Within the past week the National Center for Health Statistics released its annual report on mortality in the U.S. for the year 2004 (National Vital Statistics Reports. 2007. 55;19) Buried as the last area of comment in the report were the maternal mortality rates for that year and these showed a very troublesome statistic. The mortality rates for women during pregnancy and within 42 days following delivery have risen to 13.1 per 100,000 - the highest in more than 20 years!
Over the past two days, I have read and heard several comments related to this report with statements such as, “This is unexplained…It’s probably the result of the newer methods for gathering statistics…This is incomprehensible in this day and age of modern medicine…This represents only 540 women…” Well, you know what. None of those statements are very appealing to me. They all reflect an attitude of “It’s someone else’s responsibility,” and quite frankly it’s time we face reality and get off our butts and do something about it.
Although this represents “only” 540 women, that is still an increase of 45 over the previous year’s reporting; and I would wager, the real number is greater than that actually reported for a variety of reasons. Furthermore, although the overall rate is 13.1, the rate for blacks is actually 34.7 per 100,000, or 3.7 times the rate in whites. Several recent studies have shown that at least 40% of all maternal deaths are probably preventable. Rather than being “incomprehensible,” there are clearly several factors contributing to the rise in maternal mortality. Below are my thoughts and they are not in a rank order of importance, simply in the order in which they jumped into my head:
Poor federal funding for uninsured and underinsured women – sorry, but if we can spend $2 billion dollars+ a day in Iraq, we should be able to take care of ALL women who are pregnant or thinking about getting pregnant. Our citizens deserve that and even if a woman is here illegally, her children are going to be U.S. citizens and if not cared for properly, will increase risk to the entire Public Health system. It is an investment in the future of our country and the welfare of ALL citizens.
Cesarean section rates now exceed 30% - this procedure may not take very long to perform, but it is still a MAJOR operation and as such is accompanied by risks of hemorrhage, infection, and thromboembolic events.
Vaginal birth after cesarean section (VBAC) is almost history and repeat cesareans are associated with increased risks for the complications noted above and then some.
Obesity – guess if you take physical education out of the schools, people will get fat – you figure!, and….
Increased risk for diabetes, hypertension, large babies, birth defects, cesarean section, and attendant complications related to obesity and…
Delayed child-bearing – older women are having babies and their risks for all the complications above are well-documented.
Infertile women and women with significant medical problems are achieving pregnancies – ditto to the comments above.
Medical errors – many related to medication errors, documentation errors, inattention to allergies or unexpected allergic reactions, too few doctors practicing obstetrics and long hours worked, too few nurses, cutbacks with decreased nurse/patient ratios, reliance on ‘technology’ rather than face-to-face patient contact…..
Lack of a national electonic medical health care record - in this era of Intel, AMD, Microsoft, Apple,...this is a true travesty and providing such a record might vastly improve health care and the acquisition of meaningful statistics that could help us to improve that care.
I am quite certain this list is not complete, but it gives us more than enough areas to which our attention SHOULD be directed to start. The challenge is before us. The only question is will we as health care providers, patients, legislators, and as a nation assume responsibility for our future by addressing these issues proactively….because, quite frankly, they reflect on our health care system and society as a whole.