The most dangerous place in the developed world to give birth

August 1, 2018 9:24 AM

"The vast majority of women in America give birth without incident. But each year, more than 50,000 are severely injured. About 700 mothers die. The best estimates say that half of these deaths could be prevented and half the injuries reduced or eliminated with better care."
posted by Lycaste (10 comments total)

Related : "(California) is leading the charge to reverse the nationwide trend: Since 2006, California has cut its rate of women dying in childbirth by more than half. And it's a state whose impact could make a big difference: One in eight infants born in the United States is born there."
posted by King Sky Prawn at 10:01 AM on August 1, 2018 [5 favorites]

2017 Quartz story with better reporting.
posted by Ideefixe at 10:27 AM on August 1, 2018 [2 favorites]

The best estimates say that half of these deaths could be prevented and half the injuries reduced or eliminated with better care."

Unfortunately better care isn't all that profitable for this particular class of expectant mothers. Best go get pregnant somewhere else...
posted by jim in austin at 10:46 AM on August 1, 2018

The reporting that, I believe, kicked most of this off at ProPublica.
posted by praemunire at 10:58 AM on August 1, 2018 [5 favorites]

I think the USAToday and the ProPublica pieces have different focuses.

The ProPublica piece talks about all kinds of pregnancy related deaths, whereas the USAToday piece really focuses on the fact that women are dying from blood loss and high blood pressure who don't need to be, because US hospitals basically don't feel like putting checklists and procedures in place that are standard in many counties with much lower maternal death rates.

So while it's incredibly tragic that new mothers are dying from things like amniotic fluid embolism, which is rare and apparently underdiagnosed, it's actually fucking criminal that women are dying from hemorrhages because US hospitals won't do simple things like weigh blood soaked pads, or regularly take the blood pressure of women who just gave birth and say they are feeling unwell.

And it sounds like this is even happening at the "best" birthing centers as well as county hospitals, so while not class-blind, is a risk to all mothers simply because US hospitals aren't held accountable by any agencies for killing recently-delivered women. I guess they do better with old people, because Medicare actually checks up on the after care they get from surgeries.
posted by Squeak Attack at 2:51 PM on August 1, 2018 [13 favorites]

The best estimates say that half of these deaths could be prevented and half the injuries reduced or eliminated with better care.

I can't see the FPP link but this line made me look up the maternal mortality rates for the US and other countries on Wikipedia. Its three times worse for the US than the UK, and the UK isn't particularly good. The US is six times worse than Sweden. So how come the best estimates are saying you can only save half of those women?
posted by biffa at 3:05 PM on August 1, 2018 [1 favorite]

I know in Australia, private health care basically doesn't cover childbirth. It's not profitable. They encourage you to use the public system.

The public system is pretty good. That Wikipedia link says we're at 5.5 deaths per 100,000, which is only beaten by Sweden.
posted by Merus at 7:42 PM on August 1, 2018

The Wikipedia statistics come from this Global Burden of Disease (GBD) study. There is also a WHO study (pdf) that shows the trends from 1990 to 2015.

There is quite a big difference in the 2015 MMR values (deaths per 100,000) for the US, with 14 in the WHO study and 26.4 in the GBD study. According to the GBD study "the main differences now stem from data selection, quality appraisal, data processing, and adult mortality estimation rather than the statistical maternal mortality models themselves."

Edit. Corrected first link and added PDF warning to the other.
posted by baueri at 12:00 AM on August 2, 2018

So how come the best estimates are saying you can only save half of those women?

It's not immediately clear, but it could be that the other deaths are not clearly attributable to a cause that has an obvious solution during the actual hospitalization for birth. If the average health of an expectant mother in the US is much worse than in Sweden, there are probably issues that are going to drive up the mortality rate that may not have solutions that late in the game.

Even if you remove the effect of maternal mortality, life expectancy in the US is declining, and overall measures of health are generally lower across the board than in Western and Northern Europe.

Further fuel for my longstanding argument: The US is not a civilized country. We're a rich country.
posted by Kadin2048 at 7:59 AM on August 2, 2018 [1 favorite]

My "favorite" part of this and other pieces on this topic is that for YEARS the medical community has been claiming that the high mortality rate in childbirth/the high c-section rate is due to mothers in the U.S being old and fat. They've been blaming mothers for years for their own deaths when it was also because they were providing shitty, non-evidence based care.
posted by Aquifer at 9:19 AM on August 3, 2018 [2 favorites]