Maternal Deaths

[JackRT]

As I was reading through the January 2019 edition of National Geographic magazine I came across an article on maternal deaths. The statistics are quite shocking. Since 1990 the maternal death rate across the world has dropped and in the third world it has dropped dramatically in some nations. Good news so far but maternal death rates have actually risen in two developed nations --- Serbia and the United States of America. This is shocking considering that, as one doctor put it, the USA has the capability of being the safest nation in the world to give birth. It gets worse. The maternal death rate in the USA is three times higher for black women than for white women. Some of this might have to do with the quality of maternal care in certain areas but some doctors are attributing it to the cumulative "toxic shock" of systemic racism. Don't you think that, if MAGA is to have any meaning more than a political slogan, this would be a good place to start?

 

[Chesterton]

...some doctors are attributing it to the cumulative "toxic shock" of systemic racism.

Apparently some doctors don't know what toxic shock is.

 

[bèlla]

It may have something to do with prenatal care and the importance of receiving it throughout the pregnancy.

 

[JackRT]

Apparently some doctors don't know what toxic shock is.

Which is precisely why the term is placed in quotation marks --- so that it is not confused with the medicinal meaning of the term. I have enough confidence in doctors to know that most know exactly what is meant.

 

[JackRT]

It may have something to do with prenatal care and the importance of receiving it throughout the pregnancy.

I am certain that is a factor. Post natal care as well. Does defunding certain NGOs that provide such care help or hinder?

 

[Chesterton]

Which is precisely why the term is placed in quotation marks --- so that it is not confused with the medicinal meaning of the term. I have enough confidence in doctors to know that most know exactly what is meant.

So what does it mean?

 

[yeshuaslavejeff]

It may have something to do with prenatal care and the importance of receiving it throughout the pregnancy.

Now , today, and for decades, the fastest growing cause of death has been doctors/ medicine proscribed according to 'protocol'.... (found on sites by AMA, and FDA sites relating causes of death in the USA).....

When doctors went on strike, the death rate WENT DOWN ,
until the day they came back off strike, then it went right back up.

 

[JackRT]

So what does it mean?

There is a narrow medicinal meaning of toxic shock. The term was introduced in the NG article it give it a wider meaning as well --- that systemic long term racism can cause sufficient stress in the targets of that racism as to induce real medical difficulties.

 

[Chesterton]

There is a narrow medicinal meaning of toxic shock. The term was introduced in the NG article it give it a wider meaning as well --- that systemic long term racism can cause sufficient stress in the targets of that racism as to induce real medical difficulties.

Technically you're supposed to link to a credible news source in your OP. I'm sure it says what you say it says, I'd just like to hear how that works. Did the article mention that black women get abortions at a much higher rate than other women?

 

[PloverWing]

I think this is the article: Why giving birth in the U.S. is surprisingly deadly

 

[Chesterton]

I think this is the article: Why giving birth in the U.S. is surprisingly deadly

I have to fork over my email to read that, and I'm not going to. Someone might be interested in seeing the stats on pregnancy and abortion, both factors in maternal death, broken down by race by the CDC here: https://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_07.pdf

 

[PloverWing]

I have one of my browsers loaded up with ad blockers and script blockers, and I was able to read the article without the email-request-popup getting in the way. (It's the same browser I use to read CF. )

 

[Sparagmos]

Now , today, and for decades, the fastest growing cause of death has been doctors/ medicine proscribed according to 'protocol'.... (found on sites by AMA, and FDA sites relating causes of death in the USA).....

When doctors went on strike, the death rate WENT DOWN ,
until the day they came back off strike, then it went right back up.

When did doctors go on strike?

 

[Sparagmos]

I have to fork over my email to read that, and I'm not going to. Someone might be interested in seeing the stats on pregnancy and abortion, both factors in maternal death, broken down by race by the CDC here: https://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_07.pdf

So what do you think is the cause of higher abortion rates among black women?

 

[redleghunter]

As I was reading through the January 2019 edition of National Geographic magazine I came across an article on maternal deaths. The statistics are quite shocking. Since 1990 the maternal death rate across the world has dropped and in the third world it has dropped dramatically in some nations. Good news so far but maternal death rates have actually risen in two developed nations --- Serbia and the United States of America. This is shocking considering that, as one doctor put it, the USA has the capability of being the safest nation in the world to give birth. It gets worse. The maternal death rate in the USA is three times higher for black women than for white women. Some of this might have to do with the quality of maternal care in certain areas but some doctors are attributing it to the cumulative "toxic shock" of systemic racism. Don't you think that, if MAGA is to have any meaning more than a political slogan, this would be a good place to start?

Did the magazine discuss that women are having children later in life, that the health of American women contribute to this?

 

[Radagast]

but some doctors are attributing it to the cumulative "toxic shock" of systemic racism

That sounds like psychobabble, and I doubt that any doctors are actually saying this. Yes, pregnancy-related deaths in the US are rising:

Yes, it varies by race (12.4 deaths per 100,000 live births for white women; 40.0 for black women; 17.8 for women of other races).

The leading cause is cardiovascular disease:

Reasons behind these deaths include:

• obesity
• diabetes
• smoking
• chronic high blood pressure
• having babies later in life
• having babies by cesarean delivery (the US has a massive rate of unnecessary cesareans, and VBACs are rare)
• complications of abortion
• poor antenatal and postnatal care for both low-income and middle-income women
• healthcare policies driven by perceived exposure to lawsuits rather than by medical evidence

 

[Quid est Veritas?]

US gynaecologists have far more lax protocols. South Africa uses ESMOE protocol for perinatal sepsis or bleeding. This entails large bore IV access, colloid fluids, early Caesars with only 6 hours of non-progressing active labour allowed, etc. It is also wholely opposed to many of these birthing trends and strongly emphasises Antenatal care. Opposition to Water-birthing, home-birthing and the ilk is a part of this. This is needed as our population is overall poorer, and our services and transport have structural delays.

The US has a more wait and see approach, with less stringent guidelines. The difference is that emergency and paramedic services are supposed to be more efficient, so that if something does go wrong, it can be accounted for. My wife, a gynae herself, is horrified by many foreign protocols. I would also think that the ongoing opioid abuse problems are certainly a contributing factor. If something systemically breaks down, there are just less safeguards in place. Maternal age and obesity has also been going up in the US, which obviously increases the risk of each pregnancy. The system needs to adjust to changing demographics.

Blaming it on racism is frankly silly. Race is a factor though, in that people of African descent have a tendency to have more anthropoid pelvises rather than the more gynaecoid one in Europeans. This means that caesarian sections due to cephalopelvic dysproportion are more common in black people, and if something like a Shoulder Dystocia occurs (where the baby gets stuck), the manoevres are less effective. Further, one of the big causes of morbity and mortality is cardiovascular - Pre-Eclampsia and HELLP syndrome - which again is a place where European and African populations differ as to responsiveness of drugs.

All in all, US maternal deaths are increasing due to problems in the US health care system - which is profit-driven and thus prioritises the profitable - and by changes in the patient profile itself - older ages, more obesity and diabetes, drug abuse, etc.

 

[Quid est Veritas?]

having babies by cesarean delivery (the US has a massive rate of unnecessary cesareans, and VBACs are rare

I'd be careful here. It is difficult to determine when a Caesarian section is really necessary. If one was not done, and it was, then the legal reprecussions are legion.
It literally destroys obstetricians in legal fees, which is a major problem in the US. It is easy to pontificate after the fact, but things like CTGs or ultrasounds have much lower specificity and sensitivity than we would like. Many 'unnecessarily caesars' likely get done, but they were likely being cautious lest they get destroyed by lawyers if some risk had been present.

VBACs aren't necessarily safe either. Your risk of uterine rupture, a catastrophic complication, goes up markedly. You must carefully discuss the risk vs benefit of VBAC, and in South Africa at least, the mother may request a Caesar if she had one previously. VBACs decrease hospital stay and are wonderful if successful, but such births still run significantly more risks.

 

[Radagast]

I'd be careful here. It is difficult to determine when a Caesarian section is really necessary. If one was not done, and it was, then the legal reprecussions are legion.

Absolutely, and the fear of "we might get sued" drives US obstetricians to perform cesareans at much higher rates than the rest of the world.

VBACs aren't necessarily safe either. Your risk of uterine rupture, a catastrophic complication, goes up markedly. You must carefully discuss the risk vs benefit of VBAC, and in South Africa at least, the mother may request a Caesar if she had one previously.

Same here in Australia. But in the US, it's more common for doctors to simply refuse a VBAC, I understand.

But one fundamental problem seems to be litigation-based medicine, rather than an objective "which is the best option for this patient."

 

[yeshuaslavejeff]

When did doctors go on strike?

I don't remember. I would just internet search with terms < doctors strike > to start with, then < death rate dropped > and so on... It was once nationwide news, then world wide known, via internet and so forth.