Maternal Health Care Quality in the U.S.

Maternal Health Care Quality in the U.S.
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Last year, Amnesty International released a report entitled, Deadly Delivery: The Maternal Healthcare Crisis in the USA. The report was based on interviews conducted by Amnesty researchers with officials at agencies under the Department of Health and Human Services, such as The Office of Women’s Health, The Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services and the CDC. Additionally, individual women and families were interviewed.

Complaintive murmurings amongst “fringe groups,” criticizing the quality of maternal health care in the United States, have been going on for some time—for decades, actually. And yet, now these discussions have garnered attention amongst wider and wider circles. Large organizations like Amnesty, Lamaze International, the Coalition for Improving Maternity Services (CIMS), Childbirth Connection and their Transforming Maternity Care project, and Choices in Childbirth have either sprung up in response to their concern, or further zeroed their cross hairs on the problem. From Amnesty’s report:

“…women in the USA have a greater lifetime risk of dying of pregnancy-related complications than women in 40 other countries. For example, the likelihood of a woman dying in childbirth in the USA is five times greater than in Greece, four times greater than in Germany, and three times greater than in Spain. More than two women die every day in the USA from pregnancy-related causes. Maternal deaths are only the tip of the iceberg. Severe complications that result in a woman nearly dying, known as a “near miss,” increased by 25 percent between 1998 and 2005.

During 2004 and 2005, 68,433 women nearly died in childbirth in the USA. More than a third of all women who give birth in the USA—1.7 million women each year—experience some type of complication that has an adverse effect on their health.”  

According to Amnesty’s research, our maternal mortality rate is 13.3/100,000 (data collected between 1988–2006). For African-American women, this number is quadrupled.

Last month, the California Department of Public Health released their report, The California Pregnancy-Associated Maternal Mortality Review. Their findings are equally chilling. From the report:

“Improved vital statistics data reporting may account for about a third of the rise, leaving about two-thirds of maternal deaths that are likely due to other causes such as changes in the health status of women, changes in health care services, or the emergence of other social/environmental factors. Another reason to investigate the rise in maternal mortality is the accompanying rise in rates of pregnancy-related injury or illness, referred to as maternal morbidity.”

Medical sociologist, Christine Morton, Ph.D., works for the California Maternal Quality Care Collaborative, an organization working to improve maternal quality care and eliminate preventable maternal death and injury and associated racial disparities. She has launched a blog post series on Lamaze International’s Science & Sensibility blog, The Maternal Quality Landscape – A primer in Three Parts , starting with the state of our medical system a century ago and the impetus for developing the Joint Commission on Accreditation of Hospitals (JCAHO—now known as the Joint Commission, or, TJC) and how that plays into heightened attention toward maternity care within the greater umbrella of the medical industry.

Let’s be honest: many folks believe that the women’s perinatal healthcare system in the United States is superior because we theoretically have access to SO MUCH. And yes, in comparison to most underdeveloped nations, U.S. women experience hugely superior perinatal care and overall safety. But this is a big country in which over 4 million women give birth each year. And so, the deficiencies that exist still have enormous (and often deleterious) effects.

We ARE a nation which boasts excess: our pharmacies are overflowing with medicine (compared to underserved/underdeveloped nations) and yet a woman with no healthcare insurance may not be able to afford the medicine she is deemed in need of; we have plenty of testing equipment: performing/interpreting ultrasounds, blood & urine chemistry in the provider’s office is accomplished quickly and easily–and yet a woman lacking access to proper prenatal care misses out on that theoretically accessible testing; we have oodles of maternity care providers (women in many African and Asian countries continue to endure pregnancy, labor and birth with NO trained personnel—largely contributing to their astronomical maternal morbidity and mortality rates) and yet socioeconomic factors prevent many women from receiving adequate prenatal care.

Highly developed medical systems like ours boast people, devices and medicines out the wazoo…how can we not be the best?

And yet, the truth is in the numbers.

Without a federally-mandated maternal health care reporting system, each state sets its own standards in terms of how and if at all, pregnancy-related illness and/or death are reported/made public. With each state making its own rules, consistency simply does not exist. Amnesty’s Deadly Delivery report includes a Maternal Outcomes and Accountability Table (Appendix A, pg. 104) upon which only six out of fifty US States have mandatory reporting of maternal (pregnancy/birth-related) deaths. In other words: that 13.3/100,000 number? It’s just a really good guess. And, unfortunately, it remains far above the Healthy People 2010 goal of reducing each nation’s maternal mortality rate to 3.3/100,000. US citizens interested in seeing a federally mandated maternal mortality reporting system established, can send messages directly to their congressional representative here.

Projects like The Birth Survey aim to empower consumers of the maternity care system with self-reporting mechanisms. Likewise, Childbirth Connection’s Listening to Mothers I and II reports demonstrate the experiences of thousands of US women before, during and after their pregnancy and birth experiences. Also, Childbirth Connection’s Transforming Maternity Care website lists state and national organizations and collaboratives whose efforts focus on improving the quality of maternity healthcare.

Work is being done to assess and ultimately reduce the poor outcomes associated with the maternal healthcare system in the United States. However, until consumer pressure and governmental attentions jointly turn toward this problem, unnecessary mortality and morbidity will continue to occur at shocking and underrepresented rates.

Kimmelin Hull has been a Lamaze Certified Childbirth Educator since 2005 and is the Community Manger for Lamaze International’s Science & Sensibility research blog site. She is a physician assistant and is the author of A Dozen Invisible Pieces and Other Confessions of Motherhood. Kimmelin has also written freelance articles for regional and international parenting magazines, and maintained her own blog site, Writing My Way Through Motherhood and Beyond since 2008. A member of Montana Childbirth Collective, Kimmelin has participated in numerous community education, normal birth and gentle parenting advocacy events. A mother of three, Kimmelin and her husband raise their family in the beautiful Rocky Mountain town of Bozeman, Montana.

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