How could maternal mortality rates double in an advanced country like the U.S. that spends $111 billion a year to birth ~$27,750 per newborn?
There are 48 countries with lower maternal mortality rates than the U.S. Lowest maternal mortality rate in the world is Estonia (2/100,000) with Greece and Singapore at 3/100,000, Sweden, Belarus, Austria and Italy at 4/100,000, Japan, Iceland, Poland, Finland, at 5/100,000. [CIA Factbook Jan 2014]
The “estimated maternal mortality rate (per 100,000 live births) for 48 states and Washington, DC (excluding California and Texas) increased by 26.6% from 18.8 in 2000 to 23.8 in 2014.” More than 25 years ago, in 1987, there were 7.2 deaths of mothers per 100,000 live births in the United States, [CNN]
That isn’t all. There were 34,000 women a year who were “near misses” (maternal complications so severe the woman nearly died) between 1998 and 2005, a 27% increase.
Some obstetric authorities want to blame it on lack of prenatal care. [Contraception Journal March 2011] Thirteen prenatal visits during a pregnancy is defined as adequate. A number of health advocates clamor for equality in prenatal care, but there will always be disparities. Delivery of prenatal care to native Indian women in rural Alaska is to be challenging.
Maternal mortality is four times greater for black women, but is that because of the color of their skin, lack of education and literacy, lack of health insurance, poor nutrition, obesity, what? Nobody seems to know except to say it is multifactorial. Yes, but how much is preventable and why was there such a low rate of maternal mortality decades ago? It is difficult to find data on the weight of black women who died during or shortly after childbirth.
There is no study that indicates that the 56% increase in the rate of surgical births (Cesarean sections) from 1996 to 200827 achieved improved outcomes. [National Center Health Statistics 2010] In fact, C-sections increase the risk for post-partum infections. But it is post-delivery hemorrhages that appears to be a major problem. Newborns today are larger and heavier and this can result in tearing of tissues during delivery. Whether there is competent response in these cases is unknown.
in a national study of five medical conditions that are common causes of maternal death and injury (preeclampsia, eclampsia, obstetric hemorrhage, abruption and placenta previa), black women did not have a significantly higher prevalence than white women of any of these conditions.14 However, the black women in the study were two to three times more likely to die than the white women who had the same complication! [American Journal Public Health Feb 2007] That should tell us something right there.
The problem is not in the delivery room, it is in the mothers themselves. That is not to say hemorrhages post delivery didn’t occur in the hospital or birth center, only that a pre-existing condition made them more prone to hemorrhage.
There is a clamor for more funds to provide prenatal care. [Daily Mail UK Aug 10, 2016] Too much of the money spent on births is for the event itself, not for prenatal care. But it is doubtful throwing more money at the situation will be of any help.
Maybe America spends too much on birth and too little on birth-prep. The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found. [New York Times, July 1, 2013]
The leading causes of maternal death are hemorrhage, pregnancy-induced hypertension, and embolism. Black and nonwhite women have almost 3 times the risk of death from hemorrhage than white women. Total maternal mortality rates ranged from 1.9 deaths per 100,000 in New Hampshire to 22.8 in the District of Columbia. When data from 1979 to 1992 were analyzed, the overall pregnancy-related mortality ratio was 25.1 deaths per 100,000 for black women, 10.3 for Hispanic women, and 6.0 for non-Hispanic white women. [Journal Perinatal Education 2000 Spring]
In inherent factor is that black women have lower circulating levels of vitamin D than Caucasian women and have a 4-fold higher maternal mortality rate. [Vitamin D Wiki] This is the due to reduced ability of dark-skinned mothers to produce vitamin C from sun exposure and the likely fact more black women avoid the sun so they don’t appear to have jet black skin. Only 8% of women with dark skin had adequate vitamin D levels in one study. Women with adequate vitamin D levels (42 nanograms/milliliter of blood = to 2000 units oral vitamin D) are 4-times less likely to undergo C-sections, 4-times less likely to experience preeclampsia (elevated blood pressure) and women taking 4000 IU vitamin D half as likely to experience pregnancy complications. [Vitamin D Wiki]
In other parts of the world, newborn baby rickets, which occurs due to a lack of maternal vitamin D, increases the risk for maternal mortality. [Nomadic Peoples 1993]
Another observation is that women whose pelvis failed to properly form during childhood due to a lack of vitamin D (rickets) may experience a difficult delivery with complications and even death due to an obstructed birth canal. [Death In Childbirth 1992]
We also know by inference that low vitamin C levels are associated with hemorrhage during or following any kind during surgery [Surgery April 2002] And we know that vitamin C levels are low in women who experience premature rupture of membranes during pregnancy with elevation in the risk for maternal mortality. [Journal Obstetric Gynaecology India Dec 2014]
We know that malnutrition is an identified factor for poor birth outcomes in the developing world. [Giving What We Can; British Journal Nutrition 2001] But why would that have increased in a well-fed population like the U.S.?
In the U.S. we have “high calorie malnutrition” says Derrick Lonsdale MD. [Evidence Based Complimentary Alternative Medicine March 2006] This is evidenced by a shortage of vitamin B1 (thiamin).
It is well documented that pregnancy induces a vitamin B1 (thiamin) shortage in the mother due to sequestration by the baby. [American Journal Clinical Nutrition Dec 2001] Low thiamin is associated with hyperemesis gravidarum (HG) – nausea and vomiting. Of interest, 20% of the maternal deaths in the U.S. are undelivered and potentially HG-related. In severe cases of thiamin deficiency a condition known as Wernicke’s encephalopathy (WE) can develop, which is also cited during pregnancy, particularly among pregnant women who drink alcohol. Reported cases of WE in pregnancy are on the rise and 71-85% of cases remain undiagnosed until postmortem evaluation (autopsy). Alcoholism is a major causes of thiamin deficiency. Provision of 5 milligrams of thiamin during pregnancy is recommended. [Women’s Health & Gynecology 2015] Women who drink tea or coffee may also experience low thiamin levels.
Pregnant women may be dying needlessly due to lack of training of prenatal counselors.