
Focus on Infants During Childbirth Leaves U.S. Moms in Danger - AlphaWeaver
http://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger
======
robmiller
_The ability to protect the health of mothers and babies in childbirth is a
basic measure of a society 's development. Yet every year in the U.S., 700 to
900 women die from pregnancy or childbirth-related causes, and some 65,000
nearly die — by many measures, the worst record in the developed world._

Being one of the statistics sucks. Coming up on 37 years since I was born and
she was gone less than 30 days later from a pregnancy-induced rare blood
disease. Middle class. Suburban Chicago. Instilled in me from a very young age
to try to live a good life because of her sacrifice.

~~~
amputect
That's terrible, I am sorry for your loss.

------
cbanek
I feel in the US that we have an almost unnatural desire to protect children,
to the exclusion of other people.

Sure, who can be against children? They're young, cute (as long as you aren't
changing their diapers at the time), and innocent of any possible wrong doing.
Anything bad they do is just reflected on poor parenting, if that's the case
or not.

But yet the same pro-life people who want to save every child's life don't
seem nearly so sympathetic to mothers, even mothers that want to have healthy
children. The calls for de-funding planned parenthood and bad maternity leave
policies are at odds with having healthy babies and families. And healthy
families are exactly what insurance companies, the government, and families
can agree on. (It's cheaper for insurance, more citizens to be tax payers, and
families love kids)

Yet in the political sphere, we're trying to take away programs like SNAP and
WIC (which provide assistance to families and mothers). It's a lot cheaper to
feed a baby at home and keep them healthy than it is to feed them in a
hospital. Don't even get me started on childhood education.

I do think we have the technology to do much better, but we lack funding,
education, and political will. And it's all become entangled in the
welfare/abortion debate, which in America seems evergreen for political abuse.

~~~
yjftsjthsd-h
> But yet the same pro-life people who want to save every child's life don't
> seem nearly so sympathetic to mothers, even mothers that want to have
> healthy children.

This is rather disingenuous if you're referring to the practice of making sure
one's children are healthy by murdering the unhealthy ones before birth. If,
on the other hand, you refer to the coexistence of pro-life positions with
being unwilling to allocate money to healthcare... Yeah, that's unfortunate,
although not inherently contradictory (in my experience, both frequently co-
occur with a strong emphasis on private charity rather that government
services).

~~~
cbanek
While there is something to be said for screening for genetic diseases, etc, I
was referring more to how pro-life people more seem to care about people
having babies, rather than those babies being treated well and having a good
life and good future. Healthcare, education, nutrition, and safe & stable
housing are key to a young family.

I hear a lot about how we shouldn't have abortions, but I worry more about all
the kids and babies in foster care that aren't getting the love and attention
they deserve. Another hugely underfunded system that is notorious for abuse.

I've got nothing against people being for life, and having kids. I'd suggest
they go adopt a few kids rather than having them though. It's probably what
Jesus would want you to do.

But I can't and won't prescribe for everyone or even me before I'd have to
make such a choice. Life is strange, and complicated in so many ways. Ways so
crazy people couldn't invent them if they tried. I personally don't think we
need to make it harder on anyone.

~~~
yehi
A lot of pro life people feel that actively killing sometime (they consider a
fetus alive) is very bad and should be stopped. Where as keeping another
person alive (not passively killing them) and happy is the individuals
responsibility.

Think about the trolley problem. In one case you passively kill 4 people and
in the other case you actively kill 1. Pro life people would probably choose
to passively kill 4 while pro choice would probably choose to actively kill 1.

~~~
gech
A lot of people think letting people die is very bad too. And also a lot of
people think there is a responsibility to not let others die.

~~~
yehi
Sure, that's what's great about democracy, we can vote for what the majority
wants. I was responding to what cbanek wrote, as it seemed to me that cbanek
did not correctly understand some of the pro-lifers viewpoints.

~~~
sumedh
> Sure, that's what's great about democracy, we can vote for what the majority
> wants.

Sometimes what the majority wants, is wrong.

------
laoba
Heard this story on the way home, made the drive hard trying to hold back the
tears.

Off topic but I have two healthy daughters and a healthy wife. When I was with
my wife giving birth in the hospital it was a terrifying feeling knowing much
of it was out of my control. I can only imagine what these husbands went
through watching their wives die right before their eyes

~~~
35bge57dtjku
It sucks, but that's how humans existed for 300,000+ years.

~~~
Kluny
What a brutally insensitive comment.

~~~
le-mark
I don't read this as being insensitive, I read it as a reminder to be thankful
and mindful of the 'miracles' of modern medicine. Application of the principal
of charity.

~~~
35bge57dtjku
Thanks

------
jbandela1
So sad. I think that this is one of the areas where the advances in machine
learning in recent years can actually save lives. In medicine, the overlooking
of subtle and not so subtle clues because you are focused on something else
that grabs your attention is probably one of the big causes of these
preventable deaths. Computers are wonderful in that they can always be
analyzing and putting together patterns even when humans are focused on
something else. My hope is that in the near future these systems will get
deployed throughout the healthcare system and save many lives.

On a different note, one of the most important things for doctors to develop
is a "gut feeling" of badly sick vs sick vs not sick. Some of the best doctors
I worked with had an uncanny sense that there was something terribly wrong
with the patient, even when the lab data, etc was not very alarming, and by
acting quickly prevented all sorts of complications.

~~~
rabboRubble
I just had a disheartening conversation with someone involved in healthcare
data AI, not a doctor rather a technologist. The topic of maternal death came
up, mentioned that the US was going backwards, and holy smokes it was an eye
opener.

1 - they did not believe the maternal mortality data capturing methods in
other countries was on par with US so failed to see the backwards trends in
the US alone.

2 - called my interest in pointing out maternal death rates "noble" but
misguided as hospitals will pay attention to their "pain points" such as out
of control costs, readmission rates.

3 - after pointing out that pregnancy is the 6th highest reason for death
women 15-34, said we should focus on the top 5 because that would have more
impact on women's health.

There was more but those were main points. I ended my debate with this
message: pregnancy is the one "illness" where the patient was likely
relatively healthy to begin, and once over, will likely have similar health
after with 100% guaranteed remission upon menopause. Hospitals just need to
keep them alive. What other medical condition can have such positive outcomes
over the long term?

The whole conversation just kept reinforcing the point that maternal outcomes
are indeed affected by society / medical professionals not caring enough.

~~~
yjftsjthsd-h
> we should focus on the top 5 because that would have more impact on women's
> health

Eh, sorry if I'm missing something obvious, but isn't this true? Obviously
it's best to pursue everything possible at once, but with limited resources it
_is_ optimal to hit them in order of magnitude.

~~~
rabboRubble
It's not that the person was wrong, it's that the person saw no difference
between an accidental death (#1 cause) and death from pregnancy. Look at these
causes, and you tell me which type of death a hospital can best actively
prevent as a part of the treatment plan and those measures have the most
impact:

#1 Unintentional injuries

#2 Cancer

#3 Suicide

#4 Heart disease

#5 Chronic lower respiratory diseases

#6 Pregnancy complications

Think about which type of _young_ patient comes to them with at minimum of 6
to 9 months of warning, so much time to prepare for the "event". Think about
which type of patient can leave the hospital well with a completely normal
life expectancy. Out of those #6 death options, pregnancy is the only type of
event where, if you survive, you have a completely normal life & life
expectancy. Given that, why wouldn't a hospital invest the resource?

[https://www.cdc.gov/women/lcod/2014/all-
females/index.htm](https://www.cdc.gov/women/lcod/2014/all-females/index.htm)

------
shirro
My wife was assessed as a preeclampsia risk during all her pregnancies. The
last one they were so concerned she was airlifted to the state's top maternity
and neonatal hospital. I can't imagine getting the same level of care in a
profit motivated healthcare system without bankrupting our family.

I doubt that it is the focus on infants that is the real problem in the US but
it might be difficult to say what the real problem is without getting into a
shitstorm as health care has become so politicised.

~~~
refurb
_I can 't imagine getting the same level of care in a profit motivated
healthcare system without bankrupting our family._

That happens all the time in the US without bankrupting people.

~~~
webnrrd2k
It also happens all the time _with_ bankrupting people. I have several friends
that have gone bankrupt due to medical conditions, one who's now homeless
because he contracted MRSA in the ER, and it took 9 months in sub-ICU and
several long, expensive surgeries. His insurance capped at at 1 million per
year, but his bill was way over that by 6 months. I think it ended up being
1.5 or 2.5 million total, but I could be wrong.

So I'm not quite sure what you point is... That it's possible to get expensive
care without going bankrupt? Sometimes the US medical system works well?

------
yisymphony
Is there anything the family can do to be better prepared when the institution
is not prepared? My wife is pregnant (high-risk) and we have been concerned
since reading this article. We are in the SF Bay Area.

~~~
JauntTrooper
We just had our first child a few months ago. We had some pretty serious
complications, but the UCSF hospital system is amazing and all is good now. We
are blessed to have world class hospitals in the Bay Area.

As the article says California has been proactive and countered the national
trend: "By 2013, according to Main, maternal deaths in California fell to
around 7 per 100,000 births, similar to the numbers in Canada, France and the
Netherlands — a dramatic counter to the trends in other parts of the U.S."

The major hospitals are some of the best in the state and probably contribute
to those numbers, but just in case you may want to ask your OBGYN about the
protocols and whether they have a hemorrhage cart or other recommended
toolkits. I would also learn the symptoms of preeclampsia, and if you're ever
concerned in the hospital, ask. Congratulations and best of luck!

~~~
secabeen
Here's a nice article summarizing what California does right:
[https://www.vox.com/science-and-
health/2017/6/29/15830970/wo...](https://www.vox.com/science-and-
health/2017/6/29/15830970/women-health-care-maternal-mortality-rate)

~~~
Xcelerate
My wife has said that if we ever end up in California, she wants to fly back
the last month of pregnancy to have our child in Knoxville (she's not a big
fan of California). This article presents compelling evidence that it would be
much safer to stay there in fact.

------
newman314
My daughter was born tonight.

As I sit here holding her while her mom tries to get some sleep after an
emergency C section, this was a terrifying read.

~~~
Axsuul
Congratulations, I hope both baby and mother are doing okay.

------
jvvw
The article obviously make comparisons to the UK and having given birth twice
in the UK, it struck me as really strange that you could go for 8 hours
without having your blood pressure measured. I can't remember the exact
interval they do it at here, but I had straightforward natural births with no
major risk factors and it felt like I was having my blood pressure checked
frequently when I was in labour.

I was also surprised that somebody would be induced that early unless there
was a risk that made it necessary. I really can't imagine that happening here
and most pregnant women I've known have been desperate to avoid being induced
if they can help it.

I don't know if it's relevant to maternal mortality, but the epidural rates in
the US always stun me compare to those in the UK. The culture in my limited
circles is to try and avoid them if you can manage without. You can obviously
have one if you want and there is an anaesthetist available, but it's been a
small minority of people I know who have gone in knowing they definitely want
one. I guess they cost money too so the NHS probably doesn't push them!

~~~
le-mark
My understanding is that during natural childbirth, the pain level gradual
increases as contractions increase in strength, so there's supposedly and
acclimation to the pain going on. When labor is induced, the strong
contractions start right away and the pain is just as intense without the the
ramp up. Source: my sister who had labor induced :)

Is it possible that there's a higher use of epidurals that correlates with
induced labor because of this? Continuing with my sisters example, she did not
plan on having an epidural, but requested one after being induced.

------
peter303
Very sad. However maternal mortality rates have declined so much in past
century or so, that a case like this merits a news story. There is still room
to improve.

