583237/u.s-has-highest-first-day-infant-mortality-out-of-industrialized-world-group-reports/
http://www.huffingtonpost.com/howard-steven-friedman/infant-mortality-rate-united-states_b_1620664.html
http://www.fas.org/sgp/crs/misc/R41378.pdf
Our high rate of c-sections is definitely a topic of debate within the obstetric medical community and those interested in maternal health/wellbeing. Healthy People 2020 actually includes reducing c-sections in low-risk births withing two of their goals. Although this was also a goal in Healthy People 2010, rates of c-sections have generally been increasing since 2005.(1) Although limited, I have had experience working on an obstetric unit in an Indianapolis hospital and c-sections definitely occur that aren’t truly medically necessary. Although medical reasons must be documented, our culture has almost made it a “patient-choice” issue and it can be performed as an “elective procedure.” Sadly, I don’t think all women fully understand the implications of undergoing a major surgery and the fact that recovery is usually as difficult or worse than a vaginal delivery. Now from a delivery-of-care perspective, it is definitely far more convenient for practitioners to perform c-sections than to assist a vaginal delivery; surgical procedures have set protocols, there is less variation, they can be scheduled according to practitioner’s schedules, etc. But this does not represent the well-being of the patient as the primary concern. A study found poorer outcomes among newborns delivered by c-section, including increased respiratory distress and lower APGAR scores (a score used to assess health status of newborn within the first 5 minutes of life) (2). There is also some research being done on how c-sections affect maternal-child bonding, as the mother is under anesthesia and really ends up being disconnected from the whole experience. This is not to say there are not definitely times when the procedure is indicated and even saves the life of the mother and/or newborn. However, the statistic you found, that 10.8% of c-sections performed were thought to be unnecessary, is totally unacceptable and unethical.
ReplyDelete(1) http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=26
(2)Werner, E.F., Han, C.S., Savitz, D.A., Goldshore, M., Lipkind. H.S. (2013). Health outcomes for vaginal compared with cesarean delivery of appropriately grown preterm neonates. Obstetrics & Gynecology, 121(6).
Nicole, I think that this is a really interesting topic and I am very interested in the field of Maternal Child Health. It is incredibly fascinating to me that the procedures carried out throughout the world vary to the extremes that they do! I find it interesting to view the differences in infant mortality rate's around the world. I believe we learned that IMR is the fastest way to determine the status of a society? This would absolutely makes sense! It's super fascinating to think about the methods that we, as women, if we choose to have children will adopt and why we choose the ones that we do. I feel that there are benefits and consequences of each, so I guess that we need to refer to the literature and learn as much as we can before making this important decision. Like Kelly mentioned, and we learned in our administration course, the number of cesarian sections that are covered by insurance are going to start declining in the future, because they want to save this for times when it is absolutely necessary, not elected as a choice by the mother. Overall, I really enjoyed your post!
ReplyDelete(1)http://www.bellybelly.com.au/birth/caesarean-section-or-vaginal-birth#.UlvqVRahBEc
Nicole, this topic is very interesting to me as well. In my women's health class we recently watched a documentary called "The Business of Being Born" (on Netflix for free), which delves into the issues you are describing. It is definitely worth watching, although it is biased towards the benefits of home-births and midwives. Nonetheless, it is eye opening to see the birthing trends in the U.S. and how many medical interventions are being done that are completely unnecessary. Also somewhat related is a study that was recently published about a potential relation between induced and/or augmented labor and autism. In recent years, induced and augmented labor have been becoming more common as has autism (See study here:http://www.ncbi.nlm.nih.gov/pubmed/23938610). This is just another aspect and reason why we should look into how childbirth is occurring in the United States and how much we could improve it.
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