Here is an excerpt from an editorial in the New York Times:
"The infant mortality rate in this country declined sharply in the 20th century but then plateaued from 2000 to 2005. The Centers for Disease Control and Prevention reported last week that in 2006 the rate of infant deaths in the United States fell to 6.71 per 1,000 live births, down from 6.86 the previous year. That is still 50 percent higher than the official national goal of 4.5 deaths per thousand.
What is particularly shameful is how poorly this country compares with other industrialized countries."
What is particularly shameful is how poorly this country compares with other industrialized countries."
Full text can be found here: http://www.nytimes.com/2008/10/19/opinion/19sun3.html?_r=2&th&emc=th&oref=slogin&oref=slogin
5 comments:
Please allow me to play devil's advocate here for just a sec. There are many reasons why infant mortality could be elevated in the US, and several of them are related to our unique status as a desirable place to immigrate.
There are some cultures are parts of America wherein the conditions resemble a more agrarian society rather than an industrialized one. Migrant farm workers often live in conditions that most would consider squalor. Midwives often help in the birth and immediately thereafter, but can't make up for poor living conditions or unhealthy life styles.
That is just one example. I fully support the role of midwives in the birthing process. I think the extent to which they are subjugated is a result more of unions (unions go by many names, bar association is an example). More should be done to reduce infant mortality, but increased presence of midwives alone is not going to solve the entire problem.
Maybe I’m wrong on this, and you’re more then welcome to correct me if I am, but from what I heard the reason the US infant mortality rate is so high is because we count a not more then other countries. Let me explain, in the US if a baby is born very premature or with significant complications we do everything we can to save that baby and if unsuccessful we count it toward our infant deaths. This is not the case in other countries. If the same baby is born in another country that does not have the technology the baby dies and is not counted towards their infant deaths.
It is only because we have such great medical practices and technology that we are able to save babies that if born anywhere else would have not lived. This causes us to count a live birth where other countries don’t and subsequently have a higher infant mortality rate then countries that don’t count live births where they don’t have the means to even attempt to save the baby.
The system being used to count infant deaths is flawed and makes us look worse then we really are.
To some extent you are both correct.
The United States is considered an industrialized country. That fact is indisputable. There are other countries in the industrialized world that also have immigrants, poverty, and slums. Actually, some of the best rankings per state in the US are in states where there are large amounts of migrant workers. The majority of the other countries that are ranked higher than the United States also have access to the technology and knowledge that the OBs/FP docs/midwives have in the US. Many of these countries, and this is debatable, function better than the US in handling such problems and issues that may increase Infant Mortality (as defined as death of an infant from the moment of live birth up to one year of age). Many of these countries have Socialized Medicine therefore having women see health care providers used to normal, vaginal births. When a problem arises or a signal flag waves showing that there may be a problem these women are then referred out in care to a specialist (OB, high risk OB, etc)Women are seeing specialists in the kind of birth that they need- whether it be an uncomplicated vaginal delivery or an emergency c-section due to a serious issue.
Often in the world-wide ranking system results are skewed due to permature births that would be classified as infant mortality here and a pregnancy loss in other countries. The countries counting these losses as a pregnancy loss vs. infant mortality are often third world countries without equivalent training. Many countries, however, count infant mortality the same way we do. Many of the techniques and technological adavances that we use here in the OB units come from other industrialized countries. We would be playing dumb to think that these countries don't utilize these techniques and this equipment with the same boldness and desire to succeed as we do. As an additional note on this issue, the World Health Organization (WHO) uses a standardized definition of live birth. They then make a ranking themselves according to their standardized (adjusted) definition. Their stats are at least somewhat comparable. According to them the US is still not 'top dog'. (we're still pretty low)
I don't think midwives are the only solution to the problem.There are a lot of factors- nutrition, drug usage, birth weight (again, usually nutrition), uneducation, miseducation, socioeconomic factors, maternal health, public health practices, infant nutrition, etc. I could go on for days.... I recognize that maternal health is the cornerstone for a healthy infant. There are factors that I can't even begin to touch right now that affect a mother's health prentally.
In my opinion, the US still has abysmal health statistics (not just in obstetrics) when compared to other countries. While I am all for scientific advances and I believe that God gave us our minds to use, I do think that there is something to be said for trusting the way that God created in the beginnihinng for women to give birth. There is such a thing as taking it too far.
Unfortunately, women are being subjected (or even just encouraged to choose) to routine interventions including, but not limited to, epidurals, episiotomies, amniotomies, intrument deliveries and cesarean sections just so that it's easier on someone else. Doctors, in particular OBs, are nearly being forced out of practice due to high malpractice insurance costs. Many midwives are no longer able to practice due to the fact they pay for doctor backup and doctors and having to raise their costs to keep up with rising insurance costs. These issues bring up numerous more debates and items to be dealt with.
Miwives, breastfeeding and good general health are still all positively correlated to better infant mortality stats. While a correlation doesn't necessarily mean a cause it does, however, warrant further investigation to determine causation.
Hope any of that made sense. (I'm caring for the kids while typing.) I feel that maternal and infant health are key markers to the health of a society as a whole. My goal is not only help improve these stats but to improve the care of these two groups.
Climbing back down again. (It takes a pretty tall soapbox for such a short person.)
I just want to say that I recognize that my post can open an even bigger can 'o worms. Socialized medicine, rising insurance costs, the question of when life actually begins, immigration, etc. We're never going to be able to solve all of the issues that we face- it's just the way that our lives were designed to go. I sometimes feel like that man who throws the starfish into the water one at a time. He makes a difference to THAT one. If we can make little changes then maybe we can do big things.
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has. -- Margaret Mead
I'm so glad to have discovered your blog. Thanks for leaving a comment so I could track you down. I can't believe how big your kids are getting...they are so cute! You amaze me...4 kids, future midwife, home school teacher, etc...I enjoyed your soapbox ranting. I am amazed at how unhealthy we are as a society. Part of that has to do with our heatlh care system but I think a big part comes from the laziness/apathy on the patient's part to take care of themselves. It's frustrating!
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