Most poorer countries have seen major drops in maternal mortality since 2000. While wealthy countries are generally seeing a flatlining or slight increasing trend, the rate has nearly doubled in the US. Acutely, (ie the medical issue not social causes) what is causing this to happen? What illnesses are pregnant women now getting more frequently? Why were we able to avoid these in a time (2000) where information sharing and technological capabilities were much worse? Don’t we have a good grasp on the general process of pregnancy and childbirth and the usual issues that emerge?
It seems as if the rise of technology in medicine, increasing volume of research on the matter, and the general treatment level of US hospitals would decrease or at the very least keep the rate the same. How is it that the medical knowledge and treatment regimens have deteriorated to such an extent? Are the complications linked to obesity?
In: 1594
Covid hit in March of 2020 and it took out a lot of pregnant women. States like mine (which has one of the worst maternal mortality rates in the country) didn’t expand medicaid, so we had 11 rural hospitals close in the state. Just last month, one closed down their maternity ward because they weren’t getting reimbursed more by medicaid and couldn’t afford to deliver any more babies.
It is a social issue, not a medical one.
I did a quick bit of research on this a few years ago and found little to know actual increase, but a standardization of how to measure and report it. Several states were tracking it differently. Some states included deaths of pregnant mothers, some didn’t. Some included deaths up to six months postpartum. Some were up to 24 months. When these metrics were normalized across several states, it looked as though it was an increase but it was the change in how it was measured.
Unchecked capitalism. I worked for a pretty large hospital group for 5 years. I can tell you they have so many rules in place and “workflows” for doctors and nurses that the pregnant women become nothing but a checklist over time. There is no room for personalization in this system, it’s check off all these boxes, then making sure you document so we don’t get sued. Something goes even slightly off the rails it’s c- section time.
You have 500 bucks in savings.
You just got pregnant and want to go to the doctor. 1 appointment could cost more than 500 easy, and they might not actually give you care.
You go to a specialist, who recommends a specialist, who recommends another specialist. All these specialists only have time available during the workweek, so you need to get time off to go to each one.
Your now down 2k, haven’t received care, and get told by the 3rd specialist, that you need to go to a doctor with a specific degree/education. You look around and find that said specialist only available day is a Wednesday at 10am in about 7 weeks.
Basically rinse and repeat, and this is what our healthcare system is like. Imagine if you didn’t have the ability to drop 500 plus a month on healthcare.
Imagine if you were living paycheck to paycheck. Imagine if you didn’t have pto, or bosses who let you take a few hours off.
The increase in death is basically because in 2000 our healthcare was exspensive, but still something that was supposed to be used by the layman.
Nowadays the wool is completely off our eyes, our healthcare system doesn’t even try to hide the fact is not meant for most, and that’s causing a lot of pregnant women to get no healthcare during there pregnancy.
When I started in 2007 it was rare for mothers to be on drugs. Now more than 1/3rd are testing positive on tox screens. So much meth and opioids
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Poverty, age and health of mothers, there are many factors, than just the medical care itself, that can cause a death.
I don’t think this needs a deep study. American health insurance is crap, medical attitude towards women’s need is terrible, and practicing OB population is decreasing. Research means nothing if results aren’t put into practice or insurance won’t cover newer methods.
I’m going to go ahead and say poverty.
As expressed through obesity, poor nutrition, and lack of health care.
Which may or may be coming from the increased accumulation of wealth by the .01%, but what do I know.
A lot of people will say that a cause is that women get pregnant later in life. This is a risk factor, but it is also true equally across the developed world and the entire US, but the rise in maternal mortality has not been equal everywhere.
When you look at the stats you have to face the fact that the rise is linked to access to heath care and the politics surrounding it.
I don’t think most people realize just how bad maternal mortality has gotten in the US.
Maternal Mortality is measure in dead mothers per 100,000 live births.
In western European countries it is about **4-6** per 100,000 with some countries like Norway having fewer than **2**. COVID did a number on the stats the world over, but almost everyone everywhere seems to be recovering and getting to pre-pandemic levels or better.
In the US this has been worse for a very long time, but historically not that much worse.
Back in the late 90s, when Americans still had optimism and hope for the future, things were bad but not as bad as they are today. The number in the US was about **12** deaths per 100,000 live births and in 1998 the US government published a list of national health objectives called Healthy People 2010 Goals that included lowering the number to **4.3** per 100,000.
The numbers didn’t go down and instead actually increased slightly over the next few years.
The new Healthy People 2020 Goals were created in 2008 based on data from 2007. They were more modest and wanted to lower the value from **12.7** maternal deaths per 100,000 live births that occurred in 2007 to **11.4** maternal deaths per 100,000 live births in 2020 (a 10% improvement).
The actual rate in 2020 was **23.8**.
The latest rate for 2021 found on the CDC website is **32.9**.
The current target is getting the number down to **15.7** again and that seems hopelessly optimistic.
[CDC – Healthy People 2030 – Reduce maternal deaths]
(https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/reduce-maternal-deaths-mich-04)
The US went from “With a bit of hard work we can be as good as Western Europe” to “Under hopelessly optimistic assumptions we can may reach the point where we are as good as Kazakhstan” while actually being far, far worse.
And that **33** women dying out of a 100,000 is just ones who got as far as actually giving birth to a living child. Dying due to lack of care during pregnancy is a different stat, but it is far harder to track. Giving birth and then dying is rather easy to track and compare.
Also note that **33** is an average.
The chances for black women are **69.9** per 100,000. Chances go up with age. A Black women over 40 has a **300** in 100,000 chance of death aka 0.3%.
It also differs by state with some states in the South having rates 4 time higher than places like California.
If a person strikes enough boxes the chances can go from a remote possibility to something closer than Russian Roulette.
And it is getting worse.
To find out why things are so bad look at why the stats in Arkansas, Kentucky, Alabama, Tennessee, Louisiana, Mississippi are so much worse than in California, Illinois, Colorado or Massachusetts.
You have to look why some place have stopped counting the dead and why for example Idaho has decided to disband its Maternal Mortality committee. (Hint it is not because women stopped dying while giving birth.)
You have to look at why the CDC says that black women are at a so much higher risk than white women, why class and income correlates so much with risk of dying in childbirth.
You have to look at what most other countries are doing different. They are doing a lot of things different, but the fact that most have some attempt to ensure that everyone has health care is probably relevant. As is the fact that most countries have a mandate about maternity leave that mean pregnant people don’t have to work up until the day they give birth.
Programs for pre-natal care are important.
The fact that in the US pre-natal care is being limited in the name of preventing abortions is a very big issue.
The root cause are hate of everything that is perceived as “socialism”, fear of any sort of sex-ed that might inform young people about how their body works, religious opposition to abortion that also ends up stopping much of the pre-natal health care for pregnant people who actually want to give birth. Racism and class war also play a major role.
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