Why do we tolerate up to 80,000 mothers each year suffering big injuries in childbirth?

maternalmorbidity-300x193Here is a  sobering public health angle on Mother’s Day.

Experts on international health and development, including the likes of Pulitzer Prize-winning foreign correspondent and columnist Nick Kristof, long have argued that a key way to major improvements in distant lands rests in boosting the lot of women and girls. It’s an issue that clearly also needs attention closer to home.

National Public Radio and Pro Publica, a Pulitzer-winning investigative site, deserve yet more credit for their continuing dig into a shame of contemporary American health care — why U.S. mothers die in childbirth at a far higher rate than in all other developed countries. Their latest disturbing reporting focuses on some unacceptable numbers:

In the course of our reporting, another disturbing statistic [besides that of maternal mortality] emerged: For every American woman who dies from childbirth, 70 nearly die. That adds up to more than 50,000 women who suffer ‘severe maternal morbidity’ from childbirth each year, according to the Centers for Disease Control and Prevention [see chart above]. A patient safety group, the Alliance for Innovation on Maternal Health, came up with an even higher figure. After conducting an in-depth study of devastating complications in hospitals in four states, it put the nationwide number at around 80,000.

Obstetrician Peter Bernstein, director of the Maternal-Fetal Medicine division at Montefiore Medical Center in New York, says American women may survive the act of giving birth but do so at huge cost

Women can wind up losing their uterus and therefore becoming infertile. They can wind up with kidney problems. They can have heart attacks. They can have brain damage from all the blood that they’ve lost.

The journalists point out there’s more:

Women develop pregnancy-induced high blood pressure known as pre-eclampsia, which can lead to a stroke and organ failure; parts of the placenta can be left behind, which can lead to infection; and a woman giving birth is more prone to blood clots that can be life-threatening. The cost, though, is not just medical. The treatment for these complications can become an ongoing financial burden, and the trauma suffered from physical complications can lead to persistent emotional and psychological pain.

Big delivery crises aren’t mom’s only worry — it’s also the “near misses” that can trash their lives and those of their children and families, and there are reasons why, the news organizations say:

In the U.S., the rate of severe complications from childbirth has been rising faster than the rate of women who died. The rate of women nearly dying almost tripled between 1993 and 2014, according to the CDC. To help explain those dire statistics, experts point to risk factors that have increased in recent years: American women are giving birth at older ages and are more likely to have problematic conditions like obesity, high blood pressure and diabetes.

NPR, Pro Publica, and more important the medical community itself have identified key matters that must be addressed to improve birthing care, a procedure that many would expect would be all but perfected since it has been a part of medicine since time immemorial.

Doctors, nurses, and hospitals, to start, need to listen to and be much more responsive to women patients and stop ignoring or downplaying their health concerns. (That attentiveness and focus is a giant matter for Big Medicine altogether, as studies show, for example, that residents, who are frontline medical care givers, spend on average as little as eight minutes per patients per day, or just 12 percent of their total time, this at a flagship training institution like nearby Johns Hopkins).

Specialists and researchers also are homing in on how little time new moms get in pre- and post-partum care, where their medical and other issues could be dealt with early, fast, and before they get out of control.

In my practice, I see not only the significant harms that patients suffer while seeking medical services but also their giant struggles to access and afford safe, quality, and excellent medical care, especially attention that could avert serious and needless injury to moms, babies, and children. Others already have noted how much more parents and families pay for maternal services in this country versus other industrialized nations, and the, frankly embarrassing and disconcerting disparities in outcomes in which this nation ranks so poorly against its peers on measures of maternal mortality.

Dopey advice to discomfited moms from dealers

If any smug guys exist who think that pregnancy and delivery is easy and plain simple, they might wish to consider reporting by the Denver Post. The newspaper, serving a state that has led in the legalization of marijuana, says that researchers have found that hundreds of pot stores, when contacted by an unidentified female caller, recommended marijuana ingestion for expectant women customers suffering with morning sickness or pain. Medical expects explicitly say this should not be done.

But the pot sales people, in multiple “mystery caller” chats with medical researchers from universities and health systems in Colorado and Utah, offered “personal recommendations” on marijuana and pregnancy, no matter what scientific studies may show about its potential harms.

To be sure, many Americans deride discussions of marijuana risks — which do exist, as Aaron E. Carroll, a research scientist and professor of pediatrics at Indiana University School of Medicine, pointed out in a recent piece for the “Upshot,” the New York Times column on evidence-based findings. Carroll doesn’t take a position on pot legalization, but as a physician-researcher, he says users must educate themselves about the substance and its potential abuses and health dangers.

The growing woe of opioid-addicted kids

And, if legal pot is creating concerns for pregnant women and their unborn, it’s worth reading reports by the independent, nonpartisan Kaiser Health News Service and the New York Times magazine about a growing number of young, expectant moms’ struggles with opioid addiction.

As KHN reported:

On average, a baby is born every 15 minutes in the U.S. withdrawing from opioids, according to recent research. That staggering statistic raises concerns among doctors, social workers and mothers … who worry about how drug abuse while pregnant affects a baby’s health. … Research is just beginning to point toward the answers. A recent international multi-site study tracked nearly 100 children and their mothers, who were in medically assisted treatment during their pregnancy, for 36 months. Hendrée Jones is executive director at UNC Horizons and co-authored the study. She offered reasons to be optimistic. ‘The children through time tended to score within the normal range of the tests that we had,’ Jones said.

But the news service quotes other experts who say children can suffer developmental delays, and research on opioids’ effects on pregnant moms and their youngsters is a newer area with much to be learned still.

The New York Times magazine, meantime, details moms’ travails as they try to kick addictions to prescription opioid painkillers and illicit drugs, including by taking other medications to try to get clean. The magazine offers some harsh metrics about this public health crisis:

Of the estimated 2.1 million Americans currently in the grip of opioid addiction, many are women of childbearing age. The young-adult population has been hardest hit, proportionately, with nearly 400,000 adults ages 18 to 25 suffering from addiction to prescription painkillers (the vast majority) or heroin. Strict adherence to a birth-control regimen — or any regimen at all — is difficult for someone whose body and mind have been hijacked by drug dependence, which may help to explain why, according to the largest recent study, nearly 90 percent of pregnancies among women who abuse opioid medications are … unintended. The number of pregnant women using opioids grew significantly between 2004 and 2013, according to recent research published in JAMA Pediatrics, with the increase disproportionately high — more than 600 percent — in rural areas. Another decade-long study found a fivefold increase in the number of newborns who experienced the opioid-withdrawal condition known as neonatal abstinence syndrome, or NAS: to eight per 1,000 hospital births from one and a half. Experts estimate that a baby with NAS is born in America every 15 minutes.

We have a long way to go to help moms and kids in this country.

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