{"id":276740,"date":"2010-02-04T07:00:00","date_gmt":"2010-02-04T12:00:00","guid":{"rendered":"http:\/\/www.rhrealitycheck.org\/blog\/2010\/02\/04\/more-women-dying-pregnancy-complications"},"modified":"2010-02-04T12:05:29","modified_gmt":"2010-02-04T17:05:29","slug":"could-rising-maternal-death-rates-in-california-signal-a-broader-trend","status":"publish","type":"post","link":"https:\/\/mereja.media\/index\/276740","title":{"rendered":"Could Rising Maternal Death Rates in California Signal a Broader Trend?"},"content":{"rendered":"
\n

\n\tThis post was orginally published on California Watch<\/a><\/em>, a project of The Center for Investigative Reporting<\/a>\n\t<\/p>\n<\/blockquote>\n

\nThe mortality rate of California women who die from causes directly
\nrelated to pregnancy has nearly tripled in the past decade, prompting
\ndoctors to worry about the dangers of obesity in expectant mothers and
\nabout medical complications of cesarean sections.\n<\/p>\n

\nFor the past seven months, the state Department of Public Health declined to release a report outlining the trend. \u00a0\n<\/p>\n

\nCalifornia Watch spoke with investigators who wrote the report and
\nthey confirmed the most significant spike in pregnancy-related deaths
\nsince the 1930s. Although the number of deaths is relatively small,
\nit\u2019s more dangerous to give birth in California than it is in Kuwait or
\nBosnia.\n<\/p>\n

\n\u201cThe issue is how rapidly this rate has worsened,\u201d said Debra Bingham<\/a>, executive director of the California Maternal Quality Care Collaborative<\/a>, the public-private task force investigating the problem for the state. \u201cThat\u2019s what\u2019s shocking.\u201d\n<\/p>\n

\nThe problem may be occurring nationwide. The Joint Commission, the
\nleading health care accreditation and standards group in the United
\nStates, issued a \u201cSentinel Event Alert<\/a>\u201d
\nto hospitals on Jan. 26, stating: \u201cUnfortunately, current trends and
\nevidence suggest that maternal mortality rates may be increasing in the
\nU.S.\u201d \u00a0\n<\/p>\n

\nThe alert asked doctors to consider morbid obesity, high blood
\npressure and diabetes, along with hemorrhaging from C-sections, as
\ncontributing factors.\n<\/p>\n

\nIn 2007, the U.S. Centers for Disease Control and Prevention<\/a> reported that the national maternal mortality rate had risen, but experts such as Dr. Jeffrey C. King<\/a>,
\nwho leads a special inquiry into maternal mortality for the American
\nCollege of Obstetricians and Gynecologists, chalked up the change to
\nbetter counting of deaths. His opinion hasn\u2019t changed.\n<\/p>\n

\n\u201cI would be surprised if there was a significant increase of
\nmaternal deaths,\u201d said King, who has not seen the California report.\n<\/p>\n

\nBut Shabbir Ahmad, a scientist in California\u2019s Department of Public
\nHealth, decided to look closer. He organized academics, state
\nresearchers and hospitals to conduct a systematic review of every
\nmaternal death in California. It\u2019s the largest state review ever
\nconducted. The group\u2019s initial findings provide the first strong
\nevidence that there is a true increase in deaths \u2013 not just the number
\nof reported deaths.\n<\/p>\n

\nChanges in the population \u2013 obese mothers, older mothers and
\nfertility treatments \u2013 cannot completely account for the rise in deaths
\nin California, said Dr. Elliott Main<\/a>, the principal investigator for the task force. \u00a0\n<\/p>\n

\n\u201cWhat I call the usual suspects are certainly there,\u201d he said.
\n\u201cHowever, when we looked at those factors and the data analyzed so far,
\nthose only account for a modest amount of the increase.\u201d\n<\/p>\n

\nMain said scientists have started to ask what doctors are doing
\ndifferently. And, he added, it\u2019s hard to ignore the fact that
\nC-sections have increased 50 percent in the same decade that maternal
\nmortality increased. The task force has found that changing clinical
\npractice could prevent a significant number of these deaths.\n<\/p>\n

\nOne maternity expert who was not involved in the report, Dr. Thomas R. Moore<\/a>,
\nchair of the Department of Reproductive Medicine at UC San Diego, said
\nabout the data: "This could be a sentinel finding, and I could see
\nother states taking a closer look and finding the same thing."\n<\/p>\n

\nLow numbers, high consequences<\/strong>\n<\/p>\n

\nDespite the increase in the mortality rate, pregnancy is still safe for the vast majority of women.\n<\/p>\n

\nIn 2006, 95 California women died from causes directly related to
\ntheir pregnancies \u2013 out of more than 500,000 live births. That\u2019s a
\nsmall number by public health standards. If California had met the goal
\nset by the U.S. Department of Health and Human Services<\/a>
\nto bring the state\u2019s maternal mortality rate down to a level achieved
\nby other countries, the number of dead would be closer to 28.\n<\/p>\n

\nIt\u2019s not clear who is most at risk, but researchers have long known
\nthat African-American mothers are between three and four times more
\nlikely to die from pregnancy-related causes than the rest of the
\npopulation. That racial association is not stratified by socio-economic
\nstatus: Even high-income black women are at a greater risk.\n<\/p>\n

\nWhile the maternal mortality rate among black women is rising, the
\ntask force found a more dramatic increase in deaths among white,
\nnon-Hispanic mothers. There is not yet enough data to show if the risk
\nof death is associated with poverty.\n<\/p>\n

\n\"maternal\n<\/p>\n

\nTatia Oden French<\/span>\n<\/p>\n

\nWhat\u2019s certain is that each maternal death shatters families. That cold sum \u2013 95 dead \u2013 represents 95 stories of people such as Tatia Oden French<\/a>.
\nIn 2001, she was newly wed and had just finished her doctorate in
\npsychology. She was about to have a baby girl she would name Zorah
\nAllie Mae French.\n<\/p>\n

\n\u201cShe\u2019s the type of person that just walked into the room and lit it up,\u201d said her mother, Maddy Oden.\n<\/p>\n

\nDuring the labor, Maddy Oden was at home in Oakland, waiting for a
\ncall announcing the birth of her granddaughter. Instead, she needed an
\nemergency C-section. \u201cI woke up at 4 in the morning, and I knew that
\nsomething was wrong,\u201d Oden said.\n<\/p>\n

\nThen the phone rang. French was in trouble. Powerful contractions
\nhad forced amniotic fluid into her bloodstream, stopping her heart and
\nkilling the baby. When Oden got to her daughter at an Oakland hospital
\nthere was only one thing she could do: \u201cWe said a prayer,\u201d Oden said,
\n\u201cand I closed her eyes.\u201d \u00a0\n<\/p>\n

\nThe subsequent lawsuit was dismissed: The doctor had not deviated from the standard of care.\n<\/p>\n

\nRather than track down the cause of every death and assign blame,
\nthe California task force is focused on finding solutions. And Bingham
\nand Main have found that doctors and nurses are eager to help after
\nseeing the numbers.\n<\/p>\n

\nIn 1996, the maternal death rate in California was 5.6 per 100,000
\nlive births, not far from the national goal of 4.3 per 100,000. Between
\n1998 and 1999, the World Health Organization changed its coding system,
\nwhich may have increased reporting of deaths. The California rate was
\n6.7 in 1998 and 7.7 in 1999. Because the number of mothers who die is
\nsmall, the rate tends to fluctuate from year to year.\u00a0 \u00a0\n<\/p>\n

\nIn 2003, when California revised its death certificate, the rate
\njumped to 14.6. And in 2006, the last year for which data is available,
\nthe rate stood at 16.9. \u00a0\n<\/p>\n

\nThe best estimates show that less than 30 percent of the increase is
\nattributable to better reporting on death certificates. Even accounting
\nfor these reporting and classification changes, the maternal death rate
\nbetween 1996 and 2006 has more than doubled, Main said.\n<\/p>\n

\nNot yet public<\/strong>\n<\/p>\n

\nWhen researchers unveiled their initial findings to a conference of
\nthe American College of Obstetricians and Gynecologists in 2007, there
\nwere gasps from the audience, according to participants at the San
\nDiego event. The idea that California was moving backward even in an
\nera of high-tech birthing was implausible to some. Confirmation of the
\ntrend was noted in the 2008 report written by 27 doctors and
\nresearchers. The report was described in detail to California Watch.\n<\/p>\n

\nThe state of California has yet to share the report with the public.
\nResearchers say that, after reviewing the report in 2008, officials in
\nthe Department of Public Health asked for technical clarifications.
\nRevisions were complete and approved in the first half of 2009,
\naccording to Ahmad. \u00a0\n<\/p>\n

\nAl Lundeen, the department\u2019s director of public affairs said, \u201cThere
\nwas no effort to hold that report back. It just needed some more
\nrevisions.\u201d\n<\/p>\n

\nResearchers say that it is important for the public to be aware now
\nthat these trends are worsening. Diane Ashton, the deputy medical
\ndirector for the March of Dimes<\/a>, has seen the numbers. She says they demand a concerted response. \u00a0\n<\/p>\n

\n\u201cEven though they tend to be small numbers in terms of maternal
\nmortality, it is important \u2013 it\u2019s very important \u2013 that these trends be
\nlooked at,\u201d she said. \u201cAnd efforts need to be made to try and reverse
\nthem when they are going in the wrong direction.\u201d\n<\/p>\n

\nRising C-section birth rate <\/strong>\n<\/p>\n

\nNearly one in three babies is now born by C-section. Many scientists
\nhave acknowledged that at some point, as the number of surgeries spiral
\nupward, the risks will outweigh the benefits. But the C-section remains
\na useful tool, and in the middle of labor, doctors say, it\u2019s hard to
\nbalance the potential long-term harm against immediate crisis.\n<\/p>\n

\nToday, doctors face a condition called placenta accreta<\/a>,
\nwhere the placenta grows into the scar left by a previous C-section. In
\nsurgery, doctors must find and suture a web of twisted placental
\nvessels snaking into the patient\u2019s abdomen, which can hemorrhage
\nalarming amounts of blood. Often, doctors must remove the uterus.\n<\/p>\n

\nMain said this complication from C-sections has increased
\neight-to-10 fold in the past decade. Nonetheless, most women survive
\nthe ordeal. The point, says Catherine Camacho, deputy director of the
\nstate\u2019s Center for Family Health<\/a>, is that the rise in deaths is indicative of a larger problem. \u00a0\n<\/p>\n

\n\u201cFor every maternal death, there are 10 near misses; for every near
\nmiss, there are 10 severe morbidity cases (such as hysterectomy,
\nhemorrhage, or infection), and for every severe morbidity case, there
\nis another 10 morbidity cases related to childbirth,\u201d Camacho wrote in
\nan e-mail. \u00a0\n<\/p>\n

\nOther factors are contributing to the rise in deaths, but the
\nresearchers in California are most interested in the areas where they
\nhave control, such as the high C-section birth rate: It\u2019s easier for
\ndoctors to improve medical care than to fix more intractable problems
\nlike poverty and obesity.\n<\/p>\n

\nInducing labor before term more common <\/strong>\n<\/p>\n

\nIn 2002, Dr. David Lagrew<\/a>,
\nthe medical director of the Women\u2019s Hospital at Saddleback Memorial
\nMedical Center in Orange County, noticed that a lot of women were
\nhaving their labor induced before term without a medical reason. And he
\nknew that having an induction doubled the chances of a C-section.\n<\/p>\n

\nSo he set a rule: no elective inductions before 41 weeks of
\npregnancy, with only a few exceptions. As a result, Lagrew said, the
\noperating room schedules opened up, and the hospital saw fewer babies
\nadmitted to the neonatal intensive care unit, fewer hemorrhages and
\nfewer hysterectomies. \u00a0\n<\/p>\n

\nAll this, however, came at a cost: The hospital had to take a cut in
\nrevenue for reducing the procedures it performed. Lagrew doubts that
\nany hospital has increased its C-section rate in pursuit of profit, but
\nhe does note that the first hospitals to adopt controls on early
\nelective inductions have been nonprofits. \u00a0\n<\/p>\n

\nAccording to a report issued by the advocacy group Childbirth Connection<\/a>,
\n\u201cSix of the 10 most common procedures billed to Medicaid and to private
\ninsurers in 2005 were maternity related.\u201d On average, a C-section
\nbrings in twice the revenue of a vaginal birth. Today, the C-section is
\nthe single most common surgical procedure performed in the United
\nStates.\n<\/p>\n

\n\u201cIf all these guys were losing money on every C-section, well,
\nwhat\u2019s the old saying? Whenever they tell you it\u2019s not about the money,
\nit\u2019s about the money,\u201d Lagrew said.\n<\/p>\n

\nThe California task force isn\u2019t waiting to determine the ultimate
\ncause of these deaths. It has started pilot projects to improve the way
\nhospitals respond to hemorrhages, to better track women\u2019s medical
\nconditions and to reduce inductions \u2013 as Lagrew did at Memorial Care.\n<\/p>\n

\nAlthough the state hasn\u2019t released the task force\u2019s report, the
\nresearchers and doctors involved forwarded data to the national Joint
\nCommission, which issued incentives for hospitals to reduce inductions
\nand fight what it called \u201cthe cesarean section epidemic.\u201d \u00a0\n<\/p>\n

\n\u201cYou don\u2019t have to be a public health whiz to know that we are facing a big problem here,\u201d Bingham said.<\/p>\n","protected":false},"excerpt":{"rendered":"

This post was orginally published on California Watch, a project of The Center for Investigative Reporting The mortality rate of California women who die from causes directly related to pregnancy has nearly tripled in the past decade, prompting doctors to worry about the dangers of obesity in expectant mothers and about medical complications of cesarean […]<\/p>\n","protected":false},"author":5205,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[],"class_list":["post-276740","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts\/276740","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/users\/5205"}],"replies":[{"embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/comments?post=276740"}],"version-history":[{"count":0,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts\/276740\/revisions"}],"wp:attachment":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/media?parent=276740"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/categories?post=276740"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/tags?post=276740"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}