A lot has changed on the maternity ward since you gave birth to your children. There are many more tests, treatments, interventions and technological advancements than ever. However, contrary to popular belief, these changes aren’t making childbirth safer in the United States.
Having a Baby Has Always Been Risky
At the beginning of the 20th century, about 800 mothers died for every 100,000 live births, with approximately 40% of maternal deaths caused by sepsis. The remaining maternal deaths were attributed to hemorrhage and blood poisoning by toxins from a local bacterial infection. During the 20th century, safe blood transfusions, antibiotics and sterile surgical techniques were developed, which dramatically improved maternal health.
From the 1970s to the 1990s, America had the best maternal health outcomes in its history — only 7 to 9 mothers died per 100,000 births. Prenatal education, low-intervention birth practices and midwifery care gained traction. Hospitals became more family-friendly and most babies were born vaginally.
But by the new millennium, maternal death rates began rising. In 2013, they reached the highest rate in decades with an estimated 12 to 28 maternal deaths per 100,000 births. Arguably, a combination of factors have contributed to the rising rates.
Malpractice Insurance Gets in the Way
Patient care guidelines are geared towards protecting patients, though they’re also put in place to protect doctors and hospitals from malpractice lawsuits. That’s led to extreme patient care restrictions and the overuse of certain interventions, such as bans on vaginal births after Cesareans, which, some believe, is linked with poor maternal health outcomes.
Malpractice fears also pressure some doctors to practice high-intervention models of care so that if they wind up in court, they can say they “did everything they could.”
Too Much Medicine
Modern prenatal care includes a growing array of tests, treatments and interventions, but having more medical care doesn’t always lead to better health outcomes.
“As medical care advances, maternity care providers and patients have increasing numbers of tests, procedures, interventions and technologies to choose from,” says Ellen Tilden, PhD, CNM, nurse midwife at Oregon Health and Science University in Portland, Oregon. “These can provide important sources of information for safely guiding maternity care. However, every time one is considered, we have to weigh the reasons, risks and benefits for doing it.”
Rising C-Section Rates
C-sections can be lifesavers, but they’re also major surgeries that increase mothers’ risks for infection, hemorrhage and placental complications in subsequent pregnancies.
In the US, the C-section rate is almost 33% (2014), which is considered way too high. To ensure patient safety, the World Health Organization considers 10-15% to be the ideal C-section rate. Doing more C-sections doesn’t mean more mothers and babies are saved. It means more are exposed to surgical risks.
Unaffordable, Inaccessible Healthcare
In the US, maternal healthcare is expensive. Not every woman can afford it, even if she’s insured. For uninsured women, and the 44% of American mothers whose births are covered by Medicaid, it can be almost impossible to find doctors willing to accept them as patients.
Without prenatal care, complications go undiagnosed and untreated. And for women living in rural communities or areas where healthcare providers are scarce, prenatal care may only be accessible if they have transportation.
Obesity
It’s no secret that America has an obesity epidemic. Excess weight gain before or during pregnancy increases risks for gestational diabetes, hypertension, C-sections and other complications.
Maternal Age
More women are becoming mothers in their 40s, which is associated with increased risks for cardiac and age-related complications. The birth rate for women aged 40–44 was 10.6 births per 1,000 women in 2014, up 2% from 2013.
How Can We Make Pregnancy Safer?
To make pregnancy safer in America, we need to focus prenatal care on nutrition, exercise and lifestyle factors that improve health. We also need to make comprehensive, customized maternal healthcare affordable and accessible for every woman, and encourage prenatal education so parents are more informed.
In countries with the best maternal health outcomes, many women see certified midwives, who are considered the medical experts in normal pregnancy and birth. Midwives have excellent safety and patient satisfaction ratings and many offer continuing care postpartum. When mothers need more specialized care, they see obstetricians, who are considered the medical experts in high-risk pregnancy.
How Can You Support the Mother-To-Be in Your Life?
If grandparenthood is in your future, gently ask your mother-to-be about her birth plans and goals. Offer opinions only if asked and don’t pressure her to give birth in any specific way.
Share your experiences, but be careful: pregnant women are deluged with scary stories about births-gone-wrong and worst-case scenarios that are extremely uncommon and don’t do anyone any good. Instead, help her feel confident that her body knows what to do and that high-quality healthcare is available in case she needs help.
