While allowing for the “natural” process of childbirth (moms push and babies pretty much just “fall out," right?), what we see in developing countries is an average maternal mortality rate of 239 per 100,000 vs a decrease to roughly 12 per 100,000 (this number is slightly higher in the U.S., but we will get back to it in a minute). On any given day, over 800 women die of largely preventable pregnancy-related complications. That’s over 300,000 women per year in addition to the two and half million newborn deaths and another two and a half million stillbirths, most due simply to a lack of resources. This means that for the average 15 year old, her risk of dying of a maternal complication in her childbearing years is 1 in 180 in most developing countries, although in some, it is as high as 1 in 54! In a developed country with established healthcare, that number decreases to 1 in 4900.
So, where and why does this happen? Over 99% of maternal deaths occur in developing countries where resources are limited and skilled providers aren’t available to intervene in time to make a difference in pregnancy outcomes. The leading cause of maternal mortality worldwide is actually postpartum hemorrhage. Pitocin administration after delivery significantly reduces risk of bleeding; ironically, in the U.S., many moms actually decline this intervention despite their physician’s recommendations. Good hygiene, i.e. handwashing and keeping the perineum as clean as possible, can help decrease risk of infection, and if infection does occur, the availability of antibiotics can improve the maternal outcome. Ever wonder why your doctor checks your blood pressure at each prenatal visit? Pre-eclampsia and eclampsia, blood pressure-related complications of pregnancy, can often be managed to help minimize risks to both mom and baby, especially if caught and treated early.
Fortunately, in the U.S., we have access to all of these resources and even more. Rigorous training for physicians ensures that we have plenty of supervised experience before we provide pregnancy care on our own. We have the ability to monitor the baby’s well-being prior to delivery and help speed along that process if we see that the baby isn’t doing well. For women with prolonged labor, we are able to intervene if we can tell that a vaginal delivery isn’t in the cards. In some cases, the baby’s head is simply wider than the bones in mom’s pelvis can allow to pass through. In developing countries this sort of complication can end in the loss of the pregnancy and necrosis (breakdown) of the vaginal tissue that results in leakage of urine or stool through the vagina (a fistula). In fact, a substantial number of medical missions to developing countries focus on offering fistula repair. Here, a timely cesarean delivery can result in a healthy mom and baby.
We are blessed to have access to such an abundance of care options here, and when utilized well, this healthcare training and medical resources can make childbirth so much safer. In fact, our abundances are about the only thing that makes pregnancy more dangerous in the U.S. Complications related to the conditions listed above have been reduced so much that they play a much smaller role than obesity-related pregnancy complications, and the development of widespread obesity has begun to elevate our maternal mortality rate above 20 (much higher than average of 12 in most developed countries). A significant portion of U.S. maternal deaths over more recent years have been related to heart failure and cardiovascular disease as well as diabetes. Certainly, we also know that maternal habitus and diabetes both play a role in growing larger babies, which in turn can increase risk of birth trauma and need for cesarean delivery as they simply can’t fit through the maternal pelvis.
Still, we’ve come such a long way in reducing maternal mortality in the U.S. by establishing regular prenatal care. With a minimum of 8 years of training after college, your obstetrician has learned to recognize potential complications early, and he or she can help you manage any medical condition in a way to reduce the risks during pregnancy. In conjunction with the medical resources listed above, we are here to work with you toward your goal of being the healthiest possible mom with the healthiest possible baby :)