Maternal Health

 

Forty-seven countries have better maternal outcomes than the United States of America.  Based on data from 2010, the USA has 28 maternal deaths per 100,000 live births.  Fifty-seven* have better outcomes for babies than the USA. This is despite spending 111 BILLION dollars  on maternal and newborn care that same year.

Why does the US have such awful outcomes for moms and babies, when we spend so much?

The short answer is, “I don’t know.”  I have a few theories, and I hope someday to delve deeper into the data.

Health Care Provider Bias

Racism.  The USA is deeply divided by race, and I have had the misfortune and eye-opening opportunity to see this play out in the a labor & delivery room.  It is sad to say, but race is sometimes a factor in the way a mother is treated by staff.

Single-parenting.  This again can be attributed to assumptions and bias of a care provider.  Sometimes, women are treated poorly when a husband is not involved in the birth. I have witnessed differences in the respect, informed consent even by the same doctor.  The single mom was treated with less respect, and received no informed consent versus the married woman.

Teen-parenting.  I have not yet witnessed this first-hand, but I have heard stories from other doulas.  How nurses and doctors talk down to teen moms, assume they should be treated like a child, as if she has no respect for or control over her own body.

Again, I would LOVE to spend hours digging into statistics on different demographics.  Right now, I have a two year old who wants to stay up all night watching Octonauts and and eight-week old who will be hungry again in a few minutes.  Based on my experience, I will say that physicians, nurses and other medical staff are human and cannot always filter out their own personal biases when they interact with laboring women.

Diversity Amongst US Women

There are so many ethnic, cultural, social, religious and economic groups in the USA, it would be foolish not to assume the differences in beliefs and practices did not impact health.

Access to Health Care

From the data reported above 93% of newborn and maternal care was billed to insurance of some kind (45% to medicade and 48% to private insurance), and 7% is not described.  I assume the remaining 7% are uninsured or self-pay.

As a home-birther, I find this to be an interesting story.  It is about home-birth safety, but it highlights that the means of the mother is a factor in maternal/fetal outcomes.

Managed Health Care

Few doctors have the practice of supporting physiological birth.  I once attended a birth where the midwife asked the mother’s permission to bring in a student for delivery.  The mother consented because after 7 years of nursing and midwifery education, she had not witnessed a birth with no interventions.

There seems to be mounting evidence that interventions used without medical indication cause more complications.

As a home-birther, I find this to be an interesting story.  It is about home-birth safety, but it highlights that the means of the mother is a factor in maternal/fetal outcomes.

Lack of postpartum care

This article got me thinking about this topic today.  I talked a little about this in several posts, but the way we regard the postpartum period in the USA is illogical, unkind and unrealistic.  When you consider the number of moms who birth via major abdominal surgery, the notion that a woman should be ready physically return to work after 6 weeks is insane.  Nevermind spiritual, mental or emotional readiness.

Lack of Maternity Leave

The USA stands alone in the developed world.  It does not mandate ANY paid maternity (or paternity) leave.

What do you think impacts the USA’s pathetic fetal and maternal outcomes?

 

Do you think maternity leave and postpartum care are factors in maternal and fetal mortality?

*I have no idea why, but these two lists have different numbers of “countries” reporting.  I put countries in quotation marks because I noticed that both Puerto Rico and the Northern Mariana Islands, for example, are listed as reporting locations.  They are commonwealths of the United States of America.  I cannot explain why the data is reported this way.  I just want to make sure you understand why the lists have different total number of locations reporting.

 

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