The United States is one of eight countries where Maternal Morbidity is on the rise. In fact, our rate of maternal mortality has tripled since 1980. Defined as "maternal death that is associated with pregnancy or childbirth", America now has the highest rate of maternal mortality amongst developed countries. What a thing of horror.
There are several reasons that this is occurring, including an increased number of surgical deliveries (which are three times riskier than a vaginal delivery), complications from augmented labors, and dietary deficiencies leading to a rise in preeclampsia and eclampsia. This is only part of the list that we can see and study. But the particular issue I want to address today is that of rural healthcare, as maternal death is disproportionately high in rural areas.
Living in a very isolated area, I can attest to the state of rural maternal health in America today. The nearest hospital is 15 minutes away, a larger one is 40 minutes away, and the nearest urban hospital is an hour and a half drive. Due to the increasing cost of obstetric services in the US, the closest hospital had to stop offering them a decade ago. This has left people in my community with the option of driving 40 minutes to a hospital where OB services are offered by on-call family practice doctors OR drive the hour and a half to the "city" where there are in-house Obstetricians. Add into the equation that 5 months out of the year our area is shrouded in beautiful but dangerous driving conditions.
This situation leads women into a few undesirable predicaments:
- delivering on the side of the road, back of an ambulance, in a rural unequipped Emergency Department OR
- arriving at the hospital in early labor to find they are 2-3cm dilated and being admitted (they can't very well be sent home!). Subsequently, for every hour they spend in the hospital during early labor, their chances of interventions and surgical delivery increase.
Let us not forget that rural areas are often very impoverished areas. Many of these women cannot afford to travel the distance needed to receive prenatal care. This leads to missed visits (particularly at the end of pregnancy), and therefore, missed diagnoses of possibly fatal conditions such as pre-eclampsia (one of the big killers of mothers), hypertension, and fetal mal-position.
This is a serious problem. Thankfully, the gravity of this issue has caught the public eye:
- NPR recently teamed up with ProPublica to research and write about Maternal Death
- AmnestyUSA has published a fantastic piece called "Deadly Delivery"
- International spokespersons are searching out solutions (such as Linda Robinson, who has an impactful TEDx talk on this topic).
The World Health Organization (WHO) has been one of the forerunners in offering possible solutions to Maternal Mortality. Along with AmnestyUSA and countless other respectable organizations, the WHO has offered that an increase in midwifery care will improve outcomes for mothers and babies worldwide, particularly in rural areas. Indeed, they have said that, "Increasing the number of midwives by 25% will reduce maternal mortality by 50%)." Properly trained midwives are a very feasible and effective solution to the problem of Maternal Morbidity. As French Obstetrician, Dr. Odent, has said,
“If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving childbirth back to women.”
We, as Americans, need to re-evaluate maternal healthcare in this country. For most, birth is normal and natural, not a condition needing treatment. Do not for a moment imagine that interventions are conveniences without consequences.
For the 15% of women in this country who have high-risk pregnancies, I am deeply grateful for a medical system equipped to save lives. But for the 85% of women who are low-risk, having a baby is the epitome of wellness. Whether you deliver in or out of the hospital, be aware of the benefits and risks of both. We live in a country where we have many choices, be thankful for them and make wise decisions that are the most comfortable for you. This is your body and your baby and you have been given the intuition to care for both. Listen to your instincts, don't ignore them even if medical professionals do. Find care providers that you can trust and that trust you.
“Experiences have clearly shown that an approach which 'de-medicalizes' birth, restores dignity and humanity to the process of childbirth, and returns control to the mother is also the safest approach.” -Dr. Odent, MD, OBGYN