A Downside of Efficient and Over-teched Health Care

For any Americans prone to the assumption that U.S. wealth and capitalist “efficiency” make for inherently better health care and a safer population, think again.

An array of studies suggest that the U.S. has steadily become a more dangerous place for women to give birth than many other countries around the globe. Although this is not “news” in the sense of catching authorities by surprise, the average American probably isn’t aware of the facts, let alone the implications.

I ran across the story by chance in a Jan. 18 piece by Nicole Montesano in the McMinnville News-Register.  As Montesano stated in her lead, women in the U.S. are more likely to die in the course of childbirth than new mothers in most of Europe, quite a bit of Asia, and even the Middle East. While maternal mortality has declined in most countries over the past 20 years, it has almost doubled back home. (Note a sharply worded dissent in the comments section by an apparent female physician, though. I also will note a few disagreements with various aspects of these claims below.)

What are the possible reasons for this apparent rise in maternal mortality here? A crossfire of factors come into play, including:

·      Rising age and obesity among expectant mothers in the U.S., both of which correlate with greater risk in carrying a baby to term

·      Less access to regular medical care among African-American women, who are therefore four times as likely to die during or shortly after childbirth

·      Relative infrequency of pre- and post-partum health care for all mothers and infants in the U.S.; apparently, national health care systems like those in Canada and Western Europe require more pre-natal medical visits and provide more care after birth than U.S. insurance companies do (or new mothers are inclined to seek)

That may be important, because 55 percent of maternal fatalities occur within 42 days after birth, and that’s how long most American mothers wait, on the average, to visit their doctor for a checkup.

One of the most unpleasant yet undeniable factors in the jump in maternal mortality is the extraordinarily high rate of births by Cesarean section in the U.S. Originally devised as a last-ditch emergency procedure to save an endangered fetus’s life, Cesareans have of late become the automatic choice in about one-third of all American births.

As explained in an article on Childbirthconnection.org, the World Health Organization calculated that a healthy rate of Cesareans in a given population appears to lie between 5 and 10 percent, with a rate that exceeds 15 percent tending to do more harm than good.

The rate in the U.S. climbed steadily from 27 to 34 percent between 2002 and 2009, when it peaked at more than 1 in 3. The rate may have fallen slightly the following year, to 32.8 percent, according to the latest CDC statistics.

There are a variety of potential contributing factors to this high C-section rate, nearly all of which I would regard as rather unsavory:

·      Hospitals and doctors in the U.S. do a lot of fetal monitoring these days, though such attention does not appear to correlate to subsequent infant survival and health, only a higher rate of Cesareans

·      Doctors are recommending C-sections as a method of minimizing their own risk of litigation, because the procedure offers a quick and easy fix whenever technology suggests even a hint of a potential complication in the pregnancy

·      More pregnant moms choose induced labor and C-section as a convenience, to shorten aches, pains, and discomfort of pregnancy (see, however, the Childbirthconnection.org article, which cites studies that find this to be a minor, anecdotal factor)

Montesano’s article doesn’t mention one other possibility I can remember reading elsewhere: that less-than-scrupulous physicians and hospital administrations may also guide patients toward Cesareans because they are easier to schedule, save time, and as an actual surgical procedure bring in more money. Again, the Childbirthconnection.org piece hints at this toward the end.

But remember the payoff here: Women die. Infants die. And many of both would be alive today if everybody hadn’t been pushing Cesareans ... and if we had national  health insurance and a nationalized health care system. And that's why I favor them.

That’s also why I favor greater government regulation of capitalist industries in general. That’s why I favor greater gun control over so-called Second Amendment rights. And that’s one of the reasons I avoid driving cars as much as I can.

Because cars, and guns, and unregulated industries, and a capitalist-driven system of health care and medical insurance all kill thousands of people each year, needlessly. These are all crimes that too often go completely unpunished, so the "freedoms" that so many people defend are not worth the cost in human lives.

That’s what makes me a liberal.

NOTE: Jeff Weiss, the founder of the "American Currents" blog, will be initiating a political program on TalkShowBlog.com, as a spinoff from his weekly Pop2Reality show, which regularly has more than a thousand listeners. I will be a commentator on the new program, which we have already taken for a test drive -- an excerpt or two may go online within the next 48 hours. I will note and link it from here when that happens.