Infant Mortality Rate in US

[JimR-OCDS]

no if they do not provide anything but abortion.

Well, fact is, many provide health services for poor women, which doesn't include abortion. Obama Care will now allow those women to have their own doctors, so PP will have less business over all.


Jim

 

[Antigone]

My wife and I had a hypothesis that the recent increase in infant mortality rates could be due in part to the rising use of midwives in one's own home as opposed to doctors in a hospital.

That makes sense. The infant mortality rate over here is higher than the surrounding countries because home births are common (about one third of all births, I think, though it used to be more).

EDIT: just to be clear, it doesn't explain the US high infant mortality rates, but it could potentially explain (part of) the increase.

 

[TheOtherHockeyMom]

I would venture that the increase, while largely due to lack of access to health care during the pregnancy, might also be related to women tending to have children much later in life (I had mine at 19, 36 and 41 as an example), and the general lack of health and poor quality of diet among Americans.

 

[JimR-OCDS]

Well here's another article on the same subject, which provides more data.

More US babies die on their first day than in 68 other countries, report shows





The U.S. is a worse place for newborns than 68 other countries, including Egypt, Turkey and Peru, according to a report released Tuesday by Save the Children.


A million babies die every year globally on the same day they were born, including more than 11,000 American newborns, the report estimates. Most of them could be saved with fairly cheap interventions, the group says.


“The birth of a child should be a time of wonder and celebration. But for millions of mothers and babies in developing countries, it is a dance with death,” the report reads. “A baby’s first day is the most dangerous day of life—in the United States and countries rich and poor,” it adds.


“The United States has the highest first-day death rate in the industrialized world. An estimated 11,300 newborn babies die each year in the United States on the day they are born. This is 50 percent more first-day deaths than all other industrialized countries combined.”


More US babies die on their first day than in 68 other countries, report shows - NBC News.com

This part of the article was startling.

Teen births are partly to blame, the report says – echoing other research that has shown this. The U.S. has the highest teenage birth rate of any industrialized country.


“Teenage mothers in the U.S. tend to be poorer, less educated, and receive less prenatal care than older mothers. Because of these challenges, babies born to teen mothers are more likely to be low-birthweight and be born prematurely and to die in their first month. They are also more likely to suffer chronic medical conditions, do poorly in school, and give birth during their teen years (continuing the cycle of teen pregnancy),” the report says.

So, obviously the high rate has nothing to do with women delaying having children.


Jim

 

[MKJ]

Not that I oppose the ACA (I don't know why even it's supporters are calling it Obama care, that's a stupid name.) but I'm not sure that we can pin it all on lack of access to health care.

Canada for example is #2 and no one there lacks health care.

My wife and I had a hypothesis that the recent increase in infant mortality rates could be due in part to the rising use of midwives in one's own home as opposed to doctors in a hospital.

No. That stats for infant mortality in the US have been the pits for a long time.

Use of midwives is actually associated with better outcomes - most of the western nations with better health outcomes make far greater use of midwives than Canada or the US.

The bad stats in the US and Canada are related, I would say, to the similar type of maternity care offered in both paces, which is highly interventionist and largely based on liability and fear rather than best practice.

Here is an example: just recently it has been proposed that the definition of term be changed in pregnancy. Up until now, 37 weeks was considered term, when babies might start arriving and be healthy.

However, increasingy doctors were using that as an excuse to induce at 37 or 38 weeks - in some cases teling women that if their baby looked big they had to induce or it would be too large to deliver later.

This has, they found, led to huge numbers of induced babies needing to be treated for prematurity. That fact is that while some babies are ready at 37 weeks, plenty are not. (And best practice says that estimating birth weight is not accurate and not a reason to offer an induction.)

Similarly with many hospitals refusing vaginal births to women who have had a previous section. The literature is clear that it is safer for mom and baby to birth naturally, but instead we see hospitals completely ruling that out, mostly due to insurance issues.

C-section rates are around 30% in many hospitals, higher in some. And we also know there is a huge increase of incidents of placenta accreta - caused by a c-section in a previous pregnancy and nearly unknown at one time. It is pretty much the end of the pregnancy if it happens and is a big risk for the mom as well.

It's an insane system that is not healthy for mothers or babies. The Cochran Review has said that only about 1/3 of our common obstetrical/maternity practices are actually evidence based.

 

[JimR-OCDS]

No. That stats for infant mortality in the US have been the pits for a long time.

Use of midwives is actually associated with better outcomes - most of the western nations with better health outcomes make far greater use of midwives than Canada or the US.

The bad stats in the US and Canada are related, I would say, to the similar type of maternity care offered in both paces, which is highly interventionist and largely based on liability and fear rather than best practice.

Here is an example: just recently it has been proposed that the definition of term be changed in pregnancy. Up until now, 37 weeks was considered term, when babies might start arriving and be healthy.

However, increasingy doctors were using that as an excuse to induce at 37 or 38 weeks - in some cases teling women that if their baby looked big they had to induce or it would be too large to deliver later.

This has, they found, led to huge numbers of induced babies needing to be treated for prematurity. That fact is that while some babies are ready at 37 weeks, plenty are not. (And best practice says that estimating birth weight is not accurate and not a reason to offer an induction.)

Similarly with many hospitals refusing vaginal births to women who have had a previous section. The literature is clear that it is safer for mom and baby to birth naturally, but instead we see hospitals completely ruling that out, mostly due to insurance issues.

C-section rates are around 30% in many hospitals, higher in some. And we also know there is a huge increase of incidents of placenta accreta - caused by a c-section in a previous pregnancy and nearly unknown at one time. It is pretty much the end of the pregnancy if it happens and is a big risk for the mom as well.

It's an insane system that is not healthy for mothers or babies. The Cochran Review has said that only about 1/3 of our common obstetrical/maternity practices are actually evidence based.

That all being said, litigation between Canada and the United States is different, but this is my understanding.

In the US, you can sue anyone anytime, and lawyers will take your case on contingency basis. If they win a settlement, they get 1/3rd. The defendant has to pay for his own lawyer, which is expensive.

In Canada, this is my understanding, if you sue some one and lose, you have to pay their legal fees. Am I right on this ?


Jim

 

[TheOtherHockeyMom]

Well here's another article on the same subject, which provides more data.




This part of the article was startling.



So, obviously the high rate has nothing to do with women delaying having children.


Jim

That's kind of a relief, I think...in the sense that delaying having children doesn't seem to result in a higher likelihood of infant mortality.

 

[MKJ]

That all being said, litigation between Canada and the United States is different, but this is my understanding.

In the US, you can sue anyone anytime, and lawyers will take your case on contingency basis. If they win a settlement, they get 1/3rd. The defendant has to pay for his own lawyer, which is expensive.

In Canada, this is my understanding, if you sue some one and lose, you have to pay their legal fees. Am I right on this ?


Jim

I am not absolutely sure, but I think the judge can say that you have to pay their fees, but they won't always.

What is different is the way malpractice insurance is set up. Almost all doctors here buy it from a doctor run and owned co-op. They decided early on that they would not settle cases just to avoid paying court costs - they would fight for the member unless there was a real reason not to, even if it meant paying out more.

In the US it is different - often in such cases they settle, even when the case is not good, because they will still save money on court costs.

What this means is that in the US, a lawyer can make a good bet on winning such cases and getting paid. So many will take take cases on the agreement that they will get a percentage of whatever monies are awarded. The person bringing the case does not have to pay up front.

This is less likely in Canada unless the case is very strong. So people think very seriously about it before suing.

Also in the US, people are paying through the nose for medical care. That makes them more likely to sue as well I think - they see it as a faulty product. Whereas in Canada we tend to see it as a different sort of error. And we also don't have to pay to get the error fixed.


All that being said - what is similar here, though perhaps not quite as extreme, is the attitude to maternity care. For one thing, it is largely controlled by obstetricians, who are not the best people to control it - they are essentially specialists in the things that can go wrong in pregnancy and birth. (In Canada we are more likely to have GPs, but we also are behind on using midwives.)

That is to say - in North America we tend to see birth as abnormal, and try to fit it into a very narrow set of "normal" perameters. And we intervene aggressively with drugs and procedures when it doesn't. The problem is labour is highly variable and interfering in it tends to lead to other problems. And many many of our common labour room practices are actually totally counter-productive. Delivering on the back is a good example - it is about the most inefficient way to do it, only really good for the doctor. Most of Europe encourages other positions - it is only here that they carry on with women pushing babies out against gravity as the norm.

The other thing is, good labour practice is about a lot of waiting around, helping the mother move around a lot, keeping her company, to stay as calm as possible and comfortable and energized, and then more waiting around.

Obstetricians are surgeons, and waiting around isn't really what they are good at or trained for.

 

[Luther073082]

That all being said, litigation between Canada and the United States is different, but this is my understanding.

In the US, you can sue anyone anytime, and lawyers will take your case on contingency basis. If they win a settlement, they get 1/3rd. The defendant has to pay for his own lawyer, which is expensive.

In Canada, this is my understanding, if you sue some one and lose, you have to pay their legal fees. Am I right on this ?

Jim

Not sure about Canada, but I think in the US the person who won the lawsuit could get their legal fee's recovered but it would involve a counter lawsuit. Which means more money, more time spent in court, etc etc. And I'm not sure if there is a guarantee that they will get it. It might have to meet certain conditions.

 

[JimR-OCDS]

Not sure about Canada, but I think in the US the person who won the lawsuit could get their legal fee's recovered but it would involve a counter lawsuit. Which means more money, more time spent in court, etc etc. And I'm not sure if there is a guarantee that they will get it. It might have to meet certain conditions.

The defendant who wins, can counter sue, but as you said, more time and money.

Our civil trial system is a mess.

I use to work with a guy who subsidized his income by suing people. He said, 3 out of five cases will settle out of court, and that's enough to make it worth while.

The man was a snake.



Jim

 

[sea oat]

Not that I oppose the ACA (I don't know why even it's supporters are calling it Obama care, that's a stupid name.) but I'm not sure that we can pin it all on lack of access to health care.

Canada for example is #2 and no one there lacks health care.

Thank you for pointing this out.

Americans, are often surprised to learn they're not always the biggest and bestest at everything, but let's not lose sight of the big picture. The US's 2.62 is not much different from Canada's 2.4. Although there's room for improvement, Americans & Canadians still have much to be thankful for; these infant mortality rates are still very low in a global perspective.

Anyway, you also have a good point that the ACA likely isn't going to be very relevant. No one, like you said, lacks healthcare in Canada. Plus, the Save The Children report cites preterm births as the main reason for the 1st day deaths. It speculates about a number of factors that might explain it, like teenage pregnancies, and racial disparities....neither of which the ACA would be a magic answer for.

http://www.savethechildrenweb.org/S...mmon/downloads/State of the WorldOWM-2013.pdf (see page 55-56).

 

[sea oat]

Here is a screen shot someone took of a graph from the report, btw.

 

[MKJ]

Thank you for pointing this out.

Americans, are often surprised to learn they're not always the biggest and bestest at everything, but let's not lose sight of the big picture. The US's 2.62 is not much different from Canada's 2.4.

The Save The Children report cites preterm births as the main reason for the 1st day deaths. It speculates about a number of factors that MIGHT explain it, like teenage pregnancies, and racial disparities, but it states more research needs to be done to figure out the causes.

http://www.savethechildrenweb.org/S...mmon/downloads/State of the WorldOWM-2013.pdf (see page 55-56).

THe number of pre-term births in the US rose by 30% between the early 90's and 2000. I don't think that can be accounted for by racial differences nor by teen pregnancies.

On the other hand, labour induction also doubled during that time. I suspect that would be a better candidate for a cause.

 

[mark46]

While it is interesting that US rates are only a bit worse than Canada, the real question is about the nature of healthcare for women compared to the other THIRTY-TWO countries that have lower rates than the US or Canada.

Are there those here who think that the US provides among the best care in the world for pregnant women and to newborns? I don't.

Here is a screen shot someone took of a graph from the report, btw.

 

[MKJ]

While it is interesting that US rates are only a bit worse than Canada, the real question is about the nature of healthcare for women compared to the other THIRTY-TWO countries that have no lower rates than the US or Canada.

Are there those here who think that the US provides among the best care in the world for pregnant women and to newborns? I don't.

Yes, it's pretty pathetic for both of our nations.

One thing about Canada and the US is that we largely share a medical culture. That is the main thing that drives our approaches to medical care.

I don't think that it is a surprise either that it is women's health that has some of the most extreme permutations of the very interventionist and paternalistic models of care we tend to use.

I am not normally one to take on a lot of the feminist critique at face value, but I think this is really a case where a sudden influx of a male dominated medical profession into a new area of medicine saw women as pretty much incompetent to know what was good for them, and even saw their bodies as defective.

The whole history of maternity care in North America is quite disturbing. Some of the early stuff would make your hair curl, and while the some of those techniques are now recognized as barbaric, a lot of the attitude and assumptions behind them remains.

 

[Second Phoenix]

That took exactly one post (I bet myself it would take three - now I have to buy myself a drink)

Good Lord people:

We have a healthcare issue here babies are dying because we have lousy healthcare and what do we care about ?

Abortion.

Yeah,

Is it a wonder that pro-lifers are seen as caring only about fetus's ?

Our healthcare is great. What is lousy are personal decisions people make.

 

[TheOtherHockeyMom]

Our healthcare is great. What is lousy are personal decisions people make.

What poor personal decisions are people making that lead to our high infant mortality rate?

 

[Second Phoenix]

What poor personal decisions are people making that lead to our high infant mortality rate?

Bad health decisions, no healthcare insurance, having children when they are not prepared...etc.

 

[sea oat]

While it is interesting that US rates are only a bit worse than Canada, the real question is about the nature of healthcare for women compared to the other THIRTY-TWO countries that have lower rates than the US or Canada.

The reason I was talking about Canada is because it was suggested by the OP that access to healthcare is responsible, and that the ACA will change it. While that may or may not be true, some of us are pointing out that Canada doesn't trail very far behind us at all, even though everyone there has access to healthcare. You are free to think the relationship with the other "THIRTY-TWO countries" is more interesting, but unless you have something to add that's actually relevant to what I said, then we can move along.

 

[WarriorAngel]

No, add the abortion stats to this number and we're even worse.

Of course compared to other industrialized nations in the chart, they too have high abortion rates.

So, this is just comparing infant mortality rates, i.e. babies that have been born, but don't survive because of their mother's not having access to quality health care.

Obama Care will hopefully begin to change the facts.

Jim

Then its probably fake.

Cos Obamacare isnt quality - in fact yesterday when i was going to close my store a woman came in with a long splinter in her palm and had me take it out cos she couldnt afford her Dr - cos the ins now.
I kid you not.
That was a weird moment in history for me.

He didnt offer quality and most of the poor know this...

He offered less quality and higher premiums. And if Feisty could get in here - which her computer is DOA - she probably could make a long post on just how bad it is now.I cant remember all the details - but other ppl complain to me too.

Not to mention a lot of democrats are angry at their premiums being marked up anywhere from 200-300%.

THEN the huge deductibles on top of it. So if i were pregnant - guess what - it would be a LOT LESS likely i would get as much care - cos the deductible is prohibitive. And i feel for the women now who will be going less for care because they wont be able to afford it.

WHEREAS - in the past - medicaid helped cover 100% and you got premium services.
Married couples not exactly qualifying for medicaid will have the worse issues of all.