A couple weeks ago, right before Christmas I was struggling for a couple great post’s that were not focused around Christmas over on Babble’s Being Pregnant blog. I needed something to just write about for the day, and then it appeared in my google alerts. An article on maternal mortality rates, and how they have slowly been on the rise since the low in 1986. Granted the reporting before that had not been all that accurate, and heck today it still isn’t very accurate. Unfortunately, the CDC just like any government agency isn’t going to make a huge change until something major happens. Basically besides the point though.
I wrote a pretty simple, and straight forward blog post sharing the numbers, which I cited from the original article, and added my personal two cents into. This is something I have been watching, and blogging about in the childbirth community for some time on. I also worked on a post last year about the decline in VBAC rates, and the increase in repeat c-sections along side of the maternal mortality rates increasing. While it is speculation, and just opinion… it is something I have been watching for some time. I am not a doctor, nurse, medical professional, or someone who has any special training in statistics. Although I did get a pretty bad ass grade in statistics in high school many moons ago.
The point being, it is something I care about. I care about mothers, their babies, and their options for childbirth. I am a true birth advocate, and I support a woman’s choice when it comes to her own medical care, birth, and care options. As long as women are truly educated about their choices, more power to them…
Anyways, back to the post I wrote. In the blog post I included all kinds of information, including the speculation of American women being unhealthy prior to pregnancy and birth, the lack of proper prenatal care in many minority communities, and of course the increase in surgical birth. All of which have been cited by major medical organizations as speculation for the increase. Concluding that in the end, healthier mothers are the ones having healthier outcomes, less need for medical intervention during labor and delivery, and often having the healthiest babies, although we never know when life is going to throw a curve ball at these healthy women.
The general gist of the blog post was not only to provide these numbers and information to the readers, but help bring awareness to these women, and their untimely deaths. Just like Amnesty International has been working on with the publishing of Deadly Delivery, and of course the Safe Motherhood Quilt Project has been doing. Awareness we need way more wide spread across our country.
What happened next was probably one of the worse internet battles and show of disrespect for the mother’s who have lost their lives. Chiming in first, was a comment about home birth, which really had nothing to do with the price of tea in China. In reality, like most bloggers do, I ignored this commenter. She is known for creating fights, and honestly with Christmas coming, and the increasingly busy nature of my life in general, I didn’t have time.
Then a couple days later, the famous author, and midwife Ina May Gaskin chimed in. Someone I have read several of her books through my studies, and at that moment I felt pretty star struck. But again… not really the point of my post today.
The next week or so, and 205 comments I saw a horrible argument about midwives verses doctors, and really a whole bunch of blame being tossed back and forth, but very little attention to the real issue at hand. No one was saying “How can we change this?” or “How can we work to save these mothers?” No concern for human life, no pity or sympathy for the mothers who died… Just arguing over different agendas.
The article got insane attention once two high profile internet birth personalities started arguing. So much that the argument and post was featured on the Motherlode blog on The New York Times. During this time my e-mail box also went off the wall, along side my facebook inbox, and wall. It was certainly a crazy day. But the argument continued over there. Blame here, blame there… but again… no comments or concern for the dying women. No human reaction to dead mothers! No question of what we can do for better reporting of maternal mortality rates… No question of what we can do to prevent the deaths of these mothers… Nothing.
Just more arguing, drama, and finger pointing.
I stopped replying. I couldn’t handle much more of the arguing. The blatant disregard for human life was making me ill. The comments continued, which I had to read through moderating them, but I stopped replying. There is NO reasoning with people like that. It is a lost cause.
Today, in true internet style… the poster who started it all tried to call me out, and this is when I knew I needed to have my final word.
“And where’s Danielle who claims to care so much about mothers and babies? Why isn’t she demanding that MANA release their death rates?”
Was what was said, or I should say… asked of me.
@Amy – There is no reasoning with someone like you. I care about women, I work on a local level, I work in my community, and I have actively been working for better maternal outcomes since entering the birth community 6 years ago, before even having my first child.
I am not going to feed into this debate anymore because it is clearly useless. You do not care about mothers, you care about demonizing midwifery. You do not care about making changes, or better maternal outcomes for mothers, you care about fighting on the internet. Nothing more, nothing less.
I will continue to work for women, and their choices, and you can continue to complain on the internet all hours of the night and day.
I am done.
There is no reasoning with people like her.
There is no reasoning with anyone brainwashed by any one side of a debate.
But I had to get my own take on it all out here… in my safe place. MY website where I make the rules, and can say however I feel. And man did it feel good to get out.
Why don’t we all focus on keeping these mothers alive, better reporting of maternal mortality, and research on why these women, especially in the minority communities are losing their lives at such a higher rate!
And now in the words of Clark W. Griswold:
HALLELUJAH! HOLY SHIT! Where is the Tylenol?
I read an amazing piece over at RH Reality Check the other day, the tone of the article wasn’t extremist, or liberal… it was factual pointing out simple facts about our maternity care, statistics, and shortcomings while using valuable information provided by Amnesty International. Last spring the Deadly Delivery report was published. 154 pages of statistics, data, and stories of why our maternity care in the United States is failing. I also figured I have been really neglecting my blog while writing on Being Pregnant right now, so I knew I needed to step it up a notch… using something other than my own pregnancy to provide entertainment for my lovely readers.
In the United States we are spending the most per birth in the world. In one year, the United States spends a reported $86 Billion dollars in pregnancy related hospitalizations… That is a TON of money. Yet the maternal mortality rate in our country is higher than 49… Yes that is right… 49 other countries around the world, which include South Korea, and Kuwait. True story!
According to the Deadly Delivery report a woman in the United States is five times more likely to die during childbirth than in Greece, four times more likely to die during childbirth in Germany, and three times more likely to die during childbirth in Spain. All countries with birth rates that can be considered comparable to the United States.
While we have a higher population, and birth rate annually, these factors are certainly taken into consideration when calculating these statistics.
Every 90 seconds… a woman dies from a pregnancy related cause. 2-3 of those women are in the United States.
Since 1990, the maternal mortality rate here has DOUBLED. We have been taking steps backwards, clearly not forwards.
During this time we have also seen a rise in managed births, and the way childbirth is handled. More c-sections, more inductions, more complications in pregnancy, and a slight rise in multiples. Not enough to warrant the cesarean rise by any means, which some use as the main culprit.
During 2004, and 2005, a simple period of two years – 68,433 women died during childbirth, or from a complication of childbirth. That is simply way too many mothers gone.
Why am I being so gloom and doom about this?
I am not trying to scare women, or worry pregnant women, I am trying to help others to understand what kind of problem we are currently facing. We need to start with grassroots advocacy. Pissed off mothers on the ground level sparking a need for change, and helping others to become educated on what is going on. So many are oblivious to these numbers or think our country is top of the notch when it comes to birth. Believe me, I see it daily online. Whether on my due date month group, or in discussions on twitter (although most of my lovely ladies on twitter are great birth resources!)
The biggest problem in the maternity care system seems to be the lack of proper prenatal care for certain groups of women. There are the uninsured of course which is growing. Many women do not know the options that are available through government funded programs to help avoid the complications lack of prenatal care may cause. Then we have the immigrant communities, and of course women of color. While I am of neither community, it impacts us all as women. These are our sisters, mothers, cousins, and friends. Social barriers, and racial barriers should not be limiting access to proper care for anyone. Because you may not fall into these groups, does not make these women any less important!
The Universal Declaration of Human Rights includes: every human being has the right to health, including health care, unfortunately that is not being followed in the United States, especially when it comes to prenatal care. Unfortunately there is so much negative stigma surrounding the government funded programs, such as prenatal care for all women, which is available, that not all know this is an option. Insurance is looked at like a privilege, as well as health care when it should be a basic human right, not just for the rich, or people who happen to be lucky enough to have a job… this week. Fortunately for many, this is hopefully going to be changed with the health care plan, but there is so much he-said-she-said it virtually will never change, or be passed.
Women with limited English, and of the communities I spoke of above are at greatest risk. Women of African American background are four times more likely to die from a pregnancy related complication, or during childbirth than a woman of white background. And of high risk cases, African American women are five times more likely to die than white women. Shocking and seriously alarming numbers. But it is not across the board for all women of color in the country. Studies show that women in large metropolitian cities are at an even greater risk. Another example taken from the RHRealityCheck article :
The inequalities are also geographical; risk is not uniform across the 50 states. Women in DC are almost 30 times more likely to dies than women in Maine.
Also sparking concern about the lack of prenatal care providers in these areas. Lack of providers who will accept uninsured patients, lack of providers willing to accept women with government funded forms of insurance, and on, and on… It is a numbers and money game. Malpractice insurance is the main source for Doctors being so money hungry, I think second is the huge loans that need to be paid back after medical school too. I live in a state with the fourth highest malpractice rate for Obstetricians, I see it day in and day out with our local birthing women. Answer to the issue? Tort reform. But that is besides the point of my post today.
One out of ever 5 women in the entire country are uninsured, equaling over 13 million women in our country alone.
You know them too! They are your sisters, mothers, cousin’s, friends, co-workers, and may be the lady sitting next to you on a park bench. There is no discrimination as to who is excluded.
Again from the RERealityCheck piece :
Nearly half of all maternal deaths could be prevented with better access to good quality maternal health care. From a human rights perspective, this is completely unacceptable. To reverse these trends Amnesty International is calling on the government to implement a robust and systematic response to the issue of maternal health in the US using a human rights framework. Domestically, Amnesty International recommends establishing and strengthening Maternal Mortality and Morbidity Review Boards to investigate maternal deaths and improve care and ensuring presumptive eligibility for Medicaid for pregnant women in all states.
We have to start somewhere. Something needs to be done, and it not only needs to be changes in insurance coverage, and ways for women to get prenatal care, but there needs to be a big change in…
I mean, the list could go on for hours with all the changed that need to be made. It is a seriously broken system. What birth has become in even the last 20 years has done no justice for our mothers.
I am sorry this was so long winded, but I have been aching to write something to passionate for a while. Between sick children, commitments on other websites, real life, and the holidays… I just haven’t had time, but let me tell you this felt amazing! I will be getting back into my normal swing of things.
The other day I read a comment somewhere that childbirth originally went into the hospital because of the amount of women who died in childbirth at home. While the maternal mortality rates where higher during this time, the reason childbirth went into the hospital had nothing to do with this, but rather money.
Though my Lamaze education, I learned a lot about the history of childbirth, and I wanted to share some of the events and time line I found most interesting and helped me most in understanding the history of childbirth, especially in the United States.
Before 1700′s : Men were forbidden by law, and custom to attend childbirth
1700′s : Physicians first portrayed the idea that birth is a pathological condition that required medical intervention.
1750 : First recorded practices of medical intervention : Bloodleeting to control hemorrhage.
1847 : Anesthesia first introduced into childbirth. Although it is criticized by colleagues who feared it would have an effect on labor, and the baby. (Hmm… I think they were on to something back then!)
1850 : Oliver Wendell Holmes blamed Doctors for the outbreak of puerperal fever.
1853 : Queen Victoria used Chloroform for the first time.
1900′s : In the United States, most babies were born at home. (90-95%) and most of those births were attended by midwives.
1905 : First Maternity clothes were introduced, and women were no longer confined during pregnancy.
1908 : The American Red Cross starts to offer formal childbirth education. (Later on in the 1950′s they offered information on labor and birth in addition to pregnancy.)
1910′s : Low horizontal cesarean sections significantly decreased infection, and ruptures.
1930′s : Births become split 50/50 between hospitals and home, and the number of births attended by midwives drops to 15%.
1944 : Grantley Dick-Read published Childbirth Without Fear.
1949 : Elisabeth Bing teaches her first client and goes with her to the hospital for support.
1956 : La Leche League has its first meeting, as the breastfeeding rates are at an all time low.
1959 : Thank You Dr. Lamaze is published by Marjorine Karmel.
1965 : Bradley writes Husband Coached Childbirth and The Bradley Method was formed.
1977 : Spiritual Midwifery by Ina May Gaskin was published.
1979 : 99% of all births took place in hospitals.
1989 : First edition of “The Guide to Effective Care in Pregnancy and Childbirt” is published.
1992 : DONA Doula’s of North America was formed, and started certifying doula’s for labor support.
Now that all of that is out there, while the maternal mortality rates lowered from the start of the timeline, till around the early 1990′s… it seems like the same time that VBAC peaked in 1996, that the maternal mortality rate peaked at the lowest, then started to climb again as the VBAC rate dropped off. I know that there is only a slight correlation between the two, but the rates are back up, and slowly climbing again.
It is interesting to look at this timeline and see a lot of unfounded changed we made over the years, based on money, or preference of providers, over what actual evidence based medicine shows us and tells us.
I have wanted to share the Lamaze Birth by Number’s video for a while. It features Eugene Declercq one of my favorite Silver fox’s discussing the numbers surrounding maternity care in our country, where we rank in the world and the issues our care system presents. I have tried to find a way to get the video embedded here on my page, but I was unsuccessful in that mission. But the link for the video is : Birth By Numbers and I highly suggest taking the 25+ minutes to watch this. Whether you are a first time mother, childbirth educator, veteran mother, or just someone interested in the childbirth community, it is a must watch.,
4,138,349 – The number of births in the United States in 2005, the year this video’s information focuses on. The numbers are still similar, although they have increased and decreased in years since then.
18, 884 – The number of Neonatal Deaths in the United States in 2005. Meaning, the number of babies that died in the first 4 weeks of their lives.
1,248,815 – The number of Cesarean Sections that took place in the United States in 2005. And that number has increased every year since then.
4.6 – 4.6 neonatal deaths per 1000 babies born in the United States in 2005.
42 This is the number that the United States ranks in terms of our neonatal mortality rate. Meaning? 41 other countries have lower neonatal mortality rates than the United States and all of our magical medical technology. Below is a list of the countries who rank better than we do, which is surprising.
There are several countries on this list that cannot realistically be compared to the United States because of the small number of births they have annually, but if you were to take all the countries that have at least 100,000 live births per year, The United States still falls behind.
Take these 15 countries, and The United States has the 2nd worst rate, only behind France. Still horrible in terms of concern for health in our mothers and babies. When the numbers are broken down into countries that have at least 300,000 births per year, we are still in bad shape. 8th out of 9 countries with only France worse off than us again.
Now we move onto Maternal Mortality which is even more grim.
Now when we take countries with at least 300,000 births, The United States ranks last. We lose the most women around the time of birth than any other country who have somewhat the same amount of births.
What is most troubling about it all is that the numbers are getting worse, not better as the years go on.
While other countries are decreasing, this shows that we continue to increase or stay the same. A scary statistic for women who are having babies in the United States today.
Back to our mothers again. See that increase? EEK!
But why are we seeing a huge change like this? What has happened over the past 10 years that is aiding this problem? One thing! The increase in use of a sometimes valuable medical intervention…. The Cesarean section.
Now, if you know me, or have been reading my blog for a while, you know that I preach religiously about the over use of the cesarean section rate, and how it is causing more harm than good in our country. This next graph shows the issue with this, and why we as a country should truly be concerned by the number of surgical births taking place.
Since the 1990′s the cesarean birth rates have steadily increased, along with the maternal death rates. Also with the preterm birth rates, and other complications that this video does not go into detail on. How do I know? Because this is now something I have spent over two years of my life looking at, researching, and learning about.
When you take a minute to look at the cesarean section rates by state (below) it shows that it is not evidence based medicine being practiced across the board, it is more of a cultural impact in certain areas that impacts the overall cesarean birth rate.
What stands out to me personally, areas like Utah, Nevada, Arizona, New Mexico, Colorado, which have a couple trends to me have these low cesarean rates. One is a strong religious or Christian population. The other is a strong immigrant population. Although California has the same immigration rates with a much higher cesarean rate.
Some argue that the mothers are driving these rates up with Maternal Request Cesarean sections, but in fact that is not the issue at all. Check out this information and quote from the Listening to Mothers Survey :
I am not sure what world she lives in. No pain? No hassle? LOL! This must have been BEFORE she actually had the c-section!
But all in all, blaming the 50% increase in cesarean births on women choosing them is ridiculous because women are not signing up.
I want to keep my post to a minimum toady before it gets way too long I am going to stop here, and pick up in a couple days on the second half of this video. Considering it is almost 25 minutes long, putting it all into one post would be overkill, and slightly foolish.
Many do not know this unless you are heavily involved in the childbirth community, but the month of April is recognized as Cesarean Awareness Month. When I first started my ICAN Chapter in 2008 here in Connecticut, we submitted a request to our governors office to have Cesarean Awareness Month recognized in Connecticut. To my surprise it was denied.
That is when my project began. I created a petition which in the end collected over 300 signatures and come 2009, we submitted our request for our Proclamation, with the petition. I guess they realized we weren’t going to go away huh?
In 2009 we got our first CAM (short for Cesarean Awareness Month) proclamation, and this year in 2010 we continued our tradition and again it was granted.
But why is this important?
With the growing cesarean birth rate nationwide it is so important that we take some time and realize that the 32% numbers we are seeing are not healthy, nor are they improving maternal or neonatal outcomes. In the past month we have seen several reports in large national news sources about this, and while bringing attention to this is great, it is not going to make the change that we need.
Cesarean Awareness is important to me because of the births of my two children, so different, but much alike.
So how can you get involved?
Some of the recent news stories that include great information why Cesarean Awareness is important are :
Get out and get involved!
Listen to the Momotics Radio Show all month Cesarean related shows!
April 7th – Isa Herrera author of Ending Female Pain
April 14th – Dr. Stuart Fischbein discussing VBAC and preventing cesarean births
April 21st – Barbara Stratton, the ICAN VBAC Ban chair will be discussing VBAC bans nationwide.
I will also be on The Feminist Breeder’s Radio show this coming Sunday night at 10pm CST (11 pm for us east coasters) to kick off Cesarean Awareness Month and talk about the Post Cesarean Feelings Survey I recently worked on with The Healthy Baby Network.
HAPPY CESAREAN AWARENESS MONTH!
So much has gone on this week in my life, and in the world that I thought it would be best to really cover it all, and post why these events are important.
ABC News covered two high profile news stories regarding birth, and promotion of Natural Birth as well as Out of the Hospital birth.
Now to talk about things going on around the world of Blogging… I try to keep up with as many of my favorite blogs as I can, but with two kids, and the increased amount of things I have going on in my life it is hard to make my way every where I want to be.
If I forgot you, or your awesome blog, I am sorry!
National Institute of Health is holding its VBAC Conference this week. No ya don’t say right? I have only talked about it how many times in recent weeks right? LOL Well there are a lot of good posts, and posts about the conference coming up. I will be starting my live coverage tonight starting with The Feminist Breeder’s Radio Special. You can watch all of my live updates on NIH’s VBAC Conference here.
And last but not least, the highlights from my own life this week.
So overall, it was a pretty good week.
I am thinking about doing this type of a post weekly, so it you like it, comment and let me know!