“Birth by the Numbers”

I am preparing for a Lamaze childbirth educator training next week.  As a result I am reading  alot about birth in the US.  Quite a different picture than Laos or Uganda.  While moms and babies desperately need skilled attendants and resources in the developing world, the US medicalizes birth to a dangerous degree.

Here’s some numbers/insights I got from “Birth by the Numbers”on the Orgasmic Birth website  :

4, 138, 349 births in the US 2005

1% or 40,000 births

18,884 infant deaths (1st month of life) 2005

1, 248, 815 C sections

Calculate neonatal mortality rate =

infant deaths in first 28 days x 1,000 / live births

US 4.6 deaths/1,0000 = We are 42nd in the world.

Critics say: 1.  Not fair to compare US to small homogeneous countries. 2.  Use perinatal stats not neonatal because countries count deaths differently.

If we look at countries with 100,000+ births and use perinatal mortality stats the US ranks 15 of 16.  We also have the highest maternal mortality.  African American women die at a rate 6 or 7x times higher than birthing women in other industrialized countries.

US made no improvement in neonatal mortality in 2000-2005.  Industrialized countries are improving.  Maternal mortality in US is getting worse – 54% more deaths.  Industrialized countries went down 16%.

C-sections are overused in US, leveled in Scandanavia, UK, Germany.  If 30% rate then you are doing c-sections on low risk mothers, who has the risk of surgery: complications, infection without benefits to mom and baby.

It’s not a question of moms age: women of all ages

It’s not a question of baby age: all gestational ages

Black women have highest rates.  Strong regional patterns of rates.

Mothers driving, asking for?  In a study of 252 only 1 (0.4%) met the criterion for 1. request before 2. asking for csection for no medical reason.  They are rare.

Did they feel pressure to have c section? 25% of scheduled c sections, 25% emergency csections, 35% VBACs, 1% vaginal.

Mother are not driving this.  It is a shift in the nature of maternity care.

Risk conditions: diabetes, blood pressure (eclampsia) reduced c section rate between 1991-1996 and then back up 1996-2005.

Same for fetal distress, cord prolapse, placenta previa etc… The rates went down 1991-96 and then back up 1996-2005.

Same indications lower threshold.

They have set up a system that reflects the 1% doctrine = fear of the small risk that color the whole type of care.