I think there are a couple very important things to look at in the article I referenced with my original post (see link to article at bottom of this post)
1) As Sasha pointed out, Ina May's entire purpose of the article is to start a dialog. Are we truly reporting the totality of maternal deaths or not? (In fact, in the WHO's 2005 report, referenced later in this post, this question is asked of all coutries) The information Gaskin cited from the CDC and WHO suggests we are not. Getting to the root of the problem--defining the CAUSE of death, as pointed out by Dr. Tuteur, and then assessing which of those maternal deaths are preventable...is the end point Ms. Gaskin is going for.
The other issue the article brings up is the fact that, as a country, we spend more medical dollars per pregnant woman than any other country around the world. Logically, one would assume, this would translate into having the lowest maternal mortality rate. The unpreventable causes of maternal death are unpreventable, no matter where you live, to a large extent. But the PREVENTABLE ones ought to be caught, treated, or AVOIDED in a country where patients and providers have access to technologies, information and statistics than those in less fortunate, less advanced, and less enlightened locales.
you will find a 2005 report by the WHO (the most current available from which, I believe, Gaskin draws much of her information)that lists all data, by country, of maternal death rates world-wide. It is a 48 page report, much of it dedicated to discussing HOW this information is collected. Skip to page 30, and you will find the concise list.
Here are some stats of the number of maternal deaths per country, per 100,000 women:
US - 440
UK - 51
Switzerland - 4
Sweden - 3
Norway - 4
Netherlands - 11
I pull the stats from the northern European countries for two reasons:
1) These are countries in which midwifery care for pregnancy and childbirth is very common--either in or out of the hospital, and
2) Their reporting is more likely to be accurate (or closer to accurate) than other countries around the world. This being said, even the WHO asserts that the numbers provided in their own report are likely grossly underestimated.
There's no doubt that 99% of maternal deaths (defined, by the WHO, as deaths that occur in women from the start of pregnancy to 42 days after the end of pregnancy) occur in third world countries - and most of those in subsaharn Africa. I don't think this is a surprise to anyone.
But the point here is that, in the developed world, we are still not performing as one would expect for how much money we spend per pregnant woman, how much technology we have access to, the prenatal care that women in the US ought to be able to take advantage of, the antibiotics that are more readily available to us than any other place in the world, etc. There is still a huge gap.
I truly believe Gaskin's article is much less a promotion of home birth, as it is a call to look into the numbers, discuss what we can do better, as an entire culture (hospital birth, home birth, doctor-attended or midwife attended) to take better care of women in this very important time in their lives.
To view Gaskin's complete article, paste this link into your browser:
I encourage all to continue to plug away at this discussion. After all, whether doctor, midwife, doula, childbirth educator, PA or patient...surely we all want to see the same result at the end of the day: healthy women who are able to care for their children!
Kimmelin Hull, PA, LCCE
author of A Dozen Invisible Pieces and Other Confessions of Motherhood
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I think there are a couple very important things to look at in the article I referenced with my original post (see link to article at bottom of this post)
1) As Sasha pointed out, Ina May's entire purpose of the article is to start a dialog. Are we truly reporting the totality of maternal deaths or not? (In fact, in the WHO's 2005 report, referenced later in this post, this question is asked of all coutries) The information Gaskin cited from the CDC and WHO suggests we are not. Getting to the root of the problem--defining the CAUSE of death, as pointed out by Dr. Tuteur, and then assessing which of those maternal deaths are preventable...is the end point Ms. Gaskin is going for.
The other issue the article brings up is the fact that, as a country, we spend more medical dollars per pregnant woman than any other country around the world. Logically, one would assume, this would translate into having the lowest maternal mortality rate. The unpreventable causes of maternal death are unpreventable, no matter where you live, to a large extent. But the PREVENTABLE ones ought to be caught, treated, or AVOIDED in a country where patients and providers have access to technologies, information and statistics than those in less fortunate, less advanced, and less enlightened locales.
If you paste the following link into your browser: http://www.who.int/reproductive-health/publications/maternal_mortality_2...
you will find a 2005 report by the WHO (the most current available from which, I believe, Gaskin draws much of her information)that lists all data, by country, of maternal death rates world-wide. It is a 48 page report, much of it dedicated to discussing HOW this information is collected. Skip to page 30, and you will find the concise list.
Here are some stats of the number of maternal deaths per country, per 100,000 women:
US - 440
UK - 51
Switzerland - 4
Sweden - 3
Norway - 4
Netherlands - 11
I pull the stats from the northern European countries for two reasons:
1) These are countries in which midwifery care for pregnancy and childbirth is very common--either in or out of the hospital, and
2) Their reporting is more likely to be accurate (or closer to accurate) than other countries around the world. This being said, even the WHO asserts that the numbers provided in their own report are likely grossly underestimated.
There's no doubt that 99% of maternal deaths (defined, by the WHO, as deaths that occur in women from the start of pregnancy to 42 days after the end of pregnancy) occur in third world countries - and most of those in subsaharn Africa. I don't think this is a surprise to anyone.
But the point here is that, in the developed world, we are still not performing as one would expect for how much money we spend per pregnant woman, how much technology we have access to, the prenatal care that women in the US ought to be able to take advantage of, the antibiotics that are more readily available to us than any other place in the world, etc. There is still a huge gap.
I truly believe Gaskin's article is much less a promotion of home birth, as it is a call to look into the numbers, discuss what we can do better, as an entire culture (hospital birth, home birth, doctor-attended or midwife attended) to take better care of women in this very important time in their lives.
To view Gaskin's complete article, paste this link into your browser:
http://docserver.ingentaconnect.com/deliver/connect/lamaze/10581243/v17n2
/s3.pdf?expires=1216215994&id=45121330&titleid=10348&accname=Guest+User&checksum=27EA34D618E4B36007DBE98CE014FFEE
I encourage all to continue to plug away at this discussion. After all, whether doctor, midwife, doula, childbirth educator, PA or patient...surely we all want to see the same result at the end of the day: healthy women who are able to care for their children!
Kimmelin Hull, PA, LCCE
July 16, 2008 - 6:32amauthor of A Dozen Invisible Pieces and Other Confessions of Motherhood
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