Our maternal mortality rates are also appalling, and grossly underreported. The actual problem is even worse than the official stats.
Poor prenatal care may be part of the problem. However, the excessive use of technology is also part of the problem. Interventions like cesearan surgery, internal fetal monitors, inductions, etc are vital to the survival of mother and child in a few cases.....but also drive up both maternal and infant mortality when used inappropriately.
OB/GYNs are surgeons who specialize in injuries and diseases of the female reproductive system. They do amazing work within their area of expertise, but they are not experts in birth. Midwives are people who specialize in normal prenancy and birth, including the overall health of both mother and baby. For normal births (which is most of them) midwives do a better job and have lower infant/maternal mortality rates than OB/GYNs.
In addition, post-natal care is almost nonexistent, unless you're working with a homebirth midwife. Homebirth midwives do all the follow-up care for mother and child for six weeks. I was shocked (and horrified) to discover that the norm in "regular" care is that the OB/GYN never sees the baby again after birth. I know of at least one case in which a baby died because the message didn't pass along among the various health care personnel that the baby hadn't pooped yet. The baby died a week later of obstructed gut...which would have been treatable had anyone noticed in time. All the various health care people and the parents had gotten the erroneous message that someone, somewhere had seen the baby pass meconium. Playing telephone is a bad way to practice health care.
Too many mothers give birth and face the first few months of motherhood alone. I'm sorry, but being abandoned in a hospital room attended only by a beeping machine is simply not acceptable. Leaving a new mother alone in a house 24 hours after giving birth is also not acceptable. Every mother needs a real breathing person available to stand by her, hold her hand, advocate for her, get her a glass of water, and call for medical help if it is required. A young woman in a New York apartment died because her only support person was her mother, who was in Puerto Rico. By the time concerned neighbors convinced the police to break down her door, it was too late. The mother had bled to death. The baby had died of starvation.
What can we do about it?
1. Support midwives.
2. Ensure that every pregnant woman you know has support during labor, delivery, and the first few months of infancy. Many of the infant and maternal deaths could have been prevented by laypeople simply supporting mothers and babies. Be there. You could save a life.
I am not anti OB/GYN. Within their area of expertise, they are awesome. But their area of expertise is illness and injury, not birth. Having OB/GYNs attending normal births is like going to an oncologist for scrapes, bruises, and the common cold. Go to a general practitioner for normal medical care. Go to an oncologist if you have cancer.
My first birth was a planned homebirth, followed by a transfer to the hospital and a cesearan birth. My OB/GYN was awesome. She did a great job and I healed with no complications. When I went in to have the incision checked, I asked if she wanted to see the baby, who was in the waiting room with his daddy. She looked at me in a very puzzled way. She had no interest in the baby. None. My midwife did all of my non-surgical follow-up care, as well as caring for my baby for the first six weeks. She also had pictures of "her" babies wallpapering her offfice. Let the experts do their jobs. Midwives are the experts at normal births. OB/GYNs are the experts at complications. If you have a high-risk pregnancy or unexpected complications, for heaven's sake work with an OB/GYN! However, if you have a low-risk pregnancy, a midwife will do the best job of keeping you low-risk....and refer you to an OB/GYN if their expertise is required.
For my second birth, I did "shadow" care, where I had a homebirth midwife and a hospital backup team....who didn't know they were the backup. :) So I got to see a perfect side-by-side comparison. In every area, the midwife was more involved and diligent about my health. To take one example, I was anemic mid-pregnancy. The hospital's plan was to give me supplements, check me again when I was admitted and give me a blood transfusion if I was still anemic. The midwife's plan was to give me supplements, check again, adjust the dosage, check again, and keep modifying prenatal care until I *not* anemic. Hospitals are trained to save mothers with technology. Midwives are trained to do everything possible to make sure the mothers don't have to be saved in the first place....and to refer to OB/GYNs if mothers do need to be "saved". Guess which philosophy results in healthier mothers and babies?