Mamas on Bedrest: US Maternity Care-Living in a Glass House Throwing Stones

August 15th, 2012

I am increasingly dismayed by the fact that the US seems to think it has no maternal or infant morbidity and mortality issues. The sad truth is that the United States, in many situations surrounding maternity and childbearing, has statistics that rival many developing nations and in some cases are actually worse.

When I read various articles and news briefs, many US researchers with big money grants are reporting data from developing nations and the implications seem to be that we must reduce maternal and infant morbidity and mortality globally-i.e. “in these developing nations” to lower the global statistics. I want to go on the record asking, “How can we even begin to critique issues of maternal and infant morbidity and mortality worldwide when the US has some of the worst maternal and infant morbidity and mortality rates in the world?” In the recent blog post “Minority Mamas are More Likely to Die in Childbirth” I cited data published about maternal mortality in the United States and the disparity between women of color (primarily black women) and white women. It is one of few pieces that has actually noted and questioned high maternal mortality in black women in the United States. While it did not offer much in the way of theories as to why the rates are so unbalanced, the obvious initial steps would be to look at disparities in health care delivery in areas with a high black population and in lower socioeconomic areas.

Hold on, some of you may be saying. The US has exceptional health care, some of the best in the world. This is quite true. But not everyone in the United States has access to the exceptional health care that exists in this country. As evidenced by the heated health care reform debates, millions of Americans are without health insurance and despite the passage of the Affordable Care Act and its many provisions for women’s health care, there will still be a substantial number of people, many of them women and children, for whom our “exceptional health care” is woefully out of reach. Some will argue that saving some is better than saving none at all. Personally speaking, until everyone in this country has access to high quality health care, we as a nation have no business studying and critiquing health care practices in other countries.

In its groundbreaking work Deadly Delivery, Amnesty International shines a glaring light on the maternal morbidity and mortality issues in the United States and raises the questions are race and poverty to blame? Few if any other research groups have deigned to make the connection. But with the numbers such as they are, we are going to have to tread that road.

The United States is one of only 4 nations globally that offers no paid maternity. Out of some 178 nations, The United States, Papua New Guinea, Swaziland, and Lesotho are the only nations that offer no paid maternity leave. Of those nations, the United States is the only industrialized nation, and one of the richest nations in the world. But with all of our riches, the gap between “those who have” and “those who have not” is becoming a gaping chasm with no end to the widening in sight.

The Cesarean Section rate in the United States approximately 32% meaning that almost 1 of every 3 babies born in this country is delivered via cesarean section. This far exceeds the rate proposed by the World Health Organization (WHO) yet, we are far from finding a solution to this problem. Several maternity advocacy groups (Childbirth Connection,International Cesarean Awareness Network (ICAN) and others) are challenging the US health care system, the American Congress of Obstetricians and Gynecologists (ACOG) in particular, to take steps to turn the tide on this quelling cesarean section rate. We’re all waiting to see changes in birth policies and subsequent reduction in the national Cesarean section rates.

And then there is bed rest. How could I possibly not address one of the more controversial treatment practices in all of medicine? To date there is not solid evidence that bed rest in any way prevents preterm labor and premature delivery. We don’t have solid evidence that it in any way improves or strengthens an incompetent cervix, helps lower blood pressure or prevents any of the complications of pre-eclampsia. There is some evidence that bed rest is harmful to pregnant women and may do more harm than good. Yet annually, nearly a 3/4 of a million pregnant women are prescribed bed rest for complications of pregnancy.

I want the US to stop casting stones towards other countries for their maternity practices and to focus instead on how to lower maternal morbidity and mortality rates here at home. Until we have impeccable maternity rates and until all mamas have access to high quality health care we must focus our attention on ourselves and stop pointing fingers of criticism elsewhere.

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