More Dangerous to Give Birth in California than Bosnia?

I may be a little late in responding to this news story. My husband and I just returned from a fabulous trip to Egypt and Jordan. But I can’t stop thinking about this report from California Watch, a project of the Center for Investigative Reporting. According to an unreleased report from the California Department of Public Health, California’s maternal mortality rate has nearly TRIPLED during the past decade. In 2006, 95 California women died from causes directly attributable to their pregnancies. If California had met the goal set by U.S. Department of Health and Human Services, this number would have been no more than 28. According to the principal investigator for the report, Dr. Elliot Main, the rise in maternal mortality cannot be fully explained by population changes such as fertility treatments, obesity, and older mothers. “What I call the usual suspects are certainly there,” Main said, adding, “However, when we looked at those factors and the data analyzed so far, those only account for a modest amount of the increase.”  Main said that scientists have started to ask what doctors are doing differently. And he added, it’s hard to ignore the fact that C-sections have increased 50% in the same decade that maternal mortality increased.

The increase in maternal mortality is most likely not limited to the state of California. On January 26th of this year, the Joint Commission issued a Sentinel Event Alert on preventing deaths during and after pregnancy. The Joint Commission cautions that pre-existing medical conditions such as high blood pressure, diabetes, and morbid obesity; as well as complications from cesarean surgery, increase the risk of death for pregnant women.

Although it is challenging to reduce the incidence of medical complications such as high blood pressure and morbid obesity, the childbirth educator can influence the cesarean rate of students attending her classes. A research study done at St. John’s Mercy Medical Center in St. Louis, MO (see blog post from October 7, 2009, If a Woman Chooses To Be Induced…) confirmed that, by presenting full information about the risks of labor induction, educators can reduce the percentage of women in their classes who request or agree to elective induction. We know that induction doubles the risk for cesarean surgery for first-time mothers. Childbirth educators can promote cesarean-reducing strategies such as planning for continuous labor support from a doula or other trained labor support person; upright positions and movements for labor (which shorten labor according to a 2009 Cochrane Review); and nonpharmacologic pain management strategies (which allow for intermittent monitoring and which do not activate a cascade of interventions.) Although cesarean surgery is safer than ever before, there is no question that it does increase the risk for death for pregnant women. Reversing the current record-high cesarean rates is a matter of life and death.

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