Mercury Rising 鳯女

Politics, life, and other things that matter

I brought you into the world… (on midwifery)

Posted by Charles II on March 19, 2012

A fascinating segment on midwifery on DemocracyNow. US maternal death rates are worse than Puerto Rico. And death rates have risen substantially over the last few years.

Ina May Gaston claims to have been able to greatly reduce the rate of birth complications through natural birth methods. She notes that many maternal deaths areiatrogenic: in C-sections, the uterine artery can be nicked, for example. She says that she was able to avoid a C-section for her first 200 births. In the US, almost 1 in three births is by C-section!

As her story illustrates, those 60s hippies knew a thing or two.

2 Responses to “I brought you into the world… (on midwifery)”

  1. Phoenix Woman said

    Unfortunately, Ina May Gaskin is, to put it gently, full of it. She bases much of her claim of rising US maternal death rates on a somewhat dodgy Amnesty International report that is dissected here.

    As the dissector, ob-gyn Dr. Amy Tuteur, says in a later post:

    No, maternal mortality is NOT rising. It has fallen in 2006 and fallen again in 2007 to 12.7/100,000, facts that this piece completely ignores.

    Moreover, it is far from clear that maternal mortality was ever rising. A careful review of the data suggests that changes in the way that maternal mortality is assessed may be leading to a spurious “increase” in maternal mortality.

    […]

    …the other day Ina May Gaskin parachuted in, once again attempting to cynically exploit this tragic issue as she has been doing for years on her “Remember the Mothers” website. She calls for “honesty” and then proceed to offer a bunch of out of date bibliography salad and never addresses any of the issues that I raised.

    Here are just a few examples of articles that have been published during the last decade or so about the too high US maternal death rate: “Pregnancy-related deaths: Moving the wrong direction,” published in OBG Management, January 1998; “Maternal mortality: No improvement since 1982.” ACOG Today, August 1999; Maternal mortality: An unsolved problem. Contemporary Ob.Gyn, September 1999; “U. S. maternal death rates are on the rise.” The Lancet, 1996; “Pregnancy-related deaths increasing,” Contemporary Ob.Gyn, December 2010.

    To anyone who knows anything about obstetrics, this bibliography salad is not only out of date (newsflash: anything before 2000 is NOT in the last decade, and, considering that we are discussing maternal mortality from 1998 to 2005 has absolutely nothing to do with this purported rise), but it is laughable. OBG Management, ACOG Today and Contemporary Ob.Gyn are what is known as “throw away” magazines. They are not journals, and they are mailed to almost all obstetricians for free. It’s the equivalent of citing “House Beautiful” to make a claim about architecture.

    • Charles II said

      I wouldn’t dismiss what Gaston says so quickly, PW.

      First, I linked an independent source for US mortality. Those statistics are significantly worse than Gaston claimed.

      As to whether the cause for high maternal mortality is the number of C-sections or not is another question. I think a good case can be made that C-sections per se are not the cause. According to Wikipedia, other countries, notably Italy and China, have even higher incidence of C-sections. China has higher maternal mortality than the US, Italy much lower. So probably C-sections are not the principal factor. But C-sections are surgery and surgery always has risks. If it is possible to avoid surgery, it is likely also to be safer.

      Furthermore, the number of uninsured people has risen by about 12 million since 2000 and the quality of coverage has been declining. We do know that lack of insurance is a cause of serious illness or death. It would therefore be surprising if maternal mortality had not risen. Tuteur’s argument that this is just the result of changing methodology has to be examined skeptically. She hasn’t proved that it’s so, just raised doubts that C-sections are the cause of any elevated mortality.

      Tuteur focuses on embolism and hemorrhage as markers for C-section mortality. There’s an assumption embedded in there that may not be valid. For example, infection is also a marker of surgery, but it’s not separately broken out. If a patient is diabetic, that might be classified as an “indirect” cause of death. Looking at the CDC report she links, I’d want to know a lot more detail about their methodology before being sure that I even understood what the graphs she presents actually show.

      I appreciate the link you provided and I think it improves the discussion. Tuteur could well be right about the change in maternal mortality since 2000– it’s small enough that the causes are certainly debatable. But (a) Gaston is correct that maternal mortality in the US is inexcusably high, (b)declining insurance should cause mortality rates to rise, and (c) if natural childbirth can be safely used, it probably should be used, since hospital delivery consumes medical resources (and money), in some degree weakening the rest of the insurance/medical system.

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