MaternityCare_2.0 ~ Mother-Baby-Father-Friendly Care for Normal Childbirth that all Americans can be proud of!
Today’s blog is the final installment about an ABC article reporting on the increase in maternal mortality in the US (published by ABC on March 4th, 2010, excerpts embedded in the March 8th of this blog (Normal-Birth.blogspot.com).
We know that what has been happening is the US is wrong - the false idea that Cesarean surgery makes birth safer. Now we need to figure out how to correct this problem -- how do we transform our maternity care system? And in particular, how do we end the mindless medicalization of normal birth - the overuse and misuse of induction of labor and elective Cesarean - in healthy women and replace it with evidence-based, cost-effective maternity care. This is the best way to (a) reduce preventable maternal mortality and (b) to provide an effective and efficient system that is highly rated by childbearing families as "satisfying" and highly rated by health care officials as affordable and accessable.
The science-based model of maternity care for normal childbirth protects and preserves maternal-fetal wellbeing, while providing access to appropriate obstetrical intervention for those women or babies with complications or if medical interventions are requested by the mother. This serves the needs of healthy families far better than our expensive and inflexible high-tech model, which costs two to ten times more than it needs to.
Billions of health care dollars can be saved every year by lowering the direct cost of maternity care and reducing post-operative, delayed and downstream complications associated with Cesarean surgery.
MaternityCare_2.0 is a big first step on our national path to a safe, effective, affordable, accessible healthcare system that we Americans can to proud of -- HealthCare_2.0
Adopting evidence-based standards for normal childbirth will require legal and legislative changes that move us away from the mistaken idea that it is "substandard" for a physician to provide physiologic (i.e. non-medical) care, since childbirth is legally defined as a surgical procedure by the medical profession. We also need regulations to end the perverse incentives that pay for doing things *to* the mother (often risky, invasive or painful procedures) but don’t compensate a physician for spending time *with* the mother. Under the current surgical billing code for normal birth, medical providers are paid per procedure. This makes more interventions more profitable.
What we need is a new, non-surgical billing code for physiologically-managed childbirth that allows birth attendants to be protected from outmoded policies and inappropriate litigation, while at the same time being fairly compensated for their time and rewarded for preventing complications. This will also reduce long-term problems that burden the family and are expensive to the healthcare system.
Maternity Care 2.0 – a science-based model for the 21st Century:
For an essentially healthy population, the most efficacious form of maternity care is always the method that provides “maximal results with minimal interventions”. This is defined as a *beneficial ratio of interventions to outcomes* for each childbearing woman.
The ideal maternity care system *seeks out the point of balance* where the skillful use of physiological management and adroit use of necessary medical interventions provides the *best outcome* with the *fewest number* of medical/surgical procedures and *least expense* to the health care system.
This is the right way, the only way to eliminate preventable maternal mortality and morbidity and eliminate unnecessary suffering of the children, fathers and families left behind.
Faith Gibson - former L&D nurse, California licensed professional midwife, ratifier of the Coalition for Improving Maternity Services (CIMS) “Mother Friendly Childbirth Initiative”
www.collegeofmidwives.org
www.normalbirth.org
Monday, March 22, 2010
Wednesday, March 10, 2010
The antidote to the routine medicalization of normal labor and overuse of induction of labor and elective Cesarean surgery
Today’s blog continues the commentary on the ABC article increasing maternal mortality (published March 4th, 2010, excerpts embedded in the March 8th Normal-Birth blog).
The only good reason for a risky medical or surgical procedure is a serious health problem that makes the potentially life-threatening complications of surgery less of a danger than the disease being treated. In the absence of a potentially life-threatening condition, potentially life-saving medical interventions are themselves life-threatening.
The lives of mothers and babies are depending on us to replace the well-meaning but ill-advised ‘pre-emptive’ use of technology and routine interventions with a genuinely evidence-based and cost-effective mother-baby-father-friendly model of maternity care.
There is no getting around these very grim facts: Cesarean surgery, as the route of delivery, is associated with 33 serious complications – a number 8 times greater that the risks of vaginal birth. Not only is the risk of maternal death 2 to 5 times greater during or after operative delivery, but for every post-Cesarean maternal death there are a 100 new mothers who suffer a serious complication, such as emergency hysterectomy, secondary infertility or stillbirth in a subsequent pregnancy.
To access the research, go to: www.motherfriendly.org/pdf/TheRisksofCesareanSectionFebruary2010.pdf
The only answer or antidote to routine medicalization, with its emphasis on elective procedures such as induction and scheduled Cesareans, is a return to the time-tested principles of physiological management. Medical dictionaries define “physiological” as: “…in accord with or characteristic of the normal functioning of a living organism”.
Physiologic care provides a reliable method for working with the normal process of biology and has long been used by those countries with the best maternal-infant outcomes. The scientific literature identifies physiological management for normal birth as the safest and most economical type of maternity care for a healthy woman with a normal pregnancy. It is the scientific or evidence-based standard of care.
Physiologic care during labor and birth is associated with the lowest rate of preventable maternal and perinatal mortality and is protective of the mother's pelvic floor. It has the best psychological outcomes and the highest rate of breastfed babies. Dependence on physiological principles results in the fewest number of medical interventions, lowest rates of anesthetic use, obstetrical complications, episiotomy, instrumental deliveries, Cesarean surgery, post-operative Cesarean complications and delayed or downstream complications of Cesareans in future pregnancies.
Physiological management takes into account the positive influence of gravity on the stimulation of labor, dilatation of the cervix and decent of the baby through the bony pelvis. Maternal mobility not only helps this normal process move along without the need to use artificial hormones to speed up labor, but also diminishes the mother’s perception of pain, perhaps by stimulating endorphins.
Effective labor support always addresses the mother’s pain, her fears and privacy needs so that labor can progress spontaneously, reducing or eliminating the need for medical interventions such as artificial hormones (Pitocin) to speed up labor, pain medication, anesthesia and operative delivery.
Healthy, mentally-competent women have a natural right to have control over the manner and circumstance of normal labor and birth. Just as we acknowledge a woman’s right to choose obstetrical intervention, epidural or an elective Cesarean, so women have an even more compelling right to choose normal care based on the principles of physiological management and the healthcare system has a matching responsibility to provide access to physiologic care. It is society twin obligation to provide maternity care based on ‘best practices’ as determined by the scientific evidence, as well as seeing that women desiring or requiring obstetrical interventions do so with informed consent that also fully reflects the scientific literature.
What we need now is to reboot our maternity care system so that all categories of birth attendants (obstetricians, family physicians and midwives) are taught the body of knowledge and specific skills for effectively addressing the physical and biological needs and emotional stresses that healthy women typically face during labor. In addition, hospitals must become truly “mother-friendly” by providing evidenced-based care in a low-tech environment that is appropriate to normal childbirth.
This model of normal childbirth includes continuity of care, the full-time presence of the primary birth attendant though out active labor and the supportive presence of family members or other companions chosen by the laboring women. It acknowledges the mother’s on-going need for social and emotional support and physical privacy, which includes control over her environment and the people present. This means that laboring women are free to move about and choose their own positions and activities.
The strategies of physiologically-based care include patience with nature, the right use of gravity and proven methods to help mothers cope with the pain and stress of labor, such as one-on-one support, therapeutic touch, movement and access to hot showers or deepwater tubs.
Women who walk and move about at will and make use of traditional coping strategies to keep pain within manageable levels usually have greatly reduced rate of drugs and other interventions. However, mother-friendly care also provides ‘no-fault, no-blame’ use of pain medication or epidural analgesia when other methods don’t provide the needed relief.
Patience, maternal mobility and the right use of gravity are also critically important during the pushing stage. Even mothers who’ve had epidural analgesia benefit by pushing and delivering on their side, so they are not bearing weight on their sacrum (reducing blood supply to the placenta and O2 to the baby) or fighting against gravity as they try to push an 8# baby uphill and around the normal 60-degree angle of the pelvic outlet (the Curve of Carus).
This science-based model of maternity care for normal childbirth protects and preserves maternal-fetal wellbeing, while providing access to appropriate obstetrical intervention for those women or babies with complications or if medical interventions are requested by the mother. This serves the needs of healthy families far better than our expensive and inflexible high-tech model, which costs two to ten times more than it needs to.
Billions of health care dollars can be saved every year by lowering the direct cost of maternity care and reducing post-operative, delayed and downstream complications associated with Cesarean surgery.
MaternityCare_2.0 is a big first step on our national path to a safe, effective, affordable, accessible healthcare system that we Americans can to proud of -- HealthCare_2.0
Come back tomorrow for the last installment of this 3-part series on the irrational enthusiasm of the “system” to unnecessarily medicalized and complicate normal birth and the deleterious consequences to maternal health and the economics of our national healthcare system.
Today’s blog continues the commentary on the ABC article increasing maternal mortality (published March 4th, 2010, excerpts embedded in the March 8th Normal-Birth blog).
The only good reason for a risky medical or surgical procedure is a serious health problem that makes the potentially life-threatening complications of surgery less of a danger than the disease being treated. In the absence of a potentially life-threatening condition, potentially life-saving medical interventions are themselves life-threatening.
The lives of mothers and babies are depending on us to replace the well-meaning but ill-advised ‘pre-emptive’ use of technology and routine interventions with a genuinely evidence-based and cost-effective mother-baby-father-friendly model of maternity care.
There is no getting around these very grim facts: Cesarean surgery, as the route of delivery, is associated with 33 serious complications – a number 8 times greater that the risks of vaginal birth. Not only is the risk of maternal death 2 to 5 times greater during or after operative delivery, but for every post-Cesarean maternal death there are a 100 new mothers who suffer a serious complication, such as emergency hysterectomy, secondary infertility or stillbirth in a subsequent pregnancy.
To access the research, go to: www.motherfriendly.org/pdf/TheRisksofCesareanSectionFebruary2010.pdf
The only answer or antidote to routine medicalization, with its emphasis on elective procedures such as induction and scheduled Cesareans, is a return to the time-tested principles of physiological management. Medical dictionaries define “physiological” as: “…in accord with or characteristic of the normal functioning of a living organism”.
Physiologic care provides a reliable method for working with the normal process of biology and has long been used by those countries with the best maternal-infant outcomes. The scientific literature identifies physiological management for normal birth as the safest and most economical type of maternity care for a healthy woman with a normal pregnancy. It is the scientific or evidence-based standard of care.
Physiologic care during labor and birth is associated with the lowest rate of preventable maternal and perinatal mortality and is protective of the mother's pelvic floor. It has the best psychological outcomes and the highest rate of breastfed babies. Dependence on physiological principles results in the fewest number of medical interventions, lowest rates of anesthetic use, obstetrical complications, episiotomy, instrumental deliveries, Cesarean surgery, post-operative Cesarean complications and delayed or downstream complications of Cesareans in future pregnancies.
Physiological management takes into account the positive influence of gravity on the stimulation of labor, dilatation of the cervix and decent of the baby through the bony pelvis. Maternal mobility not only helps this normal process move along without the need to use artificial hormones to speed up labor, but also diminishes the mother’s perception of pain, perhaps by stimulating endorphins.
Effective labor support always addresses the mother’s pain, her fears and privacy needs so that labor can progress spontaneously, reducing or eliminating the need for medical interventions such as artificial hormones (Pitocin) to speed up labor, pain medication, anesthesia and operative delivery.
Healthy, mentally-competent women have a natural right to have control over the manner and circumstance of normal labor and birth. Just as we acknowledge a woman’s right to choose obstetrical intervention, epidural or an elective Cesarean, so women have an even more compelling right to choose normal care based on the principles of physiological management and the healthcare system has a matching responsibility to provide access to physiologic care. It is society twin obligation to provide maternity care based on ‘best practices’ as determined by the scientific evidence, as well as seeing that women desiring or requiring obstetrical interventions do so with informed consent that also fully reflects the scientific literature.
What we need now is to reboot our maternity care system so that all categories of birth attendants (obstetricians, family physicians and midwives) are taught the body of knowledge and specific skills for effectively addressing the physical and biological needs and emotional stresses that healthy women typically face during labor. In addition, hospitals must become truly “mother-friendly” by providing evidenced-based care in a low-tech environment that is appropriate to normal childbirth.
This model of normal childbirth includes continuity of care, the full-time presence of the primary birth attendant though out active labor and the supportive presence of family members or other companions chosen by the laboring women. It acknowledges the mother’s on-going need for social and emotional support and physical privacy, which includes control over her environment and the people present. This means that laboring women are free to move about and choose their own positions and activities.
The strategies of physiologically-based care include patience with nature, the right use of gravity and proven methods to help mothers cope with the pain and stress of labor, such as one-on-one support, therapeutic touch, movement and access to hot showers or deepwater tubs.
Women who walk and move about at will and make use of traditional coping strategies to keep pain within manageable levels usually have greatly reduced rate of drugs and other interventions. However, mother-friendly care also provides ‘no-fault, no-blame’ use of pain medication or epidural analgesia when other methods don’t provide the needed relief.
Patience, maternal mobility and the right use of gravity are also critically important during the pushing stage. Even mothers who’ve had epidural analgesia benefit by pushing and delivering on their side, so they are not bearing weight on their sacrum (reducing blood supply to the placenta and O2 to the baby) or fighting against gravity as they try to push an 8# baby uphill and around the normal 60-degree angle of the pelvic outlet (the Curve of Carus).
This science-based model of maternity care for normal childbirth protects and preserves maternal-fetal wellbeing, while providing access to appropriate obstetrical intervention for those women or babies with complications or if medical interventions are requested by the mother. This serves the needs of healthy families far better than our expensive and inflexible high-tech model, which costs two to ten times more than it needs to.
Billions of health care dollars can be saved every year by lowering the direct cost of maternity care and reducing post-operative, delayed and downstream complications associated with Cesarean surgery.
MaternityCare_2.0 is a big first step on our national path to a safe, effective, affordable, accessible healthcare system that we Americans can to proud of -- HealthCare_2.0
Come back tomorrow for the last installment of this 3-part series on the irrational enthusiasm of the “system” to unnecessarily medicalized and complicate normal birth and the deleterious consequences to maternal health and the economics of our national healthcare system.
Monday, March 08, 2010
On March 4th (2010), ABC News ran a story proclaiming: “Maternal Mortality Rates Rising in California -- New Study Shows More Women are Dying After Childbirth, but Most Deaths are Preventable”
It’s good that the media picked up this long-neglected story, but unfortunately the article draws the wrong conclusions, while failing to identify the real issue. According to this article, the increase in maternal deaths is being brought on mothers themselves – more women are dying because so many pregnant women are obese and so many women are foolishly demanding risky surgical deliveries. According to this theory, the obstetrical profession is just the helpless victim of the poor judgment of childbearing women who are forcing doctors to perform dangerous procedures.
ABC’s fact-checkers also misunderstood the crucial statistics on so-called ‘maternal choice’ Cesareans – they were wrong by a factor of *30*. Worse yet, the article only mentions the connection between fatalities due to surgical delivery and the sky-rocketing rate of elective Cesarean deliveries in a headline. However, the article itself never acknowledges the overuse of C-sections based on “physician preference” and hospital policies.
Many healthy women with normal twin, breech or VBAC pregnancies being required by their OBs or by hospital policy to have so-called "elective" C-sections, when in fact, the mother did not choose or prefer a surgical delivery. In other instances, obstetricians are doing C-sections for reasons not justified by the medical science – older or overweight mother, a post-date pregnancy, slow progress, a fetal monitor tracing that is other than perfect, or in a misguided attempt to prevent shoulder dystocia in what the provider fears may be a big baby.
When the article does suggest a remedy, it’s to recommend that every hospital have several $4,600 dollar medical devises to prevent blood clots, which are used AFTER the C-section is performed – never a whisper to suggest that the best way to prevent unnecessary maternal deaths from post-operative complications is to prevent medically unnecessary Cesarean surgeries.
Here is the jest of the ABC article [emphasis mine], followed by additional comments:
“According to the World Health Organization, the U.S. ranks behind more than 40 other countries when it comes to maternal death rates, with 11 deaths per 100,000 pregnancies when measured in 2005. More women die in the U.S. after giving birth than die in countries including Poland, Croatia, Italy and Canada, to name a few.
A new report out of California found the number of women who died in the state after giving birth has nearly tripled over the past decade, from 5.6 deaths per 100,000 to *16.9 per 100,000* in 2006. The report was commissioned by the California Department of Health but has not yet been publicly released. ABC News first learned of its existence from a watchdog group called "California Watch." www.californiawatch.org
Death after childbirth is still rare, but experts say many of those deaths could have been prevented. "We've been able to double-check the data so we can truly say there is a rise," said Dr. Elliott Main, chairman of the California Maternal Quality Care Collaborative, which worked on the report.
The Joint Commission, the leading accreditation and certification group in the United States for hospitals, issued an alert Jan. 26, 2010 stating that "current trends and evidence suggest that maternal mortality rates may be increasing in the United States."
"As many as half of maternal deaths are preventable," said Dr. Mark Chassin, president of the Joint Commission. "The rate of maternal death today is not acceptable in the United States. We need to work much harder than we have been to reduce it."
In some cases, the chances of maternal mortality rise simply because important warning signs are missed. [New father] Jim Scythes knows first-hand how important those warning signs are and how tragic the consequences of missing them can be.
"I just think it's unbelievable that in our country today people still die of childbirth," said Jim Scythe. "I had no idea that anything like that could've happened when we went to the hospital that Friday morning."
It was March of 2007. Jim's wife Valerie had a scheduled cesarean section that seemed to go well. Their daughter Isabella was born. But by the next day, Jim started to notice clues that all was not well. He says his wife's legs felt hard to the touch. "She sat in her bed for 30 hours after her surgery and then got herself up and collapsed," Scythe said. A blood clot in Valerie's leg had moved to her brain and caused a stroke. She later died.
Doctors Say Obesity & C-Sections May be Increasing Risk:
Doctors say it's hard to pinpoint exactly why the numbers are rising. Experts have cited the *growing number of obese mothers* as a big factor -- 20 percent of all pregnant women in the U.S. are now obese at the start of their pregnancy, according to the Centers for Disease Control. These women are more likely to have underlying health conditions, including diabetes or asthma, which can lead to pregnancy-related complications.”
The *popularity of scheduled C-sections* has also been cited by public health experts as a possible cause for rising maternal mortality rates. The *latest data from the CDC shows that 31 percent of the mothers now choose to have C-sections, up 50 percent since 1996*. Studies have repeatedly shown a higher rate of mortality in mothers who have a C-section delivery, especially those who have multiple C-sections.
"If the risks of a Cesarean birth are small, they're magnified greatly when you add many more Cesarean births each year," said Main, adding that "not that many women actually choose to have an elective C-section at the beginning, but it's easy to fall into a pattern of care that ends up resulting in a C-section."
While no one can know for certain in Valerie Scythes' case, simple devices called compression boots could have helped. The boots are worn around the calves and keep blood pumping to hopefully prevent clots.
Mt. Sinai Hospital in New York is at the cutting edge of preventing maternal mortality, trying to turn the trend around in the United States. For women who have a C-section at Mt. Sinai, inflatable boots are standard practice, but providing the extra treatment can be expensive.
While the compression boots cost only $14, the machine that inflates them costs $4,600. Dupree admits that the costs and lack of awareness of the technology might be keeping some hospitals from using compression boots, but a good portion of what Mt. Sinai does costs nothing at all.
Doctors and nurses at Mt. Sinai work constantly at improving communication and training to make sure that staff members ask patients the right questions and that patients are empowered to speak up when something doesn't feel right.
For more on maternal mortality and pregnancy complications, visit the CDC's page on the topic by clicking here.
@@@@@@@@@@@@@@@@@@@@@@@@
Here is my reply as posted on the ABC blog:
This overuse and misuse of Cesarean surgery is not the result of women 'demanding' C-sections.
Post-operative maternal mortality is not primarily a consequence of the mother’s age or weight.
ABC's facts are just wrong -- 31% of childbearing women do NOT choose an elective C-section -- 31% is the *total* C-section rate in the US, not the rate of so-called "maternal choice" Cesareans.
The real number for women who elect to have a medically unnecessary or ‘elective’ C-section is less than 1%. Research done by Childbirth Connection's "Listening to Mothers Survey" 2006 found only 1 new mother out of 1,600 who requested a C-section (www.childbirthconnection.org).
Sociologist Raymond DeVries, professor of bio-ethics at the U. of Mich School of Medicine, has done extensive research on this issue with similar results, as has Gene Declercq, PhD and professor in the department of Maternal-Child health at Boston University. A powerpoint PDF document with this data can be downloaded at:
www.motherfriendly.org/pdf/2008_CIMS_Gene_Declercq.pdf
Additional scientific information on the risks of Cesarean is also available @ www.motherfriendly.org.
The way to eliminate preventable post-operative complications and death after elective reproductive surgery is not by spending more money for more expensive equipment like the special $14 compression boots that require a $4,600 machine. This suggestion sounds like an info-mercial for the medical equipment lobby and the hospitals buying such expensive products.
On a practical level, no new post-op patient should ever be just "sitting in bed for 30 hours". Good nursing care requires that post-op patients get up and walk around within a few hours of surgery and continue to move about on a regular schedule to prevent pneumonia and deep vein blood clots associated with surgery. This is a time-tested and inexpensive method to prevent DVTs. For women with unusual risk-factors, the use of compression boots may well be warranted, but this technology is not a replacement for using common-sense when it come to elective use of major abdominal surgery.
The only good reason for a risky medical or surgical procedure is a serious health problem that makes the potentially life-threatening complications of surgery less of a danger than the disease being treated. In the absence of a potentially life-threatening condition, potentially life-saving medical interventions are themselves life-threatening.
There is no getting around the facts: Cesarean surgery, as the route of delivery, is associated with 33 serious complications – a number 8 times greater that the risks of vaginal birth. Not only is the risk of maternal death 3 to 5 times greater during or after operative delivery, but for every post-Cesarean maternal death there are a 100 new mothers who suffer a serious complication, such as emergency hysterectomy, secondary infertility or stillbirth in a subsequent pregnancy.
The lives of mothers and babies are depending on us to replace the well-meaning but ill-advised ‘pre-emptive’ use of technology and routine interventions with a genuinely evidence-based and cost-effective mother-baby-father-friendly model of maternity care.
Tomorrow I’ll comment on the unnecessary medicalization of normal birth, with its emphasis on elective procedures such as induction and scheduled Cesarean, and identify the only antidote to routine medicalization. Stay tuned….
It’s good that the media picked up this long-neglected story, but unfortunately the article draws the wrong conclusions, while failing to identify the real issue. According to this article, the increase in maternal deaths is being brought on mothers themselves – more women are dying because so many pregnant women are obese and so many women are foolishly demanding risky surgical deliveries. According to this theory, the obstetrical profession is just the helpless victim of the poor judgment of childbearing women who are forcing doctors to perform dangerous procedures.
ABC’s fact-checkers also misunderstood the crucial statistics on so-called ‘maternal choice’ Cesareans – they were wrong by a factor of *30*. Worse yet, the article only mentions the connection between fatalities due to surgical delivery and the sky-rocketing rate of elective Cesarean deliveries in a headline. However, the article itself never acknowledges the overuse of C-sections based on “physician preference” and hospital policies.
Many healthy women with normal twin, breech or VBAC pregnancies being required by their OBs or by hospital policy to have so-called "elective" C-sections, when in fact, the mother did not choose or prefer a surgical delivery. In other instances, obstetricians are doing C-sections for reasons not justified by the medical science – older or overweight mother, a post-date pregnancy, slow progress, a fetal monitor tracing that is other than perfect, or in a misguided attempt to prevent shoulder dystocia in what the provider fears may be a big baby.
When the article does suggest a remedy, it’s to recommend that every hospital have several $4,600 dollar medical devises to prevent blood clots, which are used AFTER the C-section is performed – never a whisper to suggest that the best way to prevent unnecessary maternal deaths from post-operative complications is to prevent medically unnecessary Cesarean surgeries.
Here is the jest of the ABC article [emphasis mine], followed by additional comments:
“According to the World Health Organization, the U.S. ranks behind more than 40 other countries when it comes to maternal death rates, with 11 deaths per 100,000 pregnancies when measured in 2005. More women die in the U.S. after giving birth than die in countries including Poland, Croatia, Italy and Canada, to name a few.
A new report out of California found the number of women who died in the state after giving birth has nearly tripled over the past decade, from 5.6 deaths per 100,000 to *16.9 per 100,000* in 2006. The report was commissioned by the California Department of Health but has not yet been publicly released. ABC News first learned of its existence from a watchdog group called "California Watch." www.californiawatch.org
Death after childbirth is still rare, but experts say many of those deaths could have been prevented. "We've been able to double-check the data so we can truly say there is a rise," said Dr. Elliott Main, chairman of the California Maternal Quality Care Collaborative, which worked on the report.
The Joint Commission, the leading accreditation and certification group in the United States for hospitals, issued an alert Jan. 26, 2010 stating that "current trends and evidence suggest that maternal mortality rates may be increasing in the United States."
"As many as half of maternal deaths are preventable," said Dr. Mark Chassin, president of the Joint Commission. "The rate of maternal death today is not acceptable in the United States. We need to work much harder than we have been to reduce it."
In some cases, the chances of maternal mortality rise simply because important warning signs are missed. [New father] Jim Scythes knows first-hand how important those warning signs are and how tragic the consequences of missing them can be.
"I just think it's unbelievable that in our country today people still die of childbirth," said Jim Scythe. "I had no idea that anything like that could've happened when we went to the hospital that Friday morning."
It was March of 2007. Jim's wife Valerie had a scheduled cesarean section that seemed to go well. Their daughter Isabella was born. But by the next day, Jim started to notice clues that all was not well. He says his wife's legs felt hard to the touch. "She sat in her bed for 30 hours after her surgery and then got herself up and collapsed," Scythe said. A blood clot in Valerie's leg had moved to her brain and caused a stroke. She later died.
Doctors Say Obesity & C-Sections May be Increasing Risk:
Doctors say it's hard to pinpoint exactly why the numbers are rising. Experts have cited the *growing number of obese mothers* as a big factor -- 20 percent of all pregnant women in the U.S. are now obese at the start of their pregnancy, according to the Centers for Disease Control. These women are more likely to have underlying health conditions, including diabetes or asthma, which can lead to pregnancy-related complications.”
The *popularity of scheduled C-sections* has also been cited by public health experts as a possible cause for rising maternal mortality rates. The *latest data from the CDC shows that 31 percent of the mothers now choose to have C-sections, up 50 percent since 1996*. Studies have repeatedly shown a higher rate of mortality in mothers who have a C-section delivery, especially those who have multiple C-sections.
"If the risks of a Cesarean birth are small, they're magnified greatly when you add many more Cesarean births each year," said Main, adding that "not that many women actually choose to have an elective C-section at the beginning, but it's easy to fall into a pattern of care that ends up resulting in a C-section."
While no one can know for certain in Valerie Scythes' case, simple devices called compression boots could have helped. The boots are worn around the calves and keep blood pumping to hopefully prevent clots.
Mt. Sinai Hospital in New York is at the cutting edge of preventing maternal mortality, trying to turn the trend around in the United States. For women who have a C-section at Mt. Sinai, inflatable boots are standard practice, but providing the extra treatment can be expensive.
While the compression boots cost only $14, the machine that inflates them costs $4,600. Dupree admits that the costs and lack of awareness of the technology might be keeping some hospitals from using compression boots, but a good portion of what Mt. Sinai does costs nothing at all.
Doctors and nurses at Mt. Sinai work constantly at improving communication and training to make sure that staff members ask patients the right questions and that patients are empowered to speak up when something doesn't feel right.
For more on maternal mortality and pregnancy complications, visit the CDC's page on the topic by clicking here.
@@@@@@@@@@@@@@@@@@@@@@@@
Here is my reply as posted on the ABC blog:
This overuse and misuse of Cesarean surgery is not the result of women 'demanding' C-sections.
Post-operative maternal mortality is not primarily a consequence of the mother’s age or weight.
ABC's facts are just wrong -- 31% of childbearing women do NOT choose an elective C-section -- 31% is the *total* C-section rate in the US, not the rate of so-called "maternal choice" Cesareans.
The real number for women who elect to have a medically unnecessary or ‘elective’ C-section is less than 1%. Research done by Childbirth Connection's "Listening to Mothers Survey" 2006 found only 1 new mother out of 1,600 who requested a C-section (www.childbirthconnection.org).
Sociologist Raymond DeVries, professor of bio-ethics at the U. of Mich School of Medicine, has done extensive research on this issue with similar results, as has Gene Declercq, PhD and professor in the department of Maternal-Child health at Boston University. A powerpoint PDF document with this data can be downloaded at:
www.motherfriendly.org/pdf/2008_CIMS_Gene_Declercq.pdf
Additional scientific information on the risks of Cesarean is also available @ www.motherfriendly.org.
The way to eliminate preventable post-operative complications and death after elective reproductive surgery is not by spending more money for more expensive equipment like the special $14 compression boots that require a $4,600 machine. This suggestion sounds like an info-mercial for the medical equipment lobby and the hospitals buying such expensive products.
On a practical level, no new post-op patient should ever be just "sitting in bed for 30 hours". Good nursing care requires that post-op patients get up and walk around within a few hours of surgery and continue to move about on a regular schedule to prevent pneumonia and deep vein blood clots associated with surgery. This is a time-tested and inexpensive method to prevent DVTs. For women with unusual risk-factors, the use of compression boots may well be warranted, but this technology is not a replacement for using common-sense when it come to elective use of major abdominal surgery.
The only good reason for a risky medical or surgical procedure is a serious health problem that makes the potentially life-threatening complications of surgery less of a danger than the disease being treated. In the absence of a potentially life-threatening condition, potentially life-saving medical interventions are themselves life-threatening.
There is no getting around the facts: Cesarean surgery, as the route of delivery, is associated with 33 serious complications – a number 8 times greater that the risks of vaginal birth. Not only is the risk of maternal death 3 to 5 times greater during or after operative delivery, but for every post-Cesarean maternal death there are a 100 new mothers who suffer a serious complication, such as emergency hysterectomy, secondary infertility or stillbirth in a subsequent pregnancy.
The lives of mothers and babies are depending on us to replace the well-meaning but ill-advised ‘pre-emptive’ use of technology and routine interventions with a genuinely evidence-based and cost-effective mother-baby-father-friendly model of maternity care.
Tomorrow I’ll comment on the unnecessary medicalization of normal birth, with its emphasis on elective procedures such as induction and scheduled Cesarean, and identify the only antidote to routine medicalization. Stay tuned….
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