Despite a health-care system that outspends those in the rest of the world, infants and mothers fare worse in the U.S. than in many other industrialized nations. The infant mortality rate in Canada is 25 percent lower than it is in the U.S.; the Japanese rate, more than 60 percent lower. According to the World Health Organization, America ranks behind 41 other countries in preventing mothers from dying during childbirth.
With technological advances in medicine, you would expect those numbers to steadily improve. But the rate of maternal deaths has risen over the last decade, and the number of premature and low-birth-weight babies is higher now than it was in the 1980s and 1990s.
Why are we doing so badly? Partly because mothers tend to be less healthy than in the past, “which contributes to a higher-risk pregnancy,” says Diane Ashton, M.D., deputy medical director of the March of Dimes.
But another key reason appears to be a health-care system that has developed into a highly profitable labor-and-delivery machine, operating according to its own timetable rather than the less predictable schedule of mothers and babies. Childbirth is the leading reason for hospital admission, and the system is set up to make the most of the opportunity. Keeping things chugging along are technological interventions that can be lifesaving in some situations but also interfere with healthy, natural processes and increase risk when used inappropriately.
Topping the list are unnecessary cesarean sections. The rate has risen steadily since the mid-1990s to the point that nearly one of every three American babies now comes into the world through this surgical delivery. That’s double or even triple what the World Health Organization considers optimal.
Some people say that the increase in C-sections and other interventions stems mostly from women, who may be requesting more of the procedures. That could be a contributing cause but it’s not the major one, says Carol Sakala, Ph.D., director of programs at Childbirth Connection, a nonprofit organization that promotes evidence-based maternity care.
“We see rates going up across all birthing groups, including all ages, races, and classes,” Sakala says. “What we are seeing is a change in practice standards, a lowering of the bar for what’s an acceptable indication for medical interventions.”…