Thursday, May 20, 2010

Maternal Deaths On The Rise In The US And Canada, While Decreasing in Other Countries

Maternal mortality data show accelerated decreases in China, Egypt, Ecuador, and Bolivia, but very alarming increases in the United States, Canada according to the results of a database analysis reported online April 12 in The Lancet.
In the United States, there was an increase of 42% from 12 maternal deaths per 100,000 live births in 1990 to 17 in 2008, which is more than double the rate in the United Kingdom, 3-fold the rate in Australia, and 4-fold the rate in Italy.

Carol Sakala, PhD, MSPH, Director of Programs for Childbirth Connection, and co-author of Evidence-Based Maternity Care, spoke with Medscape ( ) about childbirth in the United States, and the Transforming Maternity Care project.

Medscape: Although many women say they want a "natural" birth, most still choose obstetricians for maternity care, rather than midwives or family-practice physicians. Do you think that women are adequately informed about the differences between the obstetrician's view and the midwife's view of birth?
Dr. Sakala: Differences do exist in the practice styles of obstetricians, family physicians, and midwives. It is also important to recognize that practice style can vary greatly within these groups. It's a complicated situation. Consideration must also be given to differences in the make-up of their respective case loads.
That said, most childbearing women are healthy and at low risk and have good reason to expect an uncomplicated childbirth. In the Milbank report, we support providing "effective care with least harm." For healthy women and newborns, this means avoiding invasive interventions with potential adverse effects whenever possible; and promoting, protecting, and supporting women's and newborns' innate capacity for birth, breastfeeding, and attachment.
However, the present maternity care system has quite a few incentives for technology-intensive childbirth. As a result, 6 of the 10 most common hospital procedures are performed on the largely healthy population of childbearing women and newborns. We know from our national Listening to Mothers surveys that this style of childbirth is now the norm for nearly all women who give birth in US hospitals.

Medscape: If you had a wish for the future of maternity healthcare, what would it be?
Dr. Sakala: I’d like to answer this question by paraphrasing the final paragraph from the Transforming Maternity Care Vision paper, and I encourage Medscape readers to read that paper and the blueprint as well, and consider becoming involved in blueprint implementation.
In describing the vision, the Vision Team says that:
The 2020 Vision for a High-Quality, High-Value Maternity Care System will be actualized through concerted multi-stakeholder efforts ensuring that all women and babies are served by a maternity care system that delivers safe, effective, timely, efficient, equitable, woman- and family-centered maternity care. The US will rank at the top among industrialized nations in key maternal and infant health indicators, and will achieve global recognition for its transformative leadership.
 It is the opinion of Birthwhisperer, that the failure of every community in the US to ensure that women have access to practitioners who practice the according to a midwifery model vs a medical model
is much to blame for the fact that many more women are dying in pregnancy and birth.

When choosing a maternity care giver, give careful consideration to whether or not he or she views pregnancy and birth as normal healthy physiological states, as opposed to the view that they are states of being, fraught with dangers from which a woman should be medically "delivered."

As a clever women once said "Pizza is delivered, grapefruit is sectioned, but women give birth !"

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