Mamas on Bedrest are at increased risk of maternal mortality

March 16th, 2010

Mamas on Bedrest are at increased risk of labor and delivery complications due to their high risk pregnancies.  Pre-Eclampsia, Gestational diabetes, multiple gestation and preterm labor along with other complications put a mama on bed rest at increased risk of having a cesarean section delivery, which in turn puts them at increased risk of death.

Although childbirth is one of the most natural processes in all of human nature,  women have died in childbirth since the beginning of time. While much has been done to improve maternal morbidity and mortality surrounding childbirth, the very methods used to save women may be the very ones killing them.

Consider this. Despite having incurred the wrath of God and being banished from the Garden of Eden Eve, with only Adam at her side and no medical intervention whatsoever managed to give birth to twin boys Cain and Abel.  (Genesis 4:1-15)

Fast forward hundreds of years to a young couple in Nazareth. A young virgin named Mary is impregnated by God. (Luke 1:26-38) After she and her betrothed Joseph go t Bethlehem to register for the census, Mary gives birth to the Christ child in a stable-on her own with only Joseph and the animals to help her. (Luke 2: 1-7)

Now many people are skeptical about the accuracy of these biblical accounts. Yet one cannot deny that in earlier times, women did have very natural births, were attended by midwives or family members and were cared for by the women of their tribes, villages and family members.

Despite the natural occurrence of childbirth, there are inherent dangers in childbearing such as hemorrhage, blood clots and embolisms and heart abnormalities and respiratory emergencies. I grew up in Massachusetts and my elementary education consisted of various trips to historical sites in and around Boston. One place that always intrigued me was the burial ground behind the Old North Church.  Wandering through the various plots I was always struck by headstones that read something like, “Elizabeth Smith: 1832-1862. ” Then there was a headstones that said, “Baby Smith” and just one date like,” June 2, 1862″, indicating that both mother and child had both perished during childbirth. Some women had multiple little headstones beside theirs, indicative of the numerous children lost during the birth process.

Most recently California has come under intense scrutiny as their maternal mortality rate has steadily climbed since 1996 and is at an all time high of 16.9 in 2006, the last year for which data has been compiled. Physicians and researchers who are analyzing the data note that there are several contributing factors to the increase:

  • obese mothers
  • older mothers
  • fertility treatments
  • better reporting of outcomes and better record keeping
  • Preterm labor inductions
  • Rising Cesarean Section Rate

None of the people who have read the reports can deny the impact that cesarean sections may be having on maternal mortality not only in California, but also nationwide. In California, the cesareans section rate doubled between 1996 and 2006, the years for which maternal mortality showed it’s dramatic increase. Additionally, the rate of pre-term labor inductions also increased in the same time period and preterm labor induction is known to increase the rate of cesarean section. Many ask the question, “Can these results be extrapolated to other states?”

Obstetricians, midwives, birth professionals and concerned citizens are all trying to determine the proper role of cesarean section in childbirth. While no one wants to go back to the middle ages when women routinely died during childbirth, we can’t ignore that today’s infant and maternal mortality rates are rising at an alarming rate despite all of the medical advances.

The University of Illinois Medical Center’s Discovery Hospital notes early contributions to obstetrics from the Egyptians and Hebrews. The first successful cesarean section on a live woman is said to have been performed in the 1500’s in the Roman Empire by Jacob Nufer, a pig farmer who performed the procedure on his wife.  Interestingly, the procedure initially was not widely performed because of its high mortality rate-some 85%. But with the advent of anesthesia and aseptic technique, cesarean sections became safer and more widely performed and accepted. Today in the United States nearly 1/3 of children are born via cesarean section. Conversely, it is reported that many of those surgical births are not medically necessary.

In response to this growing number of cesarean sections, in 2002 Dr. David Lagrew, the medical director of the Women’s Hospital at Saddleback Memorial Medical Center in Orange County set a rule: no elective inductions before 41 weeks of pregnancy, with only a few exceptions. The results, the operating room schedules opened up, the hospital saw fewer babies admitted to the neonatal intensive care unit, and fewer hemorrhages and fewer hysterectomies occurred.

While no hospital can be accused of performing cesarean sections as a way to increase revenues, few hospitals have been quick to adopt a “no preterm induction” policy. Likewise, hospitals that have adopted a no preterm induction and/or a low cesarean rate policy have been primarily non-profit facilities (See post on Indian Health Service). These hospitals have cesarean section rates more in line with the World Health Organiztion’s 10-15% and lower maternal and infant mortality rates.

So what is the answer? Clearly no one wants to sit by and watch US maternal mortality rates rise yet the medical community is very reluctant to completely change from its current structure. This country has already lived through treacherous times for childbirth during its infancy. The advent of technology, which initially lead to a decrease in infant and maternal mortality, now poses a threat to mothers and babies nationwide. Despite the inevitable outcry from those who benefit from the use of technology (Dr. Lagrew noted in his own hospital, revenues go down when procedures go down.), it is patently evident that its use has to be reined in.

Mamas on bed rest are at increased  risk of maternal mortality. Voice your concerns in the comments section so that researchers and policy makers will put the health well being of mothers and their babies before technology, protocol and revenues.

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