Systemic Failures: Childbirth - VeggieBoards
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#1 Old 06-26-2010, 09:29 AM
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When was the last time this forum discussed death in pregnancy without making it all about the embrio/fetus/child?



Let's talk about this:

http://www.amnesty.org/en/library/as...10192010en.pdf



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the likelihood of a woman's dying in childbirth in the U.S. is
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#2 Old 06-26-2010, 10:45 AM
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It's a class thing. We all know it's a class thing. People without adequate funding for health insurance/health care die from poor or non care on a regular basis in the U.S.



This topic, as horrible as it is, is but one example of the moral failure of the practice of medicine in the U.S.
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#3 Old 06-26-2010, 11:11 AM
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Originally Posted by Eleven' date='26 June 2010 - 12:45 PM' timestamp='1277570746' post='2664919 View Post


It's a class thing. We all know it's a class thing. People without adequate funding for health insurance/health care die from poor or non care on a regular basis in the U.S.



Part of it is surely a "class thing" (and class is less decisive to medical care everywhere else in the industrialized world because everywhere else in the industrialized world has some form of state provided health care or health insurance)...



...but part of it is unique to American OB's practice of over-intervening with more invasive procedures like c-sections and induced labor which carry greater risks of mortality. Part of this is also an issue with private for-profit medicine (more surgery may mean more risk and recovery time for a mother, but it means much more money for the surgical team and the hospital since its a much longer hospital stay!). Part of it is a culture that devalues pregnant women's choices and autonomy, even those who wish to deliver healthy babies (google Pemberton v. Tallahassee Memorial Regional Medical Center and googlde Burton v. State of Florida). Part of it is just bad medical management.
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#4 Old 06-26-2010, 11:29 AM
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That is terrible!



The richest country in the world should be able to deliver health care at it's absolute best.
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#5 Old 06-26-2010, 12:23 PM
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Elaine, I knew the rates here were bad, but I had never focused on just how bad. I agree that, while it has a lot to do with lack of access to medical care for so many, it also has so much to do with the strong tendenncy toward inducing labor and C-sections.
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#6 Old 06-26-2010, 04:32 PM
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Originally Posted by suchgreatheight' date='26 June 2010 - 12:11 PM' timestamp='1277572305' post='2664932 View Post


...but part of it is unique to American OB's practice of over-intervening with more invasive procedures like c-sections and induced labor which carry greater risks of mortality.



I agree to a certain extent. I do think sometimes c-sections are pushed, ditto inducing labor, but I think there are a lot of justifiable reasons to do them. 3 of my 7 nieces/nephews were born through c-sections. My sister had preeclampsia, there was no other option. My (soon to be ex) sister in law was in labor for over 24 hours (her water had broken at the beginning) and she wasn't progressing. Her 2nd child was a scheduled c-section. All 3 are very healthy, as are the Mom's. Obesity related complications (like the 2 that follow), diabetes, and high blood pressure are also on the rise, so that contributes to those stats. My point is that it's not often over-intervening, but necessary.
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#7 Old 06-26-2010, 06:37 PM
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Whew. This topic actually gets me more riled up than talking about animal rights, or any other thing. I get so angry at the state of prenatal, labor and delivery care in North America.



I live in Canada, so it's not exactly the same here, and we've actually made great strides in recent years to incorporate more natural methods and choices for women giving birth, but we aren't anywhere near where I would like us to be.



There are so many cascading interventions that occur in hospital births it's sickening. I think one of the biggest problems is that many if not most doctors treat birth as a medical emergency, rather than as a natural event. There is a schedule and if a mom is not progessing according to their textbook standard of one cm an hour, they will start the process of intervening with the natural process, usually in the form of pitocin (oxytocin in Canada) to increase the strength and frequency of contractions. These artificially induced contractions are much longer and stronger than the natural ones, and often it's too much for mom to take pain wise, so she opts for an epidural, when she probably could have handled natural contractions using breathing, rhythm and relaxation. Epidurals are fraught with complications, and increase the rate of c sections considerably.

The induced contractions are also often too hard for the baby to take as well, which can lead to fetal distress, and then a c-section.



Labor isn't a linear process. It sometimes starts and stops in the beginning stages, and dilating from 1-5 or 6 cms normally takes at least twice as long as dilating from 6-10. In the first few, the cervix also has to thin and efface before it can open. Women often head to the hospital too early, where they wind up in a strange and stressful environment, with strangers poking and prodding them. This stress can either make labor far more painful (it hurts way more when you are tense, relaxation is key!) or it can retard or even stop progress altogether. Cervixes can actually close up when stress hormones from fear and anxiety flood a woman's body (old evolutionary tactic to avoid giving birth in unsafe situations).

When things stop or slow down (or don't progress according to a chart, the interventions happen!)



Women deserve to be treated respectfully during labor and delivery and I wish more women were able to give birth with all the emotional and physical support they need. I'm a Doula, and I've been trained to provide education and support to a woman and her partner during the process. I am natural and home birth advocate, but don't get me wrong- I am very grateful for hospitals, OBGYNS and all the magic they have. They save lives and when we need them, boy, are they fantastic. But I do think birth is a natural event and most of the time, especially in low risk situations, the interventions are just not necessary.



Doctors are trained to do all they can. It's also their legal responsibility for the most part. They prepare for and anticipate the worst, just in case. Over intervening seems safer to them, especially in these days of crazy malpractice lawsuits. I've seen a doctor quoted as saying "A normal birth can only be diagnosed in hindsight." To them, birth is a medical emergency, fraught with peril. Not something that normally goes well. But I don't blame the individuals. This is a systemic problem, one that might finally be shifting. (Alberta health care now covers midwifery!!! Free midwives and homebirths for anyone who manages to get ahold of a midwife!! Unfortunately, supply currently outstrips demand).



There is a promising future for birth here in Canada though. Hope things are changing slowly in the states as well.

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#8 Old 06-26-2010, 07:12 PM
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Originally Posted by synergy' date='26 June 2010 - 07:37 PM' timestamp='1277599067' post='2665069 View Post


There is a schedule and if a mom is not progessing according to their textbook standard of one cm an hour, they will start the process of intervening with the natural process, usually in the form of pitocin (oxytocin in Canada) to increase the strength and frequency of contractions.



Can you site a source for this? I know quite a few people who have had natural deliveries in hospitals, labor that lasted longer than 10 hours, where pitocin was not administered. Is this a common thing in some areas?



Quote:
I'm a Doula, and I've been trained to provide education and support to a woman and her partner during the process. I am natural and home birth advocate, but don't get me wrong- I am very grateful for hospitals, OBGYNS and all the magic they have. They save lives and when we need them, boy, are they fantastic. But I do think birth is a natural event and most of the time, especially in low risk situations, the interventions are just not necessary.



My sister is a Doula, has had 2 home births, 2 in a hospital, she HIGHLY recommends the home births. She had 1 in a birthing center, her last one was in a tub in her house. Her first one was in a hospital, she didn't like it (bright lights, they wouldn't give her what she wanted). With her 3rd, she had to be in a hospital because of a cyst she had removed during the 4th month. I think that's awesome (home birth), if a woman is comfortable doing that and it's a low risk pregnancy.



It also depends on your doctor. There are many doctors out there who do treat birth as something natural and only intervene when necessary. This is why it's important for women to have birth plans and make sure your doctor follows them (and choose the right doctor for them). My close friend did that and everything went smoothly. She had to be induced because of her back injury, but she said other than that, everything was great and went as she wanted it to. If I have a child, it's going to be an epic medical emergency. I don't handle pain very well
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#9 Old 06-26-2010, 08:32 PM
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I read somewhere that some studies have suggested that as malpractice suits rise in a state the # of c-sections performed rises as well. The article stated that a doctor doing this string of medical procedures incl c-sections helps them defend themselves in court. I guess if a child is born with issues from having there first bowel movement in utero the onus falls on the doctor for not inducing.



I do know a few people who's doctors induced labor because they thought the baby was large and the baby turned out to be small.
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#10 Old 06-26-2010, 09:19 PM
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Quote:
Originally Posted by Eleven' date='26 June 2010 - 12:45 PM' timestamp='1277570746' post='2664919 View Post


It's a class thing. We all know it's a class thing. People without adequate funding for health insurance/health care die from poor or non care on a regular basis in the U.S.



This topic, as horrible as it is, is but one example of the moral failure of the practice of medicine in the U.S.



It may be due in part to class, but there is free pre- and post-natal care for most lower-incomed women in the US these days. Any state-ran health department will get you into a program, give weekly checkups, vitamins, lots of information and more if your income level is below average. And even get you on WIC to help supplement food and nutrition for you and the child.



I'd say that the unnatural delivery methods are the biggest cause. Even as I was giving birth fully natural to my son, I had to literally FIGHT the doctors/nurses off of me because they wanted to inject me with pain medication and intervene with the natural process. I absolutely refused and never asked for pain medication as I believe nature is best..



Many other women bend under the intense pressure though.. The medical industry just pushes it too far!

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#11 Old 06-27-2010, 07:23 AM
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13 out of 100,000 sounds like a fairly low mortality rate to me. It's not like 1 out 10 die. It's more like 1 in 10,000 do. Still bad, but not an epidemic.



I wonder if it takes in to consideration if those who died were out of a healthy age range to have a child. Or whether they abused drugs & alcohol. Were they in good physical shape? Were they given drugs they were allergic to (or given something incorrect)? Just blind numbers don't paint the whole picture.



And I looked up fetal/infant deaths. They are MUCH higher - like 100 times higher (approx).
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#12 Old 06-27-2010, 07:38 AM
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Originally Posted by Luxxi' date='27 June 2010 - 04:19 AM' timestamp='1277608744' post='2665119 View Post


I'd say that the unnatural delivery methods are the biggest cause. Even as I was giving birth fully natural to my son, I had to literally FIGHT the doctors/nurses off of me because they wanted to inject me with pain medication and intervene with the natural process. I absolutely refused and never asked for pain medication as I believe nature is best..



Many other women bend under the intense pressure though.. The medical industry just pushes it too far!



Epidurals are used in European countries as well.
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#13 Old 06-27-2010, 08:04 AM
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Originally Posted by sleepydvdr' date='27 June 2010 - 08:23 AM' timestamp='1277645005' post='2665214 View Post


13 out of 100,000 sounds like a fairly low mortality rate to me. It's not like 1 out 10 die. It's more like 1 in 10,000 do. Still bad, but not an epidemic.



I wonder if it takes in to consideration if those who died were out of a healthy age range to have a child. Or whether they abused drugs & alcohol. Were they in good physical shape? Were they given drugs they were allergic to (or given something incorrect)? Just blind numbers don't paint the whole picture.



And I looked up fetal/infant deaths. They are MUCH higher - like 100 times higher (approx).



That's exactly what I was thinking. "Pregnancy-related causes" is very vague as well.
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#14 Old 06-27-2010, 10:23 AM
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Originally Posted by Andromache' date='27 June 2010 - 09:38 AM' timestamp='1277645888' post='2665219 View Post


Epidurals are used in European countries as well.



Yeah, I think the class and health care access issue is more important than the methods used when looking at the dangers that pregnancy in America poses. Maternal mortality rates are worse in the South than in the North. They're worse in rural areas and areas with greater poverty. They're worse among black women. I think that this is just as much about women not getting the care they need than as it is about them getting the wrong care.

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#15 Old 06-27-2010, 11:19 AM
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Quote:
Originally Posted by sleepydvdr' date='27 June 2010 - 09:23 AM' timestamp='1277645005' post='2665214 View Post


I wonder if it takes in to consideration if those who died were out of a healthy age range to have a child. Or whether they abused drugs & alcohol. Were they in good physical shape? Were they given drugs they were allergic to (or given something incorrect)? Just blind numbers don't paint the whole picture.

You could read the entire report by Amnesty International:

http://www.amnesty.org/en/library/as...10192010en.pdf



Or you could read the book (Mis)Conceptions by Naomi Wolf, which presents many of the same issues:

http://www.indiebound.org/book/9780385497459
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#16 Old 06-28-2010, 10:35 AM
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Originally Posted by Andromache' date='27 June 2010 - 09:38 AM' timestamp='1277645888' post='2665219 View Post


Epidurals are used in European countries as well.



And do they employ all of the other invasive methods too?



In all of my years, I've NEVER heard of a woman in the US dying because of lack of pre-natal or post-natal care. If you are an american citizen (not illegal alien) and need pregnancy care, it is available! Call your local Health Department and just ask them of all the *free* help they'll give (weekly checkups, vitamins, etc, everything you need for a successful pregnancy).



If a woman so chooses not to use the services available.. then the outcome is her own fault. Sad to say, but this is true.

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#17 Old 06-28-2010, 11:15 AM
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Luxxi, it happens all the time. Just because you don't hear of it, doesn't mean it doesn't happen. I was reading an article about it a few years back and all of the deaths they listed seemed to be lack of care *immediately* following discharge. We discharge women very soon and then don't follow up until their 6 week appointment. One lady was in the army, away from friends or family. No one checked up on her. Her mom called the police because she wasn't answering her phone. They said there was no reason to break into the apartment. They finally did a week later and found the mother had bled out and the baby died of dehydration and starvation. This lady was in the ARMY. Why didn't she receive proper follow-up care? Why did no one check on her? Even if it was too late to save her, the baby didn't need to die too. It was a tragic article, to say the least. There were other examples but that one stuck out in my mind. When a woman has a homebirth, the midwife usually checks on her several times postpartum and makes sure she knows she can call her 24/7. They also usually make sure she has help inside the home (family member, friend, ect). Countries with midwifery care as the primary source of prenatal and postpartum care have lower incidences of death. They are more likely to catch something a doctor would miss, like retained placenta. They treat their patients as a whole person. Doctors put them on an assembly line and get them in and out as quickly as possible. It's no surprise to me that America is one of the most dangerous places to give birth out of the developed nations in this world. The medical practices here are scary, to say the least.



I had a homebirth with my second and she was transported to the NICU. My midwife drove to the hospital (an hour from her home) no less than 6 or 7 times in the first 2 weeks, making sure I was doing ok. I had a uterine infection that she helped me with and she managed to keep me out of the hospital as well. She brought me cabbages so I could put the leaves in my bra to help with engorgement.



If I'd had a doctor and not a midwife, I'd have landed myself in the hospital with that infection (I was too focused on my baby to really even take proper care of myself and would have waited until the last minute to go to the ER). But because she came and saw ME, we got it sorted out early. Doctors in America give substandard care in the OB field, in my opinion and it's why I won't put myself in their hands when it comes to giving birth to my children.



You can go get all the routine care that is available, but if the doctors are idiots and something happens, it's NOT your fault. All the incidences they listed in that article were women who received care. It really bothers me, this "blame the victim" mentality.
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#18 Old 06-28-2010, 12:19 PM
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Originally Posted by Luxxi' date='28 June 2010 - 12:35 PM' timestamp='1277742950' post='2665780 View Post

In all of my years, I've NEVER heard of a woman in the US dying because of lack of pre-natal or post-natal care. If you are an american citizen (not illegal alien) and need pregnancy care, it is available! Call your local Health Department and just ask them of all the *free* help they'll give (weekly checkups, vitamins, etc, everything you need for a successful pregnancy).

There are many programs that help poor pregnant women who are citizens. But that doesn't mean those programs always work exactly right.



I will quote Amnesty International:

Quote:
Some 42 percent of births are covered by Medicaid, the government-funded program for some people on low incomes. However, complicated bureaucratic requirements mean that eligible women often face significant delays in receiving prenatal care.



[...] In the USA the shortage of health care professionals is a serious obstacle to timely and adequate health care for some women, particularly in rural areas and the inner cities. Finding specialists for women presenting complications or risk factors affecting their pregnancy is particularly difficult.



Women interviewed by Amnesty International also cited lack of transport to clinics, inflexible appointment hours, difficulty in taking time off work, lack of child care for other children, and the absence of interpreters and information in languages other than English, as major barriers to health care.



[...] Medicaid and government-funded clinics (known as Title X clinics) cover just over half of them, leaving more than 8 million women without affordable family planning information and services.

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#19 Old 06-28-2010, 10:20 PM
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Luxxi, just because a mother-to-be gets healthcare as soon as she's pregnant doesn't mean that pre-existing health effects won't be a risk factor.



Poor people are generally unhealthier, and to assume that good care during pregnancy can make up for bad or missing care before that is naive.
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#20 Old 06-30-2010, 10:33 AM
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synergy has basically said everything I'd like to on the subject, every other doula i've talked to seems to feel the same way. It's also a problem that the maternal death rates in the United States aren't really reported, and not every state collects data the same way, etc etc. During my doula training, the woman I was working with said I should look at the maternal death rate and times it by 1.5-2, because of all the different ways data is or isn't collected.



sad news man.



also, memphis has the highest infant mortality rate in the nation, worse than some third world countries, worse than some parts of Africa. you can really judge a country on how it treats it's women, children, and elderly, and we treat them all like s***.

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#21 Old 06-30-2010, 11:04 AM
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To be fair, we treat everyone like s***.



We just treat some more sh***y than others.
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#22 Old 07-01-2010, 05:54 AM
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*coughs* white male *coughs*




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#23 Old 07-01-2010, 07:22 AM
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I am glad that this is something that my husband will never get to worry about. However, last year I had a doctor put me on the pill and several months later he refused to see me because I had high blood pressure. He was more concerned about the high blood pressure then what I was having a problem in the area. So he dropped me. I then got off the BC pills and I am no longer with high blood pressure.

I love having a house of not having kids.
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#24 Old 07-07-2010, 10:09 AM
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Quote:
Originally Posted by Eleven' date='26 June 2010 - 11:45 AM' timestamp='1277570746' post='2664919 View Post


It's a class thing. We all know it's a class thing. People without adequate funding for health insurance/health care die from poor or non care on a regular basis in the U.S.



This topic, as horrible as it is, is but one example of the moral failure of the practice of medicine in the U.S.



Then be a responsible citizen and don't get pregnant. Healthcare is not a right, it's a privilege. I am not privileged, therefore I don't have healthcare. I can barely afford rent and food. However, because of my socioeconomic status, I am eligible for any healthcare related to birth control, provided by the state. It's free birth control! If I can't afford to be pregnant and get the right prenatal care, I can't afford to raise a child in this economy. So I won't.
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#25 Old 07-07-2010, 12:10 PM
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See, I have these crazy ideas that being poor shouldn't be a death sentence.
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#26 Old 07-07-2010, 02:19 PM
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Being poor isn't a death sentence.



Being poor and really sick probably isn't a death sentence either, due to state and federal programs.
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#27 Old 07-07-2010, 08:26 PM
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Are there any other factors affecting this? Americans, in general, are fatter and less healthy now than they were in 1987. I'm also wondering if drugs and/or alcohol are factors.



As for America being the richest country... There's a difference between the country being rich and the population being rich. Wait? How can America be richer than France or Germany? Have you seen our deficit? Our debt?

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#28 Old 07-07-2010, 09:00 PM
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US Public Debt used to compare favorably to a lot of Europe.



Bear in mind, we had something like an $8 trillion debt in an economy of $12 trillion, with about half that debt public.



Where parts of Europe had a far worse public debt/GDP ratio.



Of course, that was before the collapse of the housing market and the Shrub's urge to play in the sand with tin soldiers.
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