close to home: potentially fatal placental abnormality due in large part to previous cesareans

A still-rare (3/1000 births) but once incredibly rare (0.8/1000 before the rise in cesareans) and very serious placental complication, placenta accreta, is linked to having had previous cesarean(s). Because NJ, my home state, has the highest cesarean rate in the nation (for the 13th year in a row), one can extrapolate that we likely have the highest accreta rate as well. Here's a sobering story about a family in my town...

"We were making preparations for death," DeLeon-George, of South Orange, says now. "We grappled with a lot. There were a lot of what-ifs."

DeLeon-George had a rare condition. The placenta growing inside her was attached to scar tissue on the wall of her uterus from four previous Caesarean sections, forming its own extensive network of blood vessels, likely leading to massive bleeding — two units per minute — just as her youngest daughter Hannah was coming into the world. Essentially, the placenta, a life-giving organ for the unborn child, had become like a dangerous growth and had to be carefully extracted.

DeLeon-George’s problem is still a rare one for mothers-to-be, but doctors say as the rate of C-sections continues to increase, it’s apt to become more common. Called placenta accreta, it’s a disorder by which a placenta attaches to a previous C-section scar, and grows at an uncontrolled rate into vital organs such as the bladder, endangering the life of the mother.

maternal mortality in the US and abroad

from BBC news:

click here to see a video interview - one story of loss, right here in NJ

Maternal mortality across the world

The US spends more money on mothers' health than any other nation in the world, yet women in America are more likely to die during childbirth than they are in most other developed countries, according to the OECD and WHO. The BBC's Laura Trevelyan has been trying to find out why.

Four million American women give birth every year, and about 500 die during childbirth or from pregnancy-related complications.

In the richest nation in the world, giving birth is more risky than you would think.

"No American woman should die from childbirth in 2009, we can definitely do a lot better," says Dr Michael Lu, Associate Professor of Obstetrics at the University of California, Los Angeles (UCLA).

In New Jersey, Jim Scythes is bringing up his two-year-old daughter Isabella on his own.

His wife, Valerie, died from blood clots shortly after giving birth to Isabella by Caesarean section.

Jim still cannot believe that Valerie died after giving birth, here in America.

"When Isabella walked for the first time, I sat on the floor and cried, because Valerie should have been there. I believe this could have been prevented and now my daughter will never know her mother."

MATERNAL MORTALITY One woman dies every minute during childbirth, yet almost all of these deaths are preventable. In 2001, the UN set itself the goal of slashing maternal mortality by 75% by 2015, but it is nowhere near meeting that target. Health ministers from around the world are meeting in Ethiopia to work out how to make up for lost ground. The BBC is publishing a series of reports to mark the occasion.

So why are women in America more likely to die during childbirth than they are in most other developed nations?

The answers are complex. A healthcare system which leaves what Dr Lu estimates are 17 million women of child-bearing age without health insurance could be one factor.

Obesity, poverty and the high rate of C-sections in America all play a part.

Dr Lu says about half of American women are entering pregnancy overweight. "Obesity is a major risk factor for pregnancy-related complications.

"First we need to improve the health of women before they get pregnant, and second we need to improve the quality of maternal care in America."

Shocking story

The Centres for Disease Control (CDC) in Atlanta is the US government agency that collects national statistics on the numbers of women dying during childbirth.

Dr Bill Callaghan of the CDC says the latest maternal mortality data suggests one in four to one in five women who die have heart disease, or diseased blood vessels.

To the extent that we don't explain racial disparity in pregnancy-related mortality, we're going to have difficulty making headway into it Dr Bill Callaghan Centers for Disease Control

Could that be due to women being overweight? I asked. "It could be," replies Dr Callaghan, "the obesity epidemic has not spared women of reproductive age."

Dr Bill McCool, at the University of Pennsylvania's School of Nursing, points out that America is far above the World Health Organization's goal of a 15% C-section rate.

"Surgery of any kind has risk," he says, and a C-section is, "still the riskiest way to have a baby.

"In the US, almost one third of women have that procedure for delivery of their baby."

The statistics on maternal mortality in America tell a shocking story when it comes to African-American women.

They are three to four times more likely to die during childbirth than white American women.

Dr Bill McCool says that even wealthy black American women have a higher rate of mortality during childbirth than wealthy white women.

"People have looked at this from different angles.

"We know that African-American women tend to have higher blood pressure than the rest of the population, so is there a link there?"

JoAnne Fischer, Executive Director of the Maternity Care Coalition, which works with low income women to help them stay healthy during their pregnancies, says: "We do know that there is extraordinary stress involved in racism and in being poor. "

"And we know that sometimes this creates hypertension.

"Hypertension, obesity and diabetes are all linked, so we have to make sure women start their pregnancies healthy."

Dr Bill Callaghan, of the CDC, finds that not knowing why African-American women are at greater risk when giving birth has given him and his colleagues' sleepless nights.

"We can say that some of this may be due to socio-economic disparities.

"But it does not explain all of it.

"And to the extent that we don't explain racial disparity in pregnancy-related mortality, we're going to have difficulty making headway into it."

As doctors and US officials try to work out why American women are dying in childbirth, and what can be done to prevent it, Jim Scythes is still mourning his wife Valerie, who was all too briefly a mother.

maternal mortality

One mother dies every minute of every day in relation to childbirth - and it doesn't have to be this way. Check out the great piece in Huffington Post with a few stunning statistics like these"

Each year, more than a half million women lose their lives from complications arising before, during, or after childbirth. Almost all of these deaths occur in the developing world, and almost all of them are preventable.

and

The child of a literate mother is 50% more likely to survive past the age of 5, and when girls finish quality secondary and higher education, 84% of them will give birth with skilled medical help, more than twice the rate of mothers with no formal education.

Read more at: http://www.huffingtonpost.com/rania-al-abdullah/maternal-mortality_b_300052.html

death in birth

Time Magazine has an article, Death in Birth, (prominently mentioning White Ribbon Alliance, a global advocacy organization that works with governments to lower maternal mortality rates) on maternal mortality - worth reading.

But also read what Judith Lothian has to say in response on the Lamaze blog (the emphasis is mine):

Death in Birth
September 21st, 2008 by Judith Lothian

This week’s Time magazine reports on the frighteningly high maternal mortality rates in some parts of the world. Death in Birth describes a range of factors that contribute to women’s deaths during childbirth, including lack of access to midwives, poor health care delivery in general, and, very important, but least emphasized in this article, hygeine and nutrition. Access to clean water and adequate food would go a long way to changing things…as it did in the developed world a century plus ago. The World Health Organization is committed to providing additional training for local traditional midwives. But insuring safe water and adequate food are just as important if women are going to stop dying in childbirth in these countries.

This story seems so far away to most women in the US. But it shouldn’t. Women are dying in the US too. In fact, maternal mortality in the US is on the rise for the first time in decades. But for us the reasons are quite different. In the US intervention intensive maternity care increases risk for mother and babies. The rising cesarean rate increases risk for mothers, at the time of the surgery, and during future pregnancies and births. And routine interventions, like induction of labor, continuous electronic fetal monitoring, and restrictions on movment and eating and drinking in labor, contribute to complications and the need for more interventions.

Reading Death in Birth is sure to frighten women. But, in the US, what we should be most frightened of is standard maternity care that interferes with the normal, natural process (so beautifully designed) of labor and birth, not our ability as women to give birth safely. We know how to make birth safe for mothers and babies. Don’t interfere unless there is a true medical indication.

Why cesarean rates matter

One compelling statistic when judging a nation against others is the maternal mortality rate. It's a huge indicator of whether a country is first world or below, the prosperity of that country etc. Or is it?

The US is the top of the heap for many things, but safety in giving birth isn't one of them. We rank number 41st in the world for maternal mortality, with 13.1 maternal deaths per 100,000 live births. That means there are 40 countries where it is safer to give birth:

It is safer to give birth in the following countries: Australia, Austria,Belgium,Bosnia and Herzegovina, Bulgaria, Canada, Chile, Croatia, Cyprus, Czech Republic, Denmark, Finland, France,Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, Kuwait, Latvia, Lithuania, Luxemborg, Malta, Netherlands,New Zealand, Norway, Poland, Portugal, Quatar, Slovakia, Slovenia, Spain, Sweden, Switzerland, The former Yugoslav Republic of Macedonia, and the United Kingdom

But here's the kicker...because of NJ's status as highest in the nation for cesarean rates, if we were our own country, NJ would be 51st (down from the already deplorable 41st that is the US ranking), with 21 deaths per 100,000 live births! (and this is based on old 2004 stats - the numbers have gotten worse)

In addition the the 40 countries the US (as a whole) ranks behind, NJ would also be behind: Bahamas, Barbados, Balaras, Brunei Darussalam, Republic of Korea, Saudi Arabia, Serbia and Montenegro, Singapore, Ukraine, Uruguay.

Props to ICAN (International Cesarean Awareness Network) of Somerset County, NJ for pulling together this information. According to their calculations based on CDC statistics,

The NJ maternal death rate is 60% higher than the US average.

So this isn't a simple debate of birthing preferences - this is life & death, if not for us then for our neighbors right here in NJ.