Focus on Infants During Childbirth Leaves U.S. Moms in Danger | Hacker News Reader

Focus on Infants During Childbirth Leaves U.S. Moms in Danger

npr.org

96 pointsAlphaWeaver87 comments

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.

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

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.

> 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).

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.

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.

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.

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.

You can't really vote majorities when human rights issues are involved.

Basically same thing with other property rights. Can't vote a person out of their belongings.

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

Sometimes what the majority wants, is wrong.

Not trying to convince anyone, but: I believe abortion (with exceptions) is somewhere between manslaughter and murder morally, and therefore should be illegal. Nothing to do with religion.

The "pro-life" label is silly. I don't believe people should have more children (I don't have any). Avoiding unwanted pregancies i.e. contraception is a solved problem. Contraception should be freely available as a matter of public health, just as vaccines are.

You say that like contraception is 100% sure-fire way to avoid pregnancy.

Hate to burst your bubble, though.

https://en.wikipedia.org/wiki/Comparison_of_birth_control_me...

So what about rape and reproductive coercion? Or even cases when the woman gestating a fetus goes into a persistent vegetative state? Or even dies, like this woman - https://en.wikipedia.org/wiki/Death_of_Marlise_Mu%C3%B1oz ?

Hence the qualifier "with exceptions". This could be elaborated but again, not trying to convince anyone, was just pointing out that being anti-abortion doesn't have to be based on religious beliefs.

I don't think they were referring to people wanting to murder babies with genetic predispositions, as much as poverty stricken women who couldn't afford safe sex, may have gotten pregnant against their will, can't afford a plan B pill much less any other form of retroactive action, and wanting to not raise a child in poverty without planning.

I'm sorry man, but I just lived for 5 years in one of the worst ghettos in the country, ranked top 3% in the country in the nation for crime, and it is ungodly to witness on a daily basis what small children are subject to in places of extreme violence, crime, poverty, where the nearest grocery store is 10 miles away, much less anything else. I also live in the far north, and these children suffer in the winter.

Oh and while I'm ranting on about how horrible it is for the children, I'll just throw in the mostly irrelevant existence of the women in these areas, and the emotional, oral and physical violence I have witnessed them be subject to and thats in public. I get chills thinking what these women are subject to in private.

I've seen heroine addicts with their children dumpster diving for food in the back of my alley way on a Saturday morning as a routine, even trained their older children age 7/8 to dumpster dive for food, in America...

I've seen a mother, in a place where uber/lyft arent allowed, wait 45min for a $40 cab with melting frozen chicken nuggets she got on welfare, and sat with her and her 6 yr old son at 10pm at night, so she could not have to walk him through the worst part of the ghetto after the public transportation stopped running, because her shift ran late and it took an hour to ride the bus to pick up her son from her mothers house where he was being watched after school.

If at any time a mother or a potential mother, particularly one living in poverty and an area of high crime with no childcare situation, think they are not fit to have kids, we are doing ourselves as a society, the women, and these children, particularly one with a history of drug problems, or an in and out heroine addict, or a woman living in a violent home deems herself unfit to have children or raise them,regardless of how healthy they are in the womb a disservice to force them into existence, unless of course you would like to sit in the back of my alleyway and hand out food, coats, anti-voilence and rape education and other things that require raising "healthy" children.

The only thing violent and cruel in my opinion is for you, as a third party, to decide above a mother who is willing to admit shes unfit as a parent, that she will have kids and that your unnamed private charity will somehow rear this child a healthy unbringing.

I'm afraid you are just wrong about what encompasses having and raising healthy children,

If you look at this from the perspective of the potential mothers, the potential children, or pure economics, we are dooming ourselves as a society.

The only thing left standing as a pillar in the face of progress of enabling our society to help itself out of a viscious cycle of poverty and crime, is the emotional blackmail upon the masses guised under the idea that there is a morality based on either political, or religious, or other philosophical reference points formed by people who are not potential mothers, and CLEARLY not subjects of extreme poverty, that can be placed absolutely on all situations, where in all situations, the mother is left raising a child in poverty stricken hell with no resources because your local white suburban church and Fox news told you this is all a conspiracy, and anyways she was being irresponsible.

nonsense.

For anyone who has the opinion that mothers should be forced to have babies and if they didnt solve the problem "in time" its their own fault/ responsibility from that point on AND/OR that the private charity your local church is giving to is making a difference, I strongly recommend you go live in a real ghetto/poverty stricken area for atleast 6 months and walk the streets on a daily basis, and come out of your ignorance and then talk to me about all the things you think poverty stricken mothers should and should not do, and what they should be responsible for.

I'd honestly love to hear it....

I am tired of hearing the pro life argument from stay at home moms in suburbia who need to pass a law to scare their preteens into not getting into trouble and doing their homework instead, because of their inadequate parenting to be frank, and 50 + yr old white men who have never truly suffered in their life. Why are they so concerned with the suffering of unborn lives and not the suffering the millions of people producing these potentially born lives, in neighborhoods and areas they have never lived in?

it is always really interesting to see what few and far between things peak the interest of republican suburban white people enough for them to form an opinion, regarding entire demographics they will never interact with while driving their mini van to the local grocery store down the traffic circle. It is always over things that have nothing to do with them, do not limit their personal ability to live out their lives the way they think is "right" and is almost always because something someone else theyve never met in a situation theyve never been in is making a decision that is offensive to their way of life which again, they could continue to live out in complete isolated ignorance in the comfort of suburbia if they chose, but they choose to embarass our country by suddenly caring about what poor people are and are not entitled to.

They need a law to point to and say "see? I am right, those people are wrong, they are sluts, they are irresponsible and they are not trying hard enough, and actually I am being humane and doing the right thing by telling those women I've never met what to do with their bodies. Obviously a bunch of white 50 yr old men in congress agree with me so now I can say aha, my way of life is superior."

I think I can fairly reduce most of your post to, "it's better for children not to be born than have to live in those terrible conditions." Problem: that's not connected to whether they've been born yet. If only children with good parents should be allowed to live, why should they be spared after birth?

Yep hypocrisy abounds.

This is incredibly disingenous. The largest pro-life advocacy group, the Catholic Church, is pro-universal healthcare, pro-maternity leave (and paternity leave, the Church believes both parents should be home with their children). Moreover, the church has a long history (longer than planned parenthood) of providing accessible healthcare services. One need only look at the number of Catholic hospitals that closed during the recession because they provided free or discounted care when no one else would.

So, yeah, please stop projecting the entire sphere of simple-minded conservatism on the pro-life cause. The anti-abortion posse has supporters all over the political spectrum, not just in the republican party. If you want the democratic party to win an election, you should figure this one out.

man, i'm sorry, after today's news it will for awhile be especially hard [and not in the way "hard" is understood these days in Vatican] for me to consider seriously as genuine any declared position of Catholic Church. I mean, for Christ sake, it was the Cardinal responsible for Inquisition (department of Doctrine of Faith as it is called these days) ! :)

The Church isn't one homogeneous group. Each diocese operates independently, and each order is a separate entity, so the hospitals (which are usually run by nuns) are usually separate from the regular Church hierarchy.

Nevertheless -- regardless of the many shortcomings of its members -- the Church is still probably the single largest non-political entity behind a single payer universal health care system in the country.

>The Church isn't one homogeneous group. Each diocese operates independently, and each order is a separate entity

that definitely contradicts the Church's own teachings and declarations, and it doesn't work in the civil law space too - the courts stroke down that argument when the Church tried to use it in order to shield the assets from the child molestation lawsuits.

No... they didn't. Can you please provide a link or something showing a group of religious sisters drawn into the whole child abuse lawsuits and being considered the same entity? Preferably, a hospital, nursing home, or school.

The modern pro-life movement that people are referring to here is dominated by evangelical christians. If anything, the Catholics are marginalized in the movement.

Simply put... no. You may perceive it that way because the evangelicals make a big fuss, but the Catholic church is by far the largest group. Additionally, most evangelicals believe abortion is okay in certain cases. Their main argument against abortion is that woman should be saddled with the 'consequences of their actions'.

In contrast, the Church is against abortion in all cases, period, and doesn't think that children are a 'consequence' to be dealt with, but rather a life to be preserved.

According to wikipedia (https://en.wikipedia.org/wiki/United_States_pro-life_movemen...), a 2008 study (the Munson study) found that, of all pro-life activists, 66% were Catholic, a substantial majority.

Do they provide LBGT sex education as well? Seems like a burden the church should take on given what the leaders of this community have done.

I have a hard time taking men who have engaged in sexual child abuse as valid leaders of pro life or pro choice movement. I don't think they should have a say in anything sex related at all.

They are the last group of people on the planet right now who should be taking a moral stand on sexual rights.

Wait, you think LGBT sex requires different sex education?

When sex education was taught to me, sexual preference wasn't assumed or implied. The parts worked the way they anatomically do. STDs have no gender preference.

What is LGBT sex education? The Church provided the best sex education my wife and I got. During marriage prep, we actually learned how our reproductive systems worked, and how to monitor my wife's cycles, which led to the diagnosis of several health problems that should have been obvious in retrospect. If only we had actually been taught about our bodies in high school, it would have saved us a lot of heartache. Thank God for the Church.

> 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.

You seem to be viewing all these problems through a political and government lens. I feel it's a leap in logic to say "if someone doesn't support progressive policies then they don't care about mothers, families, and born lives".

One example, there are too many to list exhaustively, is in the recent refugee crisis. An evangelical charity supported by lots of red-staters was in there doing what it could (1).

On a personal level, the churches I've been part of do attack poverty and justice issues on many fronts. There are women's shelters, several programs for the homeless, food banks, free health care clinics, job placement programs, financial education programs, sponsorship of impoverished third-world children, sponsorship of impoverished third-world villages, and so on. There is also a fund for helping church members (some of whom come from local shelters or are otherwise poor) pay bills as needed. And there are innumerable education, mentoring, and counseling programs offered to help families be emotionally and spiritually healthy, partly to avoid the need for programs for people with broken homes and so on.

I am not afraid that I don't care about mothers just because Planned Parenthood is not on the list. Modulo big mistakes in the implementation (1), I am fine with SNAP, WIC, etc. when they're used to help poor families. I don't know any pro-life people who feel a burning need to cut these things.

And, as a side note, it's really a bad idea to keep bringing up Planned Parenthood as being pro-mother. From time to time we have friends with money problems that need pregnancy care. We contacted the local Planned Parenthood asking about their offerings, only to find that they offer none, really. Not even referrals. They more or less said they do abortions and birth control and do not offer programs for women who are planning an actual pregnancy. A local pro-life pregnancy center also did not offer anything in house, but did refer us to some pro-life shelters and programs that would help out with prenatal care.

1) https://www.samaritanspurse.org/disaster/refugee-crisis-in-e...

2) I'd rather just move to minimum income, set it to a healthy level, and stop conflicting over funding levels of each of the multitude of entitlement programs. Poor people are hurt (or at least helped a lot less) by doing indirect charity through price fixing, corporate charity, etc. For example, do you know what might help with the homeless problem? Cheaper homes. But we insist on propping up housing prices, subsidizing sprawling McMansion-ridden suburbs, setting up people in unaffordable homes saying it's an investment, etc.

> You seem to be viewing all these problems through a political and government lens. I feel it's a leap in logic to say "if someone doesn't support progressive policies then they don't care about mothers, families, and born lives".

> I don't know any pro-life people who feel a burning need to cut these things. (SNAP, WIC)

I definitely am looking at it through the political/government lens. And while it's possible for someone to be pro-life and support progressive policies, I'm not sure who they would vote for that could represent them. There's a huge political fault line over many hot-button topics. People that are voting for pro-life conservative representation are usually the same representatives trying to reduce healthcare and are against social welfare programs. It could be said that many people were voting against their own healthcare interests, which we're soon to find out.

I'm all about people standing by their principals, and doing what they can, but I feel like this is government's problem, and charity while good isn't nearly enough to cover the scope of the issues, and certainly can't fix them at the source. I agree with your (2) as well. The 'charity' and price fixing of prescription drugs has been really interesting, because the drug companies quote the "reduced" price, but then if you hear the actual price charged to an insurance company, you'd faint. The "it might only cost you $10" on TV commercials is totally a way to play to people's ideas that prescriptions are affordable for everyone. It'd be much better for everyone to just have a reasonable price than try to be "charitable" (at least to some, and then rip off whoever has money).

We have to agree to disagree about planned parenthood though. Birth control, abortions, and other women's health care (that isn't related to pregnancy) is still important care, even if you disagree with them on religious terms. I wouldn't say that it's pro or con mother (and I don't think I ever did), but I would say it is pro-woman and definitely pro-choice.

I think the only place that would be against mothers is when you're going to a place and they try to convince you to do something you don't want to do, which I've heard happens at some of these centers.

http://www.salon.com/2016/09/15/support-shams-anti-abortion-...

Perhaps, just perhaps, the Pro Life position is about appealing to a segment of voters who wouldn't be attracted by the Cut Taxes for the Wealthy position?

You should know that people who are against one of the following are called "pro-life" (and therefore Trump-supporters, racists, alt-right and nazi...) as well:

- 3rd-trimester / late term abortion without physical-health reasons.

- The selling of body parts instead of freely giving it away for research. See: https://en.m.wikipedia.org/wiki/Planned_Parenthood_2015_unde... (later said to only be the cost of transportation)

- The idea of post-birth termination. See: http://jme.bmj.com/content/39/5/261

are called[by whom?] "pro-life"

By many people that are pro-abortion. The following way of thinking seems to be norm nowadays: https://en.m.wikipedia.org/wiki/You%27re_either_with_us,_or_...

I think the term "pro-life" is being abused to put labels on people who are just against the points I mentioned. These people are not necessarily "anti-abortion".

Who exactly is pro-abortion? Do you think there are women out there getting their kicks from getting pregnant just to have an abortion because it's such a fun time?

It's an imperfect choice in an imperfect world, where a lot can happen. I wouldn't say anyone is "pro-abortion", but a lot of people are pro-choice, knowing that a blanket ban puts people at risk.

> I think the term "pro-life" is being abused to put labels on people who are just against the points I mentioned. These people are not necessarily "anti-abortion".

So what you're saying is someone who thinks it's okay to get a first trimester abortion for any reason is pro-life? That seems absurd.

Sorry I meant "pro-choice" and I agree with what you say. I never wanted to say that abortion is a good thing or there are people that want this.

What I wanted to say is that there are not just 2 sides:

pro-choice: agreeing with any form of abortion (note: I am not saying people want it)

pro-life: against any form of abortion

As I keep getting downvoted. Can you explain, as English is not my native language, why being pro-something also implies that the people undergoing that something are liking it?

If someone is pro-war, does that imply that the people that are part of the war are liking it?

Terminology is extremely important, the words we use have meaning.

"Pro-abortion" implies (especially when compared to "pro-life") that abortion is to be promoted above other options or abortion is something good or something to strive for. The correct term is "pro-choice" because its not about promoting abortion, its about promoting an individual's choice of how to handle a pregnancy and making every option safely and readily available to them.

"Pro-choice" and "pro-abortion" are not synonyms of each other and calling the pro-choice movement "pro-abortion" is not correct.

Thank you for the explanation.

Mothers risk their lives to give birth. If at any point in time a mother chooses to no longer offer her body as a temple for human growth, that is her decision, period. Forcing women to have children and give birth is sickening.

Here is something I would like to see some statistics into: the demographic of women who wish to have abortions during their third trimester or after for non related health reasons. I am not sure this is the case, but I would be willing to bet its not women in their 30s/white suburban housewives planning a family, and this is almost entirely skewed towards a poverty stricken demographic who usually is unable to afford a pregnancy test, and furthemore, live in neighborhoods/areas where there is a constant onslaught of domestic violent and sexual abuse, leaving women vulnerable, much less with $60 to walk to rite aid to grab a pregnancy test and plan B pill.

Alot of poor women do not know they are pregnant until multiple months in, even in the United States. This may sound bizarre and only possible out of sheer neglect, but I have friends who work for and at Planned Parenthood.

Excessive stress, physical abuse, weight gain or loss due to poor diet (welfare food/doritoes or not having access to food at all), mostly extreme stress (rape/abuse) can lead to missing periods.

If I lose 5 ibs in a month I miss my period. It could be very difficult for women with little to no resources and erratic lifestyles to actually know until a few months in if their only affordable resources are whether they are having a period or not. Not all women are regular in the first place, and a number of factors much more commonly occurring can, and often do, contribute to missing periods.

Of course, the pro-life is not going to look into that or advertise women in these situations as victims in desperate need of help but rather careless neglectful sluts who want to murder babies at their convenience.

Regardless, childcare, childbirth, safe sex, or any retroactive actions to safely and quickly remedy a potential pregnancy into a ...not pregnancy is expensive, with the minimum threshold of a plan B pill being $50, which was expensive for me in college, and simply unrealistic for women on poverty miles away from one.

Republicans thought making this expensive would deter pregnancy. Precisely the opposite, it simply delineates who can afford healthcare related to safe sex, family planning and raising children in a healthy environment, and who cannot, and places all the burdens of societies in ability to provide these things to humans at a minimum level of decency onto the shame/reputations and sluttiness/morality/choices of the mother. The vicous cycle does a great job of perpetuating poverty where poor women in non ideal situations are left with decreasing cycles of access to education, safe and respectful environments and access to knowledge/healthcare.

People who can afford healthcare will get it, even if they have to drive to another state to do so, not everyone can take their husbands landrover and use their health insurance to seek out a doctor highly regarded for safe abortions.

It's just a system that favours the rich.

Also, as a last note, I'm really tired of watching disgusting 50 + yr old politicians have an opinion about what women do with their bodies. It's none of their business. It would be inappropriate in person and it's inappropriate in the context of politics as well.

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

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

Welp. No need to progress as a species. As it has always been so it shall ever be.

What a brutally insensitive comment.

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.

Thanks

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.

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.

Pregnancy at least used to be one of the things insurance companies were excited to cover you for. It means you aren't sick, and the more money they spend (and labor is pretty cheap, compared to a lot of health care), the more likely they'll save it in the future by having a healthy mom and a healthy baby. Unhealthy/premature babies can be a huge ongoing expense.

No. Before the ACA pregnant women were specifically excluded without a rider.

Not at all, pre-ACA it was impossible to purchase an individual plan that covered prenatal care and childbirth, they just weren't available. Couple self employed friends had babies during that time and they had to pay for everything out of pocket, tens of thousands of dollars.

Also, being pregnant does not mean you "aren't sick," not sure what gave you that idea.

My bad, I was thinking of employer sponsored healthcare, and I think they usually didn't count labor under the deductible. But yes, buying any kind of healthcare on the public market pre-ACA was terrible.

And I meant that being pregnant is a normal healthy condition, that happens to normal healthy people. Sick people can be pregnant, of course, and sickness can be precipitated by being pregnant (like gestational diabetes), but in general it's something that happens normally, unlike illnesses.

> And I meant that being pregnant is a normal healthy condition, that happens to normal healthy people.

It was normal, until early 20th century doctors (mostly male) decided that the midwives (mostly female) didn't actually know anything about childbirth. To protect women from the "incompetent" midwives, the doctor guild successfully exterminated their competition.

Midwives used to have little tricks for normal pregnancy problems, like how to get a breech baby to turn. Much of the institution's knowledge was lost in the Purge.

I realized a while back that there are two books called The American Way of Birth [1]. The local science library had a copy of the earlier one. This book examines the "medicalization" of normal female experiences.

[1] https://news.ycombinator.com/item?id=13742782

This 2013 NY Times article [2] has a nice summary of the effects of the medicalization of childbirth on the costs thereof:

  [...] Childbirth in the United States is uniquely 
  expensive, and maternity and newborn care constitute the 
  single biggest category of hospital payouts for most  
  commercial insurers and state Medicaid programs. The 
  cumulative costs of approximately four million annual 
  births is well over $50 billion. 
  [...]
  Those payment incentives for providers also mean that   
  American women with normal pregnancies tend to get more of 
  everything, necessary or not, from blood tests to 
  ultrasound scans, said Katy Kozhimannil, a professor at 
  the University of Minnesota School of Public Health who 
  studies the cost of women’s health care.

[2] American Way of Birth, Costliest in the World - http://www.nytimes.com/2013/07/01/health/american-way-of-bir... (this article was probably not directly inspired by either book of the same name)

[minor edits - formatting, etc]

Whether is is "normal" or "happens normally" is not important from an insurance standpoint because from their end its nothing more than a bunch of expensive claims, even "normal" births are just a bunch of expensive claims. Childbirth is a far cry from "pretty cheap," an uncomplicated vaginal birth costs tens of thousands of dollars minimum. You seem to be ignoring months of prenatal care and the care for any pregnancy complications that may come up, of which there are many. Childbirth costs are much more than just the cost of "labor."

The fact you couldn't purchase individual plans that covered these expenses is a huge testament to that. It was so expensive that it required the force of law to get insurance companies to cover them.

> 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.

Not if your first question is "why do so many pregnant mothers die during childbirth?" - GP's point is that it's a disheartening realization.

That being said, it's not necessarily true - after all, if X resources would be more effective mitigating cause of death A than cause of death B, then presumably you would want to (from a utilitarian calculus) direct them to A, irrespective of whether A or B causes more deaths.

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

This is a protocol issue. The United Kingdom and a few States follow a specific programme which dramatically improves maternal outcomes. The US needs to do two things: capture the data and implement the protocols.

The US already has the best healthcare in the world. The problem is that it isn't evenly distributed. Improving the technology without improving the distribution likely won't substantially improve the statistics relative to other developed countries which are capable of adopting similar best practice but delivering it to more of their population.

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.

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.

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?

Bankruptcy wouldn't be the worst outcome.

Our private medical insurance and income were never considered in our treatment and while controlling health care costs is a concern everywhere I never felt it influenced the delivery of services. We have more doctors per capita, more hospital beds, better life expectancy and spend less on health care and do it with a comparable tax burden and lower public debt. Nowhere in the article does it acknowledge that the developed countries with falling maternal mortality rates have very different healthcare systems to the US.

It just might be a factor in this.

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.

Go to UCSF or Stanford. California follows the high risk protocol. Also just ask your doctor about this.

Perhaps try reaching out to the reporters, or even some of the experts mentioned in the article?

I've done it before and gotten responses, and in the cases of an article like this I can't imagine you'd be the only person with such questions.

Found this interesting comment on Reddit about "H" teams, and evidently they're at Kaiser.

https://www.reddit.com/r/BabyBumps/comments/6ar5xi/trigger_t...

Do you have a doctor you can trust right now, monitoring the pregnancy? Make sure they have a plan in place for whatever may come up, and that they've shared this with the appropriate hospital. UCSF, Stanford are probably the best hospitals to be at.

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!

Here's a nice article summarizing what California does right: https://www.vox.com/science-and-health/2017/6/29/15830970/wo...

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.

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.

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

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!

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.

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.

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