High maternal death rates shames the US
Despite top-notch health care, the United States might be the most dangerous place in the developed world to give birth.
YOLANDA Mention, who had just given birth to a baby girl at one of South Carolina’s top hospitals, should probably be alive today — certainly in a country with the world’s most advanced health care system.
But the 38-year-old wife and mother was sent home from the hospital in March 2015 with dangerously high blood pressure. That same night, she and her husband, Marco, returned to the ER.
Though her blood pressure had climbed and she had an excruciating headache, she sat in the waiting room for hours, according to a lawsuit filed by her husband.
By the time she was ushered into an exam room, she suffered a stroke. She died a few days later, leaving the couple’s three girls motherless.
The right treatment at the right time – IV medication that costs less than US$60 (RM244) a dose – could well have saved her.
Despite politicians’ claims that America has the best health care of any country, similar tragedies occur repeatedly across the United States, which today is the most dangerous place in the developed world to give birth.
You read that correctly. About 700 mothers in America die each year in childbirth, many of them needlessly – a maternal death rate far higher than that of other developed nations, including Canada, France, Germany, Japan and the Britain.
And 50,000 mothers are severely injured each year in childbirth, USA Today found in an investigation published last week.
About half of these deaths could be prevented, and half the injuries reduced or eliminated, through simple changes in care that doctors, hospitals and medical experts have known about for years. Yet too many “hospitals and medical workers skip safety practices known to head off disaster”, the paper reported.
High blood pressure is one leading killer and cause of injuries. The other is heavy blood loss during delivery, which often goes untreated until too late. Hemorrhaging can be diagnosed by checking for obvious danger signs and carefully measuring blood loss – rather than visually estimating it. Then life-saving actions can be started in time.
Despite repeated failures even at highly rated hospitals, the federal agency and private groups that hold enormous leverage have not used that sway to fix this medical disaster.
The Centers for Medicare and Medicaid Services, which takes an aggressive approach to improving health care for seniors, has failed to do the same for pregnant women, even though Medicaid pays for nearly half of the nation’s four million births a year. As a condition of getting Medicare payments, hospitals must publicly disclose complication rates and other data on services used by seniors. But the agency sets no similar rules for childbirth complications.
Nor have the Joint Commission, a private group that accredits hospitals, and the influential American Hospital Association, with 5,000 members, wielded their power to ensure that hospitals follow wellknown best practices.
When those practices are followed, deaths and injuries decline. California, where many hospitals have adopted safety practices established by experts, cut its maternal death rate in half from 2009 to 2015 – to 4.5 per 100,000 births.
Meanwhile, deaths rose across most of the country and stand at a rate of 58.1 in Louisiana, the worst in the nation.
Several easy steps are available to lessen the toll of death and injury, including:
Stop blaming the victim :For decades, some hospitals and doctors, looking for excuses, have faulted women being overweight or unhealthy, or blamed poverty or age as leading causes of complications,
when one of the real culprits is failing to follow best practices. This won’t change until medical personnel own up to their part of problem.
Learn from experts :The American College of Obstetricians and Gynecologists and the AIM program (Alliance for Innovation on Maternal Health) have put out recommendations and “safety bundles” with simple steps and timetables to follow. All hospitals have to do is adopt these recommendations from experts who offer the gold standard of care.
Go public: Internal data on delivery deaths and injuries, or even answers as to whether a hospital follows best practices, are closely guarded secrets.
Half of 75 hospitals in 13 states that USA TODAY contacted repeatedly refused to answer whether they were following the AIM program’s practices for haemorrhage and hypertension. Making this information public would give women a way to choose safer hospitals and provide pressure for improvement.
Vote for change: Congress, which has largely ignored this deadly problem, should pass a bipartisan measure, introduced in the Senate and House, to help states establish review boards to track and investigate maternal deaths.
As the dismal statistics attest, many women are suffering life-altering injuries during childbirth. Others are dying, and newborns are being left motherless.
Doctors and hospitals know exactly how to reduce the awful toll. It should not be allowed to continue. It is America’s shame. – TNS