Obesity, elective cesarean contribute to U.S. maternal mortality rate

In the 14 years that I've worked in the world of obstetrics, I've witnessed three maternal deaths. All three occurred in the immediate postpartum period, all were unexpected, and all were devastating for everyone involved, but most of all for the families and children left without a mother.    

In the U.S., when a woman goes into the hospital to have a baby everyone expects that she will come home a few days later, happy and healthy, with a new baby. While this is usually the case, maternal death does still occur.

One usually associates maternal death with impoverished nations, and certainly the picture is grim in places like sub-Saharan Africa and Afghanistan. But in 2010, the World Health Organization reported that 33 countries ranked above the United States in maternal mortality.   

The statistics are alarming. Women in the US are more likely to die from pregnancy-related causes than women in Canada, Poland, Croatia and Greece, just to name a few. And black women in the United States are four times more likely to die from pregnancy-related problems than white women.

Though the 20th century saw a rapid decline in the maternal mortality rate in the United States, it has changed little over the past 20 years. The Joint Commission on Hospital Accreditation has warned that the maternal mortality rate may be increasing once again. 

In poorer countries, much of the problem lies with access to health care, transportation issues and lack of skilled birth attendants. But why are mothers still dying in the United States when we spend more on health care than any other country in the world? 

Some of the most common causes of maternal death in this country are hemorrhage, postpartum blood clots and underlying cardiac disease.

The CDC cites the rise of obesity and elective cesarean rates as possible contributing factors to the problem.  Hypertension, diabetes and asthma — all culprits in pregnancy-related complications  — are all more common in obese women. 

Although the risks of cesarean birth are relatively minimal, studies have shown a higher mortality rate when compared to vaginal birth.   

There are no easy answers.  According to the advocacy website, Every Mother Counts, a woman dies every 90 seconds from pregnancy-related complications but  90% of these deaths are preventable. In honor of Mother's Day, I urge you to learn more about the prevention of maternal mortality both in this country and throughout the world. 

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