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 | maternal deaths on the rise in california |
Did you all see this article? Maternal deaths in California have tripled in the past ten years. That’s the most significant rise in deaths since the 1930s. For comparison: it’s currently safer to give birth in Kuwait or in Bosnia than in California.
[via pushedbirth]
And on that note, I’m off to visit my midwife this morning, sickly toddler and mostly unsick older children in tow. This should be an adventure.
Who is your mw? If you don’t mind saying, that is.
Heard a discussion about the findings last week on NPR. They say some is better reporting (a new checkbox on the death certificate asks if the deceased has been pregnant within the past year, which catches things like heart attack in childbirth that was otherwise being chalked up to just heart attack.) They say, in general, a high C-section rate (anything over 10%) increases maternal death rates. They say that California, because it represents such a huge percentage of the national births, is an indication of what’s going on in the rest of the country. They say that, overall, there is financial incentive to do more invasive stuff, which always carries risk. And they say that, until we fix the system to make MDs lose money by doing surgery, we’ll keep having this problem.
They noted that scheduled C-sections were not the issue, but that repeated C-sections definitely are (the death rate skyrockets at and after third C-section), the obesity rate is a huge factor, as is poor maternal health in general.
Didn’t hear how much lower the birth center and homebirth death rates are, but I’d like to.
That’s what the article says too, though they also cite inductions as another factor.
I wonder about comparative numbers too. I imagine they’re difficult to come by here. For one thing, I believe this study looked only at death certificates, which I don’t think list place of birth and/or intended place of birth in the case of maternal mortality. Researchers would have to link up death certificates with the corresponding birth certificates (which, as you know, in California do include both place of birth and intended place of birth).
Then there’s the issue of how to classify the births, specifically those that were intended to be out-of-hospital but were transferred. Do they count in the OOH group (because of intent, and because decisions made about care early on could affect the ultimate outcome), or in the H group (because that’s where they were, and because it’s possible that the fatality was caused by iatrogenic factors)?
Plus it’s hard to compare groups of such varying size with any degree of accuracy, and homebirths account for only single-digit percents of births in California, and birth center births (in freestanding centers, not in-hospital birth centers) don’t account for all that much more.
But I do wonder.
Iatrogenic? The editor does not like it when you use words he doesn’t know.
Sorry! From Webster’s: iatrogenic is “induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedure.”
I was saying something that happened in the hospital– a treatment, intervention, or procedure– could have caused the death, making it not the “fault” of being a planned out-of-hospital birth. In cases like that, it would be misleading to label the case an out-of-hospital fatality, even though that was the intended place of birth.
But designing a study that takes that into account is tricky. Some deaths that take place in a hospital (after transferring) will be unpreventable, regardless of location of birth; some will have been preventable, but the result of decisions made prior to the transfer (ie out of the hospital); and others will have been preventable, but are the result of something that happened after the transfer (ie in the hospital). Researchers could try to ascertain which was the cause in each death, and assign the cases to a study group based on that, but that would require access to more than death certificates and birth certificates, and would introduce more human error.