Dr. Tuteur, thank you for the correction on the figures from the chart.
However, my point remains the same. As an industrialized nation that spends oodles of money per pregnant woman I, for one, would expect our country to have THE BEST maternal survival outcomes when compared to other countries that boast similar qualities of health care. We have access to THE BEST medicines, diagnostic instruments, research institutes...so why wouldn't the US find itself at the very top when it comes to maternal well-being? It comes down to philosophy. It comes down to how we, as health care providers approach our patients to begin with...even before we start talking tests and risk factors and statistics.
Many will claim, that the problem initially began when we, as a culture, decided to tightly "manage" pregnancy and childbirth as if it were a disease state--when we began meddling in a process much further beyond providing good quality prenatal care, and access to antibiotics which, indisputably DO make a big impact on mother/baby outcomes.
And as far as your claim, Dr. Tuteur, that the stats on the 2005 Maternal Mortality report, compiled via the efforts of the WHO, UNICEF, UNFPA and the World Bank, are ERRONEOUS...I'm sure the family members and friends of each and every woman that dies during pregnancy, childbirth or in the postnatal period do not find those deaths to be ERRONEOUS. Whether intentional or not, this type of statement is indicative of the callous attitude that has come to roost in our health care system.
And I do not speak in hypotheticals here. I worked in a very prominent university medical system for several years after graduating from PA school. I saw it all the time.
When we talk about how women of lower socioeconomic status tend to be those at higher risk for pregnancy related complications and maternal death, I have to ask the question: is it because their uteruses...their bodies...are that much less capable of handling pregnancy, labor and delivery and the postnatal period, or is it because their socioeconomic status puts them at risk for receiving LESS THAN OPTIMAL CARE? And I bring this up, because I have seen this too. Over and over again.
I have seen surgeons delay scheduling badly needed surgeries in patients, primarily because they were insured under Medicaid. I have witnessed people who over-use the emergency room because they can't afford health care insurance and therefore don't have a primary provider--and end up being labled "frequent flyers" and regarded as little more than a nuisance...even when they finally DID present with a serious complaint. Is this an abuse of the system? Sure. But the system is set up to encourage this type of abuse to begin with. I have watched patients who are thought to be so uninformed--often times individuals of a minority race-- treated as if they didn't deserve to be given choices about what happened to their bodies, whether in childbirth, in the ER, in surgery, in general medicine...that they were just given medication, or underwent procedures without TRUE INFORMED consent.
As healthcare providers, we don't like to face these uncomfortable truths about the profession in which we work. It's easy for us to say, "yeah, but that's not me." We did, after all, go into medicine because we wanted to HELP people. But the fact is, our medical system on the whole is very broken--and the issues brought up in Ina May Gaskin's article, and in this on-going discussion, are one element of that broken system.
If we all continue to claim, "yeah, that's not me;" thereby perpetuating the broken medical system...perpetuating the under reporting of maternal deaths...perpetuating the over use of medical interventions surrounding the time of childbirth that put woman at all sorts of risk for complications that RARELY get explained to them...then we will never approach a time of healing this brokenness.
It takes courage to face hard statistics--statistics that suggest we could be doing better. But the fact is, maternity care in the United States could be SO MUCH BETTER. And the demand for that improvement is either going to come from the health care providers themselves, who are really willing to face those stats head-on, and do something to change them, (such as the almost 33% c-section rate our nation now boasts) or from the customers of the health care industry (the empowered women who will demand more, or take their "business" elsewhere.
Kimmelin Hull, PA, LCCE
author of A Dozen Invisible Pieces and Other Confessions of Motherhood
Comment Reply
Dr. Tuteur, thank you for the correction on the figures from the chart.
However, my point remains the same. As an industrialized nation that spends oodles of money per pregnant woman I, for one, would expect our country to have THE BEST maternal survival outcomes when compared to other countries that boast similar qualities of health care. We have access to THE BEST medicines, diagnostic instruments, research institutes...so why wouldn't the US find itself at the very top when it comes to maternal well-being? It comes down to philosophy. It comes down to how we, as health care providers approach our patients to begin with...even before we start talking tests and risk factors and statistics.
Many will claim, that the problem initially began when we, as a culture, decided to tightly "manage" pregnancy and childbirth as if it were a disease state--when we began meddling in a process much further beyond providing good quality prenatal care, and access to antibiotics which, indisputably DO make a big impact on mother/baby outcomes.
And as far as your claim, Dr. Tuteur, that the stats on the 2005 Maternal Mortality report, compiled via the efforts of the WHO, UNICEF, UNFPA and the World Bank, are ERRONEOUS...I'm sure the family members and friends of each and every woman that dies during pregnancy, childbirth or in the postnatal period do not find those deaths to be ERRONEOUS. Whether intentional or not, this type of statement is indicative of the callous attitude that has come to roost in our health care system.
And I do not speak in hypotheticals here. I worked in a very prominent university medical system for several years after graduating from PA school. I saw it all the time.
When we talk about how women of lower socioeconomic status tend to be those at higher risk for pregnancy related complications and maternal death, I have to ask the question: is it because their uteruses...their bodies...are that much less capable of handling pregnancy, labor and delivery and the postnatal period, or is it because their socioeconomic status puts them at risk for receiving LESS THAN OPTIMAL CARE? And I bring this up, because I have seen this too. Over and over again.
I have seen surgeons delay scheduling badly needed surgeries in patients, primarily because they were insured under Medicaid. I have witnessed people who over-use the emergency room because they can't afford health care insurance and therefore don't have a primary provider--and end up being labled "frequent flyers" and regarded as little more than a nuisance...even when they finally DID present with a serious complaint. Is this an abuse of the system? Sure. But the system is set up to encourage this type of abuse to begin with. I have watched patients who are thought to be so uninformed--often times individuals of a minority race-- treated as if they didn't deserve to be given choices about what happened to their bodies, whether in childbirth, in the ER, in surgery, in general medicine...that they were just given medication, or underwent procedures without TRUE INFORMED consent.
As healthcare providers, we don't like to face these uncomfortable truths about the profession in which we work. It's easy for us to say, "yeah, but that's not me." We did, after all, go into medicine because we wanted to HELP people. But the fact is, our medical system on the whole is very broken--and the issues brought up in Ina May Gaskin's article, and in this on-going discussion, are one element of that broken system.
If we all continue to claim, "yeah, that's not me;" thereby perpetuating the broken medical system...perpetuating the under reporting of maternal deaths...perpetuating the over use of medical interventions surrounding the time of childbirth that put woman at all sorts of risk for complications that RARELY get explained to them...then we will never approach a time of healing this brokenness.
It takes courage to face hard statistics--statistics that suggest we could be doing better. But the fact is, maternity care in the United States could be SO MUCH BETTER. And the demand for that improvement is either going to come from the health care providers themselves, who are really willing to face those stats head-on, and do something to change them, (such as the almost 33% c-section rate our nation now boasts) or from the customers of the health care industry (the empowered women who will demand more, or take their "business" elsewhere.
Kimmelin Hull, PA, LCCE
July 16, 2008 - 8:59pmauthor of A Dozen Invisible Pieces and Other Confessions of Motherhood
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