Why is Maternal Death Such an Issue in America?
The U.S. is known for its medical advancements—and in light of that, it's shocking to think that while most countries have seen a decline in maternal death rates, we've moved in the opposite direction.
In fact, an April 2019 report from the Institute for Health Metrics and Evaluation concluded that eight countries experienced a decrease child and adolescent mortality – but not maternal mortality – in the past 27 years. America was one of those countries, along with American Samoa, Canada, Greece, Guam, Jamaica, St. Vincent and the Grenadines, and Zimbabwe. The U.S. maternal mortality rate increased 67.5%, which is the highest increase of all the countries.
An investigation completed by NPR and ProPublica in 2017 determines that there may be a reason moms are dying during childbirth. Maternal deaths may increase as infants deaths plummet because providers are more concerned with caring for their babies during pregnancy and childbirth, and maternal safety may be getting neglected.
According to the report, between 700 and 900 women die due to pregnancy or childbirth-related causes, and American women are three times more likely to succumb to these causes than Canadian women. There are a few factors that increase this risk: Low-income and rural areas see more maternal deaths, for example—but the issue doesn't discriminate.
Women are undeniably delaying motherhood until they're older, and age itself may play an important role in this trend. But the research has led the people behind this investigation to believe the focus on infant survival may be harming mothers, and some experts seem to agree.
"We worry a lot about vulnerable little babies," Barbara Levy, vice president for health policy/advocacy at the American Congress of Obstetricians and Gynecologists and a member of the Council on Patient Safety in Women's Health Care told NPR. "We don't pay enough attention to those things that can be catastrophic for women."
But not all experts are on board with this line of thinking. “I feel like the title of [the investigation] is a little misleading and not accurate [based on] what my experience as an Ob-Gyn has been. The teaching in my experience is that the mother’s well-being trumps the fetus. I think our goal is to always have a healthy mother—when a baby becomes viable after 24 weeks, certainly we consider that we have two patients, but not at the expense of the mother," Ob-Gyn Kameelah Phillips, M.D., says.
Dr. Phillips believes maternal death rates in the U.S. may be high due to other factors. "We have overwhelming rates of obesity, hypertension, of older mothers, of multiples—our profile as a nation looks nothing like the profiles of the countries we're being compared to. That does not in any way excuse our poor report card, but I think it does have a significant role in the numbers that we have."
New Standards May Combat Maternal Death
The Joint Commission, America’s largest hospital accreditation group, recognizes the high maternal death rate. In April 2019, they proposed new standards aimed at protecting mothers against death and injury during childbirth. The standards would necessitate, for example, that hospitals evaluate mothers for risk of hemorrhage, and that all emergency department staff be trained on delivery room complications.
If approved, the standards would apply to 2,700 birthing hospitals, which would lose their accreditation with the Joint Commission if they don’t follow them. According to USA Today, these best practices are currently recommended but ignored by many hospitals. USA Today expects the final decision on the standards shortly after May 29, when the time period for public comment expires.
We imagine any mother would encourage medical professionals to save her baby's life instead of her own, but let's not forget that moms are more than just vessels to carry babies into this world. Childbirth is an incredibly tough thing, and regardless of what factors are responsible for our country's poor record where maternal health is concerned, we can only hope it improves soon. Infant lives are valuable beyond expression—but so are the lives of mothers.
