I've written at length about my experiences giving birth to my children. I've described - in what I'm sure is, to the average reader, excruciating detail - the challenges that I faced and the difficulties that I endured in giving birth, and I've been completely frank about the fact that I found the whole process terrifying. But I've also always been very clear that I still think that I was very fortunate in those experiences. I did, after all, survive them, as did my babies. We might not have been so fortunate if we didn't live in a community with good hospitals and good doctors and the very best medical care available. We mightn't have been so lucky if we lived anywhere other than the affluent West.
I said as much the other week, when I wrote, here, about Haiti:
I've been thinking about what a luxury that is, to be able to reflect on all the nuances of the how of giving birth successfully, when for many women, the question is only if. There are too many women in Haiti right now who don't know whether they'll be able to successfully birth their children. And too many new mothers who don't know whether they or their babies will survive. And too many children who have lost their mothers already, and too many mothers who have lost their children, and it all makes me feel more than a little guilty for spending more than three seconds lamenting my torn vulva.
Those poor, poor women living in disaster-torn countries, or poverty-stricken countries, or anywhere, really that isn't North America or Europe or the wealthier corners of anywhere else, we think. Maternal health - maternal mortality - is such a very different issue for them than it is for us.
Or is it?
A story posted this week at AlterNet states that the rate of maternal mortality in California has been rising dramatically and is now actually higher than in Kuwait or Bosnia. According to California Watch, "the mortality rate of California women who die from causes directly related to pregnancy has nearly tripled in the past decade, prompting doctors to worry about the dangers of obesity in expectant mothers and about medical complications of cesarean sections." You wouldn't have known this, though, because - according to the same story - "for the past seven months, the state Department of Public Health declined to release a report outlining the trend."
Writes Nathanael Johnson at California Watch:
Although the number of deaths is relatively small, it’s more dangerous to give birth in California than it is in Kuwait or Bosnia. “The issue is how rapidly this rate has worsened,” said Debra Bingham, executive director of the California Maternal Quality Care Collaborative, the public-private task force investigating the problem for the state. “That’s what’s shocking.”
"The problem may be occurring nationwide. The Joint Commission, the leading health care accreditation and standards group in the United States, issued a “Sentinel Event Alert” to hospitals on Jan. 26, stating: “Unfortunately, current trends and evidence suggest that maternal mortality rates may be increasing in the U.S.”
Researchers aren't sure why, exactly, maternal mortality rates are increasing. They suspect that there is a relationship between maternal mortality rates and an increase in the number of c-sections performed in the US, although they're careful to say that "the C-section remains a useful tool, and in the middle of labor... it’s hard to balance the potential long-term harm against immediate crisis." The increased rate of c-sections can't, they say, entirely account for the increased rate of maternal mortality - they know that there are other factors that account more directly for some share of maternal deaths, such as obesity and poverty - but researchers are interested in the issue of c-sections - and other delivery practices such as early induction, the rates of which have also increased - because these are more easily controlled than issues related to maternal health and to socio-economics (it is easier, they say, to make an effort to reduce the number of cesarean sections performed in the US than to address obesity and poverty.)
In any case, says California Watch, "the California task force isn’t waiting to determine the ultimate cause of these deaths. It has started pilot projects to improve the way hospitals respond to hemorrhages, to better track women’s medical conditions and to reduce inductions – as Lagrew did at Memorial Care... (and) although the state hasn’t released the task force’s report, the researchers and doctors involved forwarded data to the national Joint Commission, which issued incentives for hospitals to reduce inductions and fight what it called “the cesarean section epidemic.”"
Still, the problem of socio-economic disadvantages shouldn't be overlooked. It's easy to forget that while many of us live relatively advantaged lives, those advantages are always relative, and often relative to others within our own borders. Inuit leaders in Canada recently reminded the Canadian government that maternal and infant mortality rates in their communities were tremendously high compared to those of other communities in Canada. And recent stories have pointed to the frighteningly high maternal and infant mortality rates in First Nations communities in Canada, standing in stark contrast to those of non-aboriginal communities. And again, the findings of the researchers cited in the California Watch story - poverty is a factor in high maternal mortality rates in some communities. Which, really, shouldn't surprise us.
We should, of course, remain alert to the risks of over-medicalizing pregnancy and birth: it's ironic, seeing as medical interventions save so many mothers' and babies' lives, but nonetheless important to remain well aware of the fact that these interventions can be as risky as they are helpful. But more than this, we need to remember that the relative wealth and privilege of our communities is no guarantee that all mothers and children in those communities will be equally protected by that privilege - or even that those who enjoy privilege are immune from risk. When we think about saving the lives of mothers and babies around the world, we need to remember that such life-saving is also needed at home.
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