Curtailing the Scapel: C-Sections and the Rise of Maternal Mortality

September 26, 2007

In an op-ed in the L.A. Times, Jennifer Block further contextualizes last month’s surprising news that the U.S. maternal mortality rate rose to 13 deaths per 100,000 live births in 2004.

That amounts to the deaths of 540 women in 2004, 45 more than were reported in 2003 when the rate was 12 deaths per 100,000 live births. That also happened to be the first year since 1977 that the maternal death rate rose above 10 per 100,000 live births.

The statistics were released by the CDC’s National Center for Health Statistics (PDF).

Block, the author of “Pushed: The Painful Truth About Childbirth and Modern Maternity Care,” takes a closer look at the numbers:

For a country that considers itself a leader in medical technology, this figure should be a wake-up call. In Scandinavian countries, about 3 per 100,000 women die, which is thought to be the irreducible minimum. The U.S. remains far from that. Even more disturbing is the racial disparity: Black women are nearly four times as likely to die during childbirth than white women, with a staggering rate of 34.7 deaths per 100,000.

These high rates aren’t a surprise to anyone who’s been investigating childbirth deaths. Physician researchers who have conducted local case reviews across the country consistently have found death rates much higher than what the CDC has been reporting. In New York City between 2003 and 2005, researchers found a death rate of 22.9 per 100,000; in Florida between 1999 and 2002, the rate was 17.6. Other reports by CDC epidemiologists have acknowledged that deaths related to childbirth are probably underreported by a factor of two to three.

Caesarean sections, which now account for a staggering almost 30 percent of all births, and increasing maternal obesity, which can lead to more complications, are cited as probable reasons for the increase. Some researchers also point to changes in the way childbirth deaths are reported.

As Block notes, a c-section is major surgery, “and although it saves lives when performed as an emergency intervention, it causes more harm than good when overused. Here’s why: Caesareans are inherently riskier than normal, vaginal birth. They also lead to repeat caesareans. And repeat caesareans carry even greater risks.”

According to a 2006 study by the World Health Organization that was published last year in the medical journal Lancet, a hospital’s caesarean rate should not exceed 15 percent. “When it does, women suffer more infections, hemorrhages and deaths, and babies are more likely to be born prematurely or die,” writes Block, adding that at some U.S. hospitals, nearly half of all births are delivered surgically.

While 1 in 4 low-risk first-time mothers will give birth via caesarean, the vast majority of them — 95 percent — will have another caesarean when they give birth to their next child, writes Block. Vaginal birth after caesarean (VBAC) is a pretty low-risk event, but more medical institutions are banning VBACs, and doctors shy away from it for a variety of reasons, including malpractice liability.

Indeed, last month, Rachel wrote about a Maryland woman whose obstetrician dropped her — via a letter — when she was eight months pregnant because her first birth was by caesarean and she now wanted to attempt a vaginal birth.

“Universal care alone won’t solve the problem; what pregnant women need is entirely different care,” concludes Block. “They need doctors and hospitals that promote normal labor and delivery. Of course, reducing obesity belongs on the healthcare agenda, and so does curtailing the scalpel.”

Plus: Live near Newton, Mass.? Block will be reading from “Pushed” this Sunday, Sept. 30, at Newtonville Books at 2 p.m.

Future event information is available here. And let’s also put in a plug for Block’s excellent blog, Pushed Birth, a new addition to the OBOB blogroll.

Comments are closed.