U.S. mothers are dying. Why don't we know that?
This past week as I wandered, or you might say stumbled, around Stumble Upon familiarizing myself with the layout and realizing the potential to find a lot of great blogs, I came across an article that stopped me in my tracks. I wish I could say it was a fabulously uplifting story, but the reality is that it was the complete opposite.
I want to pause for a moment here and take this opportunity to note that I did not write this with the intent of scaring pregnant women. There is already enough fear surrounding childbirth in this country and I don't wish to contribute to it. However, I feel strongly that the information below needs to be brought to light and so I wrote this with the intention of raising awareness and educating those who are interested.
A couple of years ago Orlando mother Claudia Mejia checked into Orlando Regional South Seminole hospital to have a baby. The birth went well, but then something went wrong, very very wrong. Ms. Mejia was told she contracted streptococcus, a flesh eating bacteria, and toxic shock syndrome and if she wanted to live, she would have to have both sets of limbs amputated. No further explanation was given. Twelve days after giving birth she was transferred to Orlando Regional Medical Center where she became a quadruple amputee, unable to hold or care for her new son. She has since filed suit against the hospital asking for answers as to how this could have happened. It appears that a judge ruled in favor of releasing her records in April 2007, but I was unable to find any more information to indicate if that ever happened.
This is no doubt a major tragedy, but what I find even more disturbing than the fact that this happened is that it did not seem to get much media attention. Why is that? Had Ms. Mejia been famous, more affluent, or Caucasian would it have made national headlines? Or would that even make a difference?
Unfortunately, this scenario of obscuring maternal complications and mortality appears to be the norm in the United States, rather than the exception.
Not two weeks before, I read an article by pioneering midwife Ina May Gaskin titled "Masking Maternal Mortality" in the March-April 2008 issue of Mothering magazine. Gaskin asserts that "the number of American women who die as a result of pregnancy and birth is almost four times higher than it should be" and says that begs the question, "Why is no one talking about it?"
The last time I recall hearing about a maternal death in the news was in the spring of 2007 when Valerie Scythes and Melissa Farah, two friends and teachers from the same school, both died following c-sections at Underwood Memorial Hospital in Woodbury, N.J. Had they not had the coincidences of knowing each other, both having been at the same hospital, and dying within weeks of each other, would either of their deaths have received media attention?
The maternal death rate in the United States is the highest it's been in decades - 13 deaths* per 100,000 live births and, even more startling, for black women 34.7 deaths per 100,000, in 2004. Gaskin asserts it also may be seriously underreported. According to the Center for Disease Control in 1998, "there is so much misclassification in the US system of maternal death reporting that the actual number could be as much as three times greater than the number officially published each year."
A significant part of the problem is that the 50 states are not required to use the same death certificate and only 21 states ask on their death certificate some version of this question, "Was the deceased pregnant in the week or months preceding her death?"
Another issue noted by the CDC is that physicians often do not fill out the cause-of-death section of the death certificate accurately enough. Additionally problematic is the US autopsy rate has dropped to less than 5 percent, there is usually no external review process when a maternal death takes place and hospital employees with knowledge about the death are generally warned to stay quiet about it.
How can we possibly expect to have accurate reporting under those conditions?
Contrast this with the United Kingdom where every three years the British Royal College of Obstetricians and Gynaecologists publishes a book titled "Why Mothers Die." In addition to providing detailed, accurate numbers for each category of maternal death, "Why Mothers Die" also makes recommendations regarding what should be done to reduce the number of deaths over the next three years. The book is available to the public in bookstores, so anyone and everyone can have access to this information.
Also in sharp contrast to the US, when a maternal death occurs in a hospital in the UK, a team of people who do not work at the hospital is dispatched to review all of the woman's records.
Where does that leave us here in the US? We have a mother who was forced to become a quadriplegic unable to get answers from the hospital as to why. We have an underreported rate of mothers dying from pregnancy and birth complications, often without any kind of outside review. And according to the CDC we have no improvement in the maternal death rate since 1982. Yet none of these stories are getting the kind of media attention they deserve.
To help draw attention to the underreported maternal death rate and lack of media interest, Gaskin started The Safe Motherhood Quilt Project. Whenever she receives documentation that a US woman has died from pregnancy- or birth-related causes from 1982 to the present, she arranges to have a quilt square made to honor her. The quilt, which can be viewed virtually online and is up to 85 squares, "acts as the voice for women who can no longer speak for themselves." It is quite sobering to view, even online. The last square was just added one month ago.
Perhaps by raising awareness and demanding more information, we can turn the tide in this country.
She who has health has hope; and she who has hope has everything. -- Arabic Proverb
Refuse to be a Womb Pod: The Top Five Underreported Birth Stories for 2007
Banana Peel: I think I'm moving to Iceland...
The Lactivist: Go to Give Birth, Come Home with No Limbs
USA Today: Answers prove elusive as c-section rate rises
SouthCoast Today: At 67, hippie-midwife who changed childbirth in America still crusades for natural method
* Ina May Gaskin informed me that since she wrote the Mothering article, the most recent figure for the maternal death rate has risen. It is now at 15/100,000 births.
Contributing editor Amy Gates also writes about attachment parenting, activism, green living and photography at Crunchy Domestic Goddess.
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