Each year, more than 65,000 pregnant women in the United States suffer life-threatening complications, including physical and psychological conditions aggravated by pregnancy, and more than 600 die from pregnancy-related causes. Elizabeth Dawes Gay reported that inadequate health care in rural areas and racial disparities are drivers of this maternal health crisis. Nationally, African American women are three to four times more likely than white women to die from pregnancy-related causes, with rates even higher in parts of the US that Gay characterized as “pockets of neglect,” such as Georgia, where the 2011 maternal mortality rate of 28.7 per 100,000 live births was nearly double the national average.
Women’s Policy Inc., a nonprofit, nonpartisan public policy organization, hosted a briefing in April 2016 for US maternal mortality experts to address problems and present solutions to a panel of congressional staffers, federal employees, and women’s health advocates. “The U.S. is the only nation in the developed world with a rising maternal mortality rate,” Rep. Lois Capps stated at the meeting. Dr. Keisha Callins identified issues that contribute to the rising maternal mortality rate, including “provider shortages, lack of physical access to care, . . . low educational attainment, poverty, poor access to healthy foods, neighborhood violence and stress.” The prevalence of caesarian section (C-section) delivery is another factor. The World Health Organization recommends that no more than 10–15 percent of births should be C-section deliveries; in the US, one in three babies is delivered by C-section.
Gay described a maternal safety bundle initiative—“best practices, guidelines and protocols to improve maternal health care quality and safety”—that has been developed by the Alliance for Innovation on Maternal Health, or AIM. These “bundles” include “equipping hospital labor units with a fully stocked cart for immediate hemorrhage treatment, establishing a hospital-level emergency management protocol, conducting regular staff drills and reviewing all cases to learn from past mistakes.” (See also Marsha Walton, “Hospitals Train to Track, React to Maternal Bleeding,” Women’s eNews, June 23, 2015.)
Across the US, the number of women who are vulnerable to high-risk deliveries is rising. In addition, doctors rarely warn patients of the potential for serious injuries and complications that can occur following birth, according to a report by Kiera Butler for Mother Jones. Women have a right to make informed decisions about their bodies and serious medical situations; however, when it comes to birth and its aftereffects, Butler found that doctors simply are not providing vital information. Though laws in many states require doctors to inform women of the potential complications and dangers that can occur during delivery, no such laws require doctors to inform about potential long-term problems following delivery, or to share the fact that some complications are more prevalent in women who give birth vaginally than in women who deliver by C-section.
This is a big problem for millions of women, as, according to a 2008 study by researchers at the California HMO Kaiser Permanente, 80 percent of women who suffer from pelvic floor disorders are mothers, and women who delivered vaginally are twice as likely to experience these injuries as women who have had a C-section or who have not given birth. According to Butler’s Mother Jones report, numerous other studies suggest that “50 to 80 percent of women who give birth experience tearing of the pelvic skin and muscles,” and, for more than one in ten women who give birth, these injuries are severe enough to damage the anal sphincter muscle, which can lead to loss of bowel and bladder control. Sexual dysfunction, stress urinary incontinence, and pelvic organ prolapse—a chronic and painful condition of the uterus or bladder that often requires multiple surgeries to repair—are some other common conditions more prevalent following vaginal birth than following C-sections, yet doctors rarely discuss these issues with pregnant patients.
Beyond pain and embarrassment, the financial costs of these sometimes preventable conditions are also great. According to Butler, citing the website Healthcare Bluebook, “the typical price for a vaginal hysterectomy, one of the most common fixes for uterine prolapse, is about $14,400, including hospital costs, while a bladder repair surgery for incontinence runs about $28,000.” For those who opt not to have surgery, adult incontinence products can be an equally large strain on the wallet. And companies are cashing in; in fact, Mother Jones reports that the industry is “projected to grow from $1.8 billion in 2015 to $2.7 billion by 2020, and it is expected to catch up to the baby diaper market within a decade.”
The corporate news media have paid limited attention to maternal mortality and morbidity in the US. In 2012, Motherlode, a parenting blog connected with the New York Times, published an article, “An Unspoken Risk of Vaginal Birth,” that noted the extent to which mainstream publications underestimate the number of women affected by serious injuries sustained during vaginal childbirth. In May 2016, a report in the Washington Post addressed the high maternal mortality rates among American women and mentioned a national prevention campaign to avert such deaths. A September 2016 article by Sabrina Tavernise for the New York Times provided good, though brief, coverage of the rising rate of maternal mortality in the US.
Elizabeth Dawes Gay, “Congressional Briefing Puts U.S. Maternity on Exam Table,” Women’s eNews, April 15, 2016, http://womensenews.org/2016/04/congressional-briefing-puts-u-s-maternity-on-exam-table/.
Kiera Butler, “The Scary Truth About Childbirth,” Mother Jones, January/February, 2017, http://www.motherjones.com/politics/2017/01/childbirth-injuries-prolapse-cesarean-section-natural-childbirth.
Student Researchers: Jane C. Hau (Citrus College) and Hope Matheson (North Central College)
Faculty Evaluators: Andy Lee Roth (Citrus College) and Steve Macek (North Central College)