ARLINGTON, VA. (April 8, 2011) – Maternal mortality will be the focus of two events in the Washington, D.C. area this weekend. On Saturday, Birth Matters VA is putting on the sold-out Healthy Mothers, Healthy Birth Summit at the Dulles Campus of Shenandoah University. On Sunday, midwife Ina May Gaskin, author of the classic Spiritual Midwifery and the just-released Birth Matters, is taking her Safe Motherhood Quilt on a march to the Capitol.
The goal of both events is to raise awareness about the underreporting of maternal mortality in the United States and to call for infrastructure that accurately records this problem nationwide so that it can be studied and the rate of deaths related to pregnancy and childbirth can be lowered.
In 1998, the Centers for Disease Control released a report showing that no improvement in maternal mortality had been made since 1982. Additionally, the report showed that black women face four times the risk white women face of dying for causes related to pregnancy or childbirth.
The report put the 1982-1998 maternal death rate at 7-8 maternal deaths per 100,000 live births; the Healthy People 2000 goal set in 1987 was 3.3 or fewer maternal deaths per 100,000 live births. In addition to noting that the U.S. had not made any progress toward the Healthy People 2000 goal, the CDC report also points out that its report’s numbers reflected only known maternal deaths. On the problem of underreporting, the report reads: “The number of deaths attributed to pregnancy and its complications is estimated to be 1.3 to three times that reported in vital statistics records.”
Gaskin explained in an interview that infrastructure changes are necessary to obtain accurate data that will allow the problem to be studied. In the U.S., there is no standard death certificate whose use is required or whose list of questions includes recording whether a woman was pregnant within a year of her death. Contrast this to the United Kingdom where maternal deaths must be reported within 24 hours and a team collects data that cannot be used in any malpractice suits. Rates are studied over three years when analysis is made, along with recommendations and lessons learned.
In the U.S., Gaskin noted, “we’re taught to think it’s terrible to have government involved in health care.” But, she asked, “How else are you going to get correct data?” If hospitals – corporations – have their bottom line to protect, we are naïve to think that accurate voluntary reporting is going to happen.
It’s easy for American women to assume that no pregnant women die in hospitals because hospitals can – and feel they need to – put out the impression that “nobody dies here.” Gaskin cited the example of a pregnant woman who had an aneurysm and died – through no one’s fault – before reaching the hospital. The hospital, scared of having this maternal death on its “report card,” asked if they had to actually report the death. If the U.S. had a standard maternal death reporting system in place, there would be no question about how, much less whether, to report this death. Her case would be included and studied to give a more accurate picture of maternal death and its causes.
In 1999, Gaskin started collecting names of women whose deaths were connected to pregnancy and birth. Many of these cases seem to point in some way to inductions. “We should not have an induction rate of more than 10%, but there are some parts of the country where more than half of women are induced,” Gaskin noted. She also cited elective cesarean sections as a problem: “Surgery is always going to have a degree of danger and should only be used if there is a greater degree of danger by not having surgery.”
Gaskin said that The Maternal Health Accountability Act of 2011 – H.R. 894 – is a “great first step” toward accurate accounting and study of maternal death. The bill reads: “To amend title V of the Social Security Act to provide grants to States to establish State maternal mortality review committees on pregnancy-related deaths occurring within such States; to develop definitions of severe maternal morbidity and data collection protocols; and to eliminate disparities in maternal health outcomes.”
However, Gaskin remains skeptical that much will change without “substantial penalties for inaccurate reporting.” We are not used to having accurate reporting required, she explained, but “we need comprehensive data so we can determine priorities…If we want to study maternal death, we have to study why we’re having them.”
Saturday’s summit will bring together practitioners, researchers and advocacy groups to discuss the problem. On the agenda will be Gaskin’s research, Amnesty International’s Deadly Delivery report, and data reflecting racial disparities in birth. On Sunday, Gaskin will lead a rally showcasing the Safe Motherhood Quilt 2-4 p.m. at the fountain in Upper Senate Park.
Jessica Claire Haney is a freelance writer, editor and tutor. Her writing has appeared in parenting publications and poetry journals. A former high school English teacher, Jessica is mother to a five-year-old son and a baby girl. She is passionate about holistic health and well-being and is a leader of a chapter of Holistic Moms Network.
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