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Why is the Maternal Mortality Rate in the U.S. So High?

Thursday, May 27th, 2010

In the richest nation on earth, with an advanced health care system, and the technology available to monitor and treat mothers and their babies, you’d expect the United States to have among the lowest rates of maternal mortality. So it’s distressing to learn that, although it’s still relatively rare for mothers to die as a result of pregnancy and childbirth, it happens here more often than it should. The U.S. is ranked 41st in maternal deaths among 171 nations analyzed by U.N. experts. That’s a worse record than virtually any other developed country — even worse than a good number of under-developed countries. What’s even more distressing: the death rate is rising.

The question is why? Why is pregnancy so risky in such a rich nation?

Often, the reason is a pre-existing disorder that complicates pregnancy, such as obesity, high blood pressure, or diabetes. The lack of access to good quality care among the uninsured also puts women at risk, leaving them without diagnosis and treatment for conditions that can cause problems until the condition gives rise to a full-blown emergency.

But there’s one contributor to maternal death that might surprise you. Our wealth, itself, could be contributing to the risk, because it encourages the prevalence of Cesarean-on-demand.

According to the CDC, in 2007, 31.8 percent of births were by Cesarean section. The rates of births by C-section have risen every year for at least eleven years.

While C-sections can be, and often are, life-saving, it’s difficult to justify that high a rate. The World Health Organization estimates that the U.S. rate is twice what would be medically necessary.

Cesarean births are now treated as routine, but major surgery is never routine. Major surgery comes with the risk of complications, including hemorrhage. And the C-section, as common as it has become, is still major surgery.

Childbirth is usually very safe, but it could be safer. Giving all women access to pre-natal care and preventive medicine is an important start. But it’s also important to remember that a woman’s body was designed to deliver babies the old-fashioned way. And choosing unnecessary surgery instead could be inviting trouble.

– Yvonne S. Thornton, MD, MPH