Why are Maternal Mortality Rates so High in the U.S.?
by Marc McCallister
A recent study by USA Today has brought attention to a critical failure that persists within America’s healthcare system. Expectant mothers in the United States are more than two times more likely to die during childbirth compared to expectant mothers in the U.K., Canada, Japan, Sweden, Australia, France and Germany. Like other medical errors, maternal mortality and maternal injury during childbirth are usually preventable events that could be avoided.
It is a fact, that medical errors are a leading cause of preventable death in the United States. In 2015, a study led by physicians at Johns Hopkins concluded that as many as 250,000 Americans die each year from medical errors. At that rate, medical errors constitute the third leading cause of death based on the CDC’s official list of morbidities. Maternal mortality and maternal injury during childbirth are specific examples of the inexcusable errors that pose a real threat to our loved ones.
The major medical causes of maternal mortality include hemorrhage, high blood pressure (preeclampsia/eclampsia), infection, and bleeding post Cesarean section. For unexplained reasons, our nation’s hospitals have failed to implement appropriate protocols for responding to and treating deadly, but easily treatable complications that repeatedly put women in danger. In addition to maternal mortality, a significant number of women also suffer life-altering harms or near death experiences during child birth. It is estimated that approximately 50,000 women are “severely injured” during child birth every year. Sadly, a close look at the many cases that have been uncovered reveals an alarming lack of attention to safety guidelines and an unwillingness to learn from past mistakes. According to USA Today’s investigation, half of maternal deaths, as well as maternal injuries, could have been avoided if correct safety procedures had been followed.
In the face of trending data that shows significant increases in maternal deaths, The Joint Commission, a private accreditation group that sets safety standards for thousands of U.S. hospitals, does not require its accredited hospitals to report how often health care providers fail to follow national guidelines for protecting moms against leading childbirth dangers. The persistent lack of transparency precludes any critical review of cases or the ability to learn what happened to a given patient. Unless a commitment is made to fully understand the causes of preventable maternal deaths, a hospital’s ability to take corrective action and protect expectant mothers will continue to lag all other developed countries.
Fortunately, it appears that there is a growing recognition by hospitals and administrators that the increasing rate of maternal death cannot continue. In recent years, a coalition of the nation’s leading medical societies created the Alliance for Innovation on Maternal Health (AIM). The program created and formalized safety practices that are proven to reduce maternal mortality and maternal injury. Maternal “safety bundles” have been created for known risk factors of maternal death. The “safety bundles” set out detailed treatment plans, safety equipment, training programs and internal reviews, to increase readiness, recognition and prevention.
In contrast to the U.S.’s rising maternal mortality rate, California’s maternal mortality rate stands out as an exception. Since 2006, California’s maternal mortality rate has fallen by more than half. Many believe it is as a result of hospitals voluntarily implementing safety practices endorsed by the leading medical societies as the gold standard of care.
What can be done to protect you or your loved ones from a tragedy that is often times preventable?
Be an advocate for safety.
Doctors and nurses have limited time to spend with each patient. Oftentimes, the conversations are confusing and involve complicated medical terms that do not make sense. Being an advocate does not make you an adversary of the doctor. Being an advocate allows you to ask questions and slow things down in order to understand the treatment plan and know what to expect, which also includes what could happen if complications arise. If the plan is to deliver the baby by Cesarean section, it is important to speak with the doctor about risks and complications unique to that procedure.
As patients, family members, and friends, we have a responsibility to demand better care and better training and preparedness from our medical providers. Certainly the statistics show us there is significant room for improvement.
Plan for doctor appointments.
Prior to the delivery date, it is important to spend time thinking about questions and concerns. Expectant mothers undergo a lot of changes and many are forced to juggle and balance work-life stresses as the ever approaching due date lingers on the horizon. Consequently, there are a lot of variables that can alter critical thinking (fatigue, anxiety, hormones, emotions, etc.) and make it difficult to formulate and ask important questions during a prenatal appointment. In order to avoid being rushed or forgetting to ask an important question, write down a list of questions that need to be address before the due date.
In the end, the only way the United States will be able to reverse course and reduce the rate of maternal mortality and injury is if multiple entities insist on this change. Hospital administrators, insurance companies, malpractice insurers, and those entities responsible for paying for childbirth must stand up and insist that health providers and hospitals take the necessary steps to protect our sisters, daughters, wives, and moms.
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