In 2018 there is reality and what certain segments of society prefer to believe.
Reality is that immigrants enrich our country, take jobs that no one else wants, and are no more likely to come to our border than they ever were. In the overheated imaginations of our president’s followers, immigrants steal from our country, take all the desirable jobs, and have begun coming to our border in massive numbers.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Brooks’ New York Times piece is inaccurate, disorganized and based on personal beliefs not supported by facts.[/pullquote]
Why the discrepancy? Because cognitive dissonance won’t allow blue collar white workers to blame the real authors of their misery: the Republicans who promote the interests of the rich over the needs of the working poor.
In 2018 there is the reality of maternal mortality and what certain segments of society prefer to believe. This includes Kim Brooks, the author of America Is Blaming Pregnant Women for Their Own Deaths, an opinion piece in the NYTimes.
Reality is that maternal mortality is disproportionately a problem of black women, that the leading causes of death are heart disease and pre-existing chronic medical considitions, and that women are dying from LACK of high tech interventions not too many interventions. In the overheated imagination of Kim Brooks, an individual with no professional education or training in obstetric issues, the problem is that doctors are mean to women.
Brooks’ piece is inaccurate, disorganized and based on personal beliefs that are not supported by the facts.
This appears to be the key sentence:
For experts studying the United States’ maternal mortality and injury rates — which are estimated to far surpass those in other developed countries — and for women in labor, the failure to treat mothers as people is neither antiquated nor dystopian, but absolutely pressing.
That’s is sheer, unadulterated bullshit, the intellectual equivalent of claiming that immigrants are ruining our country. Reality is very different.
Reality #1: Women of African descent die at much higher rates than women of other ethnicities.
Reality #2: Maternal mortality rates are a function of “whiteness” of the country.
Reality #3: The leading causes of maternal death are cardiac disease and pre-existing medical conditions
Reality #4: Women are dying in the days, weeks and months before and after childbirth, NOT in labor.
Reality #5: Women are dying because of lack of access to high tech interventions.
Reality #6: Maternal mortality is a social problem as much as it is a medical problem.
I could write reams about these issues but a few graphs and charts make reality quite clear.
1. This graph shows the stark difference between maternal mortality rates for black women and all other women:
2. This disaparity is true for all industrialized countries and in some it is even larger. As a result, the “whitest” countries have the lowest maternal mortality rates and international comparisons that don’t account for ethnic composition within nations are meaningless.
3. Why do women die in pregnancy, childbirth and the year afterward?
The most important message in this graph is that fully 41% of US maternal deaths are caused by cardiovascular (including cardiomyopathy) and non cardiovascular diseases. And that reflects the fact that pregnant women are now older, more obese and suffering from more chronic diseases than ever before.
4. In her piece Brooks refers repeatedly to dying in childbirth, but as Neel Shah, MD notes, more than 80% of maternal deaths don’t occur on the day of delivery and more than 60% aren’t even within a week of delivery.
5. Brooks, like most people imagines that maternal mortality is a problem of too many interventions and unnecessary interventions (“too much, too soon”) when in reality it is a problem of LACK of interventions (“too little, too late”).
Brooks approvingly quotes an executive of the California Health Care Foundation:
“Women know what they want when it comes to labor and delivery, and it turns out the things they want (midwives, doulas, fewer unnecessary interventions and cesarean sections) are less expensive and produce better outcomes.” The problem is not that pregnant women are uneducated or uninformed; the problem is that those in charge aren’t listening to them.
There is precisely ZERO evidence that midwives, doulas, fewer interventions and fewer C-sections could reduce maternal mortality. Indeed, just this month the New England Journal of Medicine published What We Can Do about Maternal Mortality — And How to Do It Quickly recommends four strategies to reduce maternal deaths:
- Best practice bundles for common obstetrical emergencies
- Enhanced preparedness for complications
- Drilling for emergencies
- Timely transfer to high resource hospitals
6. Pointing out that maternal mortality is in large part a social, not a medical problem is not blaming pregnant women for their own deaths anymore than pointing out that drug abuse is primarily a social problem not a medical one.
The leading causes of maternal death are cardiac disease and pre-existing medical conditions; that’s because maternal age is increasing, obesity is increasing and therefore the prevalence of chronic medical conditions is increasing. No one is to blame for that and refusing to acknowledge it is a lazy attempt to protect women’s feelings at the expense of their lives.
The bottom line is that America is NOT blaming women for their own deaths. Claiming that midwives, doulas and fewer interventions will prevent maternal mortality is like claiming that a border wall will protect blue collar workers from economic harm. Some people may prefer to believe it, but it’s not reality.
