A.J. asks from Milton, PA on August 31, 2011
Infant Mortality Rate
OK. For those of you who watch the news. The numbers are in. The US's infant mortality rate is skyrocketing. We're ranked 41st in the developed world for delivering babies safely down from 20 something several years ago.
I personally know several of the millions of women like myself without health care insurance who skimped on prenatal care to save money. Surely this lack of prenatal care on a grand national scale impacts the statistic a bit among other factors contributing to failed live births.
Obviously people remain attached to their political ideas and won't budge on the health care reform issue, nor does anyone really have any power regarding changing it. Some even still think America has a good health care system compared to other countries. (which counties, I'm not sure).
SO. Ladies. What can we do about this? Is there a way to fix this? How? If it's not a political issue, then what is it? What can we do?
Nurses and doctors out there, what's the story? Babies being born is not a new phenomenon. We have hospitals here. What is going wrong?
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K.A. answers from San Diego on August 31, 2011
I remember talking about this with my husband. Yes some of this is our broken and terrible health care system and lack of accessible and affordable medical care. Some women get no pre-natal care at all when they desperately need it.
Another is that as a developed nation we have more women and men able to try methods to over come their infertility problems. This often means that a baby that would never have happened in a less developed country can happen here. This is a blessing, don't get me wrong. I wouldn't have my niece without the help of the medical community. But there are more chances for things to go wrong. There are more multiple pregnancies because of fertility drugs. Multiple pregnancies are risky when they occur naturally, now we're artificially making more of them. The sad truth is that not all of these pregnancies are going to end well.
Another problem is that the health of Americans is declining. The rate of obesity is exceptionally high here. Being obese can make a pregnancy risky.
I also blame OBs rush and hurry attitude and the increase in planning a baby's birthday either by induction or c-section. Again, there is a medical time and place for these things but it is over used. Far too often a baby is born too early and this causes health issues that can be fatal. We need to go back to letting the baby tell us when it's ready unless baby or mama are in eminent danger. Scheduling for someones convenience needs to be outlawed!
I absolutely believe that our health care system needs to be fixed but I don't think that is the whole picture either in this case.
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K.W. answers from Seattle on August 31, 2011
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?
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T.C. answers from Colorado Springs on August 31, 2011
I think part of the problem is the hospitals themselves. When I lived in England, I was blessed to deliver a baby there. The philosophy that I was told is this: every woman has the right to have a homebirth. Seriously. Midwives deliver their babies, even in hospitals. It is the norm. You only see an OB if you have a complication. You don't need an OB in most cases. OBs are trained for the emergencies, the out of ordinary circumstances. These should be (and in a natural delivery are) very rare. I believe part of the problem is that labor and delivery are managed way too much with the convenience and profit for the doctor at a high importance. We use too many drugs to "aid" delivery. They drive up the profit for the hospitals, and they lead to more risk for the baby and mother. Bad combo. I actually used one of their free-standing birthing centres. It as wonderful. If I had had an emergency, I would have been taken by ambulance to the nearest hospital. That doesn't happen very often. BTW, my next baby was born at home in the US. The first 4 in hospitals in Japan and the US. The birthing centre and home were the best for me.
How is this for you?
(taken from http://bighealthreport.com/1411/death-by-doctor-3rd-leadi...)
The prestigious Journal of the American Medical Association published a study by Dr. Barbara Starfield, a medical doctor with a Master’s degree in Public Health, in 2000 which revealed the extremely poor performance of the United States health care system when compared to other industrialized countries.
The most shocking revelation of her report is that iatrogentic damage (defined as a state of ill health or adverse effect resulting from medical treatment) is the third leading cause of death in the U.S., after heart disease and cancer.
This means that doctors and hospitals are responsible for more deaths each year than cerebrovascular disease, chronic respiratory diseases, accidents, diabetes, Alzheimer’s disease and pneumonia.
Yes, our healthcare is quite ill.
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S.T. answers from Kansas City on August 31, 2011
the Infant Mortality Rate includes all children born living up to age 1. so this includes very premature babies who may die later due to complications of prematurity, also babies who die of SIDS, or any other reason. and even when you read the sites that post the IMR stats they will tell you it is hard to calculate to compare to other countries because not all countries count it the way that we do.
and, as much as a fan of health care for your child and for getting proper prenatal care no matter the financial burden, I wouldnt necessarily think that lacking prenatal care can cause that much of an increase. women have been giving birth since the dawn of man, and there was no such thing as prenatal care for the majority of time.
ETA: here is a link to the CDC website as to the top 10 leading cause of death in the US, the real reasons not made up ones just to scare people
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S.P. answers from New York on August 31, 2011
So, looking at the link sent by poster 1, the marked increase in late preterm births is the main cause of the widening gap. We have more late preterm births than other countries (by a lot) and the mortality rate has not gone down. So says the CDC.
I must say that I'm concerned about the huge number of "planned" deliveries that are out there. I had a scheduled early induction, at 35+ weeks, but only because I had a condition that is known to cause stillbirths, with sudden infant distress occurring late in the pregnancy. BUT I had great prenatal care, and we did an amnio to make sure her lungs were ready. She had a perfect apgar coming out, but there were some issues with her being so tiny. I would NEVER have chosen to do an early induction if my perinatologist hadn't told me it is absolutely the standard practice in my case, and I hadn't felt I was putting my babies life at risk by waiting. But I know people who pushed to induce early because it was August and they were hot, and darn it, they just didn't want to suffer another month. No responsible OBGYN should agree to that, but sadly too many do.
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G.B. answers from Oklahoma City on August 31, 2011
I know how hard it is for me, I don't have any insurance. I can't afford any if it were available anyway. My hubby gets SSDI and therefore gets medicare. The kids we are guardians of get state medical cards.
I have no means or avenues to get medical care. My doc is the ER doc on staff. Whether it is for an emergency or not. I have no choices. There is a free clinic in the local hospital but the entire family income can only be a few hundred dollars per month. Ours is much more than that.
I would love for some government official to plan the budget to fix some problems. Like sending funding to low income areas to open free clinics, to raise the limits for family income for benefits like food stamps, to make jobs available for people who look every day week after week after week. To send money to programs that would provide more help for America's struggling and poor. That is one way to start fixing America.
One thing I am sure that is showing in these statistics is the drug babies that don't make it. Free rehab and more low income housing is needed for all that just can't make it otherwise. Like the mentally ill who can care for themselves and have a good life but not able to work full time. People who end up disabled, all the others out there who are really trying and not making it.
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R.H. answers from Boston on September 01, 2011
I wasn't able to pull the video, so I'm not sure exactly what they said, but...Infant mortality rate takes into account all babies who die within the first year of life, from any cause. Perinatal and Neonatal mortality rates are more specific to labor/delivery/late miscarriage/etc. I can't speak to those stats but I believe we are well behind on them as well.
Having said that, I do think that motivated, healthy, women who are willing to take the time to read on their own and do a bit of homework should consider using midwifery services instead of an OB. It's so much cheaper, and it offers you an opportunity to take charge of your health instead of becoming a victim of hospital politics.
My total prenatal, birth, postnatal and breastfeeding support costs were around $3000. total. My prenatal visits were long. We talked about my sensations, weight gain, food choices, level of activity, psychological states, mentally preparing for the big day, pain control strategies, breastfeeding, fears, the whole deal. I never felt rushed. Postnatal care occurred in my home, in my bed. They came to my house. The care I received was top notch, BUT I do think it is important for women, all women, whether you see an OB or a midwife, to educate yourself as much as possible. Women should begin preparing their bodies for pregnancy before they even start trying. If you're overweight you need to tackle that problem first. We have a lot of high risk pregnancies in this country. I wish I could see the video because I'd like to know if they took that into account.
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P.M. answers from Tampa on September 01, 2011
America also has an insanely high rate of maternal mortality for childbirth complications (usually from hospital births).
We can modify slightly what Europe has done. Regular pregnancies go to highly trained more affordable Midwives - who due to education and training are automatically covered by an OB if something else is needed. Then only high risk go to OBs.
What is going wring is this... America and their medical professionals see pregnancy and child birth as a chaotic, traumatic, pathological illness. They are TRAINED to see something wrong and to perform surgery - after all they are trained specialty surgeons. Too many interventions are done, too many of those FAIL and too many cesareans are being created out of normal births due to those failed interventions.
I'm 100% for single payer, government supported healthcare that is cheap to free for all people living in this large nation - much like almost every other country - developed and developing - in the World.
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