Safer to Give Birth in Bosnia Than California

by Heidi Stevenson

3 February 2010

If you're a pregnant woman in California, you'd be better off moving to Bosnia. The mortality rate from pregnancy of California women has tripled in recent years and is now higher than in Bosnia, a war-ravaged nation creeping back into the industrial world. Attempts to explain California's Department of Public Health report as simply a matter of better reporting have proven to be false.

The report has been in existence for seven months, but has yet to be released. California Watch, which revealed the issue, spoke with the investigators to learn the result, which is documentation of the greatest increase in maternal deaths since the Great Depression.

The study, organized by Shabbir Ahmad, acting Division Chief of Maternal, Child, and Adolescent Health Programs and Center for Family Health at the California Department of Public Health, reviewed every maternal death in California. It investigated whether the increase could be attributed to issues of maternal obesity or age, or fertility treatments, but found that they cannot account for the increase in mortality. The lead investigator, Dr. Elliot Main, stated:

What I call the usual suspects are certainly there. However, when we looked at those factors and the data analyzed so far, those only account for a modest amount of the increase.

Dr. Main went on to say that caesarian sections had increased by 50% during the same ten-year period studied.

The reason for withholding the report from the public has been to avoid tracking down the causes and assigning blame, but instead, the desire is to find solutions. This author has a bit of trouble with that logic. By conflating "tracking down the causes" with "assigning blame", the impression is one of high-minded intent, but why not track down the causes and find solutions? After all, you're unlikely to find solutions without knowing the causes. Clearly, the reasons for withholding the report have nothing to do with avoiding the blame game.

The initial findings were revealed to a conference of the American College of Obstetricians and Gynecologists, effectively a guild of obstetricians, in 2007, and some audience members issued audible gasps.

Nonetheless, Jeffrey C. King, MD, of the American College of Obstetricians and Gynecologists recently stated that he "would be surprised if there was a significant increase of maternal deaths," though he hadn't seen the report.

Caesarian Deliveries

The greatest danger in caesarian deliveries is caused by the huge number that are done. A condition called placenta accreta results from the placenta growing into scar tissue left by an earlier caesarian. Delivery can cause hemorrhaging. Repair, which is another surgical procedure, itself can cause hemorrhage. Removal of the uterus is a common result, and death can occur.

Placenta accreta is happening 8-10 times more than a decade ago.

The Deputy Director of California's Center for Family Health said in an e-mail:

For every maternal death, there are 10 near misses; for every near miss, there are 10 severe morbidity cases (such as hysterectomy, hemorrhage, or infection), and for every severe morbidity case, there is another 10 morbidity cases related to childbirth

The increase in maternal deaths means a huge number of other near-disastrous incidents must also occur.

Induction of Labor

One of the most disconcerting developments in pregnancies is the induction of labor. Forcible starting of labor through injection of drugs had increased to 22.5% of all deliveries in the US by 2006. The method has been available for decades, and there are situations in which it may be appropriate. However, many specious reasons are now being used, such as the baby being overdue—though due dates are actually nearly arbitrary times based on an assumption that babies should be born at 39 weeks of gestation—while the average worldwide is actually about 42 weeks. Some doctors even start to suggest induction by 36 weeks. It's quite obvious that the huge number of inductions is for scheduling purposes—either for the convenience of the parents or the doctor.

Induction of labor doubles the odds of having a caesarian delivery.

The Medical Director of Women's Hospital at Saddleback Memorial Medical Center in Orange County, California, Dr. David Lagrew, found that a large number of inductions were being done at his hospital. So, he ruled that elective inductions could not be done before 41 weeks into a pregnancy. The result was fewer hemorrhages and hysterectomies in the mothers, fewer babies having to be treated in neonatal intensive care, and freeing up the hospital's operating rooms for more appropriate surgeries.

From the hospital's point of view, though, it had a major downside. Their income dropped. Caesarian deliveries are double the cost of normal vaginal births—and that doesn't consider the money taken in by the surgeries, treatments, and hospitalizations resulting from complications of caesarean deliveries, or the neonatal intensive care treatment required for some of the babies.

It Isn't Only California—It's National

The problem is probably happening throughout the United States. On 26 January 2010, a Sentinel Event Alert was distributed by The Joint Commission, a group of and for health care organizations. It states:

Unfortunately, current trends and evidence suggest that maternal mortality rates may be increasing in the U.S.

The Sentinel Event Alert considered caesarian delivery as a potential cause only in terms of how to limit harm from it. The question of whether caesarians should be done so frequently wasn't even a consideration, although nearly one in three deliveries in the US is now done surgically.

All of the Alert's suggestions were focused on things that would bring women even further into the clutches of the medical system. There isn't a hint of consideration for the possibility that the problem is mostly caused by modern medicine.

The Joint Commission report references a study produced by the Hospital Corporation of America that claims most maternal deaths could not be prevented. To which the only response can be made with mouth dropping wide open to say, "Huh?"

Maternal Health Isn't the Only Health Deficiency in the US

Just one last point to help illuminate the results of the most intensive modern medical care in the world: According to the CIA, the life expectancy in Bosnia is slightly greater than in the United States.

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