Friday, August 24, 2007

More U.S. women dying in childbirth

Death rate highest in decades; obesity and C-sections may be the cause

ATLANTA - U.S. women are dying from childbirth at the highest rate in decades, new government figures show. Though the risk of death is very small, experts believe increasing maternal obesity and a jump in Caesarean sections are partly to blame...

...To be sure, death from childbirth remains fairly rare in the United States. The death of infants is much more common — the nation’s infant mortality rate was 679 per 100,000 live births in 2004...

...But the fact that maternal deaths are rising at all these days is shocking, said Tim Davis, a Virginia man whose wife Elizabeth died after childbirth in 2000.

“The hardest thing to understand is how in this day and age, in a modern hospital with doctors and nurses, that somebody can just die like that,” he said...

...“There’s an inherent risk to C-sections,” said Dr. Elliott Main, who co-chairs a panel reviewing obstetrics care in California. “As you do thousands and thousands of them, there’s going to be a price.”

Excessive bleeding is one of the leading causes of pregnancy-related death, and women with several previous C-sections are at especially high risk, according to a review of maternal deaths in New York. Blood vessel blockages and infections are among the other leading causes.

Experts also say obesity may be a factor. Heavier women are more prone to diabetes and other complications, and they may have excess tissue and larger babies that make a vaginal delivery more problematic. That can lead to more C-sections. “It becomes this sort of snowball effect,” said King, who is now medical director of maternal-fetal medicine at Riverside Methodist Hospital in Columbus, Ohio...

Interesting...they'll admit to C-sections being dangerous, but in hospitals, doctors state them as common place and safe with such excuses to perform them as, "you're baby is too big", "lack of progress", etc.

First of all, God created this big baby for the mother's body and knows exactly what He's doing. On top of that, how can they know how big the baby is until he's out? Here's some info on the acuracy of ultrasounds:

Different methods are used to estimate the baby's age or fetal weight and there is great debate in the ultrasound community over the efficacy and relative merits of each method. Keep in mind that results can differ based on the method used, the skill of the sonographer, and the relative position of the baby. Therefore, take such estimates of fetal age or weight with a big grain of salt. They are not known to be terribly accurate most of the time.

...This worry leads to one of the most dubious uses of ultrasound----an ultrasound for estimating fetal weight. This practice is very controversial. Research clearly shows that ultrasounds for estimating fetal weight are often quite inaccurate, and especially so at the extremes of size (extra-small or extra-large). Doing ultrasounds for estimating fetal weight is a very questionable policy, but many providers routinely do it anyhow.

The accuracy of ultrasound for detecting macrosomia seems to run generally from 50% to 65% or so, very low accuracy to be the basis for so much intervention. For example, Pollack et al. (1992) found that only 64% of the babies estimated to be macrosomic (big) actually were. Levine et al. (1992) found that HALF of the ultrasound predictions of fetal weight were incorrect. Delpapa and Mueller-Heubach (1991) found that 77% of ultrasound fetal weight predictions exceeded actual birthweight and only 48% were even within 500g (about one pound) of the actual birth weight. Furthermore, 23% were more than 1 pound overestimated, and 50% of the babies predicted to be macrosomic weren't macrosomic at all.
Notice that predicting macrosomia through estimated fetal weight is as accurate or only slightly more accurate than tossing a coin! It is not very good science. Yet doctors routinely continue to order ultrasounds to estimate fetal size, particularly in large women. And these incorrect predictions continue to result in huge amounts of intervention, which have major health implications.

For example, when the baby is predicted to be 'big,' the doctors often induce labor early in the mistaken belief that this will be more likely to result in vaginal birth and to avoid birth injuries. Or they strongly pressure women (especially big women) to have an elective cesarean, which brings its own set of substantial risks, both for this pregnancy and any future pregnancy the woman may have. Unfortunately, research shows that early induction and/or elective cesarean for macrosomia are NOT justified in non-diabetic women, and may be questionable in some diabetic women too... (Link)


Then there's "lack of progress". Every birth is different and lack of progress can simply mean, "I'll be late for my golfing appointment." Sad times. Labor stalls for reasons - whether the mother needs to build up the antibodies for the baby for any sicknesses nearby or whether labor was induced and the baby simply isn't ready.

I'm so grateful to God that He's given me people who care enough about my family to get me to question doctors. ESPECIALLY prior to having my baby! If I did as all else to and ended up with an OBGYN who believed the last ultrasound we had saying that I was due July 30, I would have been induced and probably had a C-section as the baby STILL isn't ready to come out days after the Aug. 22 due date.

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