Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Are hospitals a dangerous place to have a baby?

Kaci Durbin, MD
Physician
June 21, 2017
1K Shares
Share
Tweet
Share

There has been a lot of talk lately about maternal mortality. A recent story published in ProPublica and NPR has been circulating social media, highlighting the problems with our labor and delivery system. The story is heartbreaking, describing a preventable postpartum death in a young, healthy mother. While the article makes many good points, I do believe it is misleading when it comes to the reasons maternal deaths are increasing in our country. Based on the data from the article, this particular case appears to be one filled with medical errors. Although the United States has work to do when it comes to improving safety for mothers, I do not believe this is what is driving the apparent increase in maternal mortality.

Many people have commented since the article was published; claiming that “all the technology” we have at our disposal is not working. We have advanced fetal monitoring, state of the art equipment, modern laboratory testing and medications. Moms should not be dying. While I agree that the goal maternal mortality should be zero, I do not believe that will ever happen. Labor and delivery is dangerous. Childbirth kills and it has killed for hundreds and thousands of years. Our technology is working. Despite what social media and your neighbor may tell you, a hospital is the safest place to be when you are having a baby. In 1915, according to published records, 608 out of every 100,000 mothers died during or shortly after giving birth. That is six out of every 1000 women, and honestly, the number was probably higher. Without strict reporting mandates, many maternal deaths were likely missed. Going further back and examining maternal mortality records in England (which were likely also underreported) the maternal death rate was approximately five per 1000 women from 1800-1899 and 10 per 1000 women from 1700-1750.3 That is 1 percent of women! 1% of women died while having a baby. Let that sink in for a minute.

Why was the ProPublica story so shocking? We don’t hear of women dying in childbirth anymore. It happens, but it is not as commonplace as it was a century or two ago. Pregnancy, labor and delivery are seen as happy times. Women do not think bad things can or will happen to them. People plan their labors like they are planning the party of the century. The “birth experience” is stressed over safety. Women write lengthy and detailed birth plans that often restrict the physicians and nurses’ ability to care for them. They risk themselves and their infants delivering at home or with an untrained professional. They choose birthing centers over hospitals. They decline fetal monitoring and intravenous lines and antibiotics. These women have never seen a term stillborn. These women have never seen a young, vibrant new mother die. These women hear stories like the one in ProPublica and tell themselves hospitals are a dangerous place filled with unnecessary interventions. They are better off at home having a nice “natural” birth.

Obviously, hospitals and technology are bad, right? Our maternal mortality rate, although down from 1915, is now increasing. Is it increasing? To be honest, our data stinks. We have likely been underreporting for years. In 18th- and 19th-century England, maternal mortality data was gathered from parish registries. In the United States before 1986, maternal mortality data was gathered from vital statistics, such as death certificates. Often these certificates did not specifically list whether or not that patient was pregnant, causing underreporting. Then, in 1986, the CDC started “requesting” that states report maternal mortality data. A little over a decade later in 1999, coding and classification of maternal deaths was improved via the revision of the International Classification of Diseases. In 2003, standard birth and death certificates were revised nationwide to capture more data. So although it looks like maternal death has been increasing dramatically, it is possible that much of that increase is due to increased and better reporting.

If you don’t buy that, let’s look at why maternal mortality might be increasing. To understand that, one first has to look at the cause of death. While our technology and medical advancements have saved countless mothers from dying of infection and postpartum hemorrhage, we have a new problem. Moms are not as healthy as they were a few decades ago. Mothers are obese, older and have more chronic health problems. Heart disease is now the number-one killer of mothers according to the CDC. 15.5% of maternal deaths recorded were due to cardiovascular disease and another 14.5% from noncardiovascular diseases. This number was nonexistent a century ago.

One can also see by examining the available data that mortality increases with increasing poverty and limited access to care. States with high poverty levels as well as states with high immigrant populations were shown to have an increase in maternal deaths. Women who are unable to receive adequate medical care have worse outcomes.

Bottom line: medicine works. Cases that make the mainstream news are often filled with stories of malpractice and medical errors. While these things to occur and everyone needs to work to prevent medical mistakes and misses, this is not what is driving the recorded maternal mortality increase. Many factors are at play. To say that the hospital is dangerous based on a case you read about on social media is akin to refusing to wear a seatbelt because you heard a story about a seatbelt leading to someone’s death. Has it happened? I’m sure it has at some point. Yet, I am still going to wear my seatbelt.

It amazes me that women still choose to ignore medical advice and deliver at home. After all “women have been doing it for thousands of years.” True, but many of them didn’t live to tell about it. If you want the home birth experience, you, unfortunately, have to accept the home birth mortality.

Kaci Durbin is an obstetrician-gynecologist.

Image credit: Shutterstock.com

Prev

Healthy eating can be funny. Watch how.

June 21, 2017 Kevin 0
…
Next

Want to fight burnout? Embrace the suck.

June 21, 2017 Kevin 4
…

Tagged as: OB/GYN

Post navigation

< Previous Post
Healthy eating can be funny. Watch how.
Next Post >
Want to fight burnout? Embrace the suck.

More by Kaci Durbin, MD

  • Online physician reviews: Patients are the ones who will suffer

    Kaci Durbin, MD
  • Doctors: You have a PR problem

    Kaci Durbin, MD

Related Posts

  • When hospitals are like prisons

    Christopher Blackman
  • Why the baby formula shortage happened

    Divya Srinivasan and Tejas Sekhar
  • How hospitals can impact generic drug companies

    Mark Kelley, MD
  • If you build a budget, hospitals will adapt

    Peter Ubel, MD
  • How hospitals are taking advantage of the 340B Drug Pricing Program

    Peter Ubel, MD
  • How hospitals drive up health costs

    Elisabeth Rosenthal, MD

More in Physician

  • Why write? Physicians share their stories of healing through writing.

    Kim Downey, PT
  • A doctor struggles to provide mental health care in Appalachia

    Ryan McCarthy, MD
  • Physicians are burned out. Could entrepreneurship be a cure?

    Arun Mohan, MD, MBA
  • The dark role of science, medicine, and tasers

    L. Joseph Parker, MD
  • Beyond K-pop and kimchi: Unraveling the mental health tapestry of Korean Americans

    Dae Sun Hwang, Thomas Pak, MD, and Joo-Young Lee, MD
  • Escape diagnostic rabbit holes with Markov chains

    Anonymous
  • Most Popular

  • Past Week

    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • The dark role of science, medicine, and tasers

      L. Joseph Parker, MD | Physician
    • From fishing licenses to gun control

      Mitch Bruss, MD | Policy
    • 3 key things to do before year end to reduce taxes

      Amarish Dave, DO | Finance
    • Tips for success as a plastic surgeon [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physicians turn feelings of frustration and powerlessness into purpose and hope

      Kim Downey, PT | Physician
  • Past 6 Months

    • Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

      Catherine L. Chen, MD, MPH | Physician
    • The erosion of compassion in medicine

      Daniel Luger, MD | Education
    • Emergency department burnout: a cry for change

      Anonymous | Conditions
    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • Pain medicine realities: beyond the opioid crisis

      Richard A. Lawhern, PhD and Stephen E. Nadeau, MD | Conditions
    • When medical protocol meets family concerns

      Richard Young, MD | Conditions
  • Recent Posts

    • Tips for success as a plastic surgeon [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why write? Physicians share their stories of healing through writing.

      Kim Downey, PT | Physician
    • A complex patient interviews a retired physician

      Ann McColl and James Whitlock, MD | Conditions
    • Navigating life’s crossroads: Change, accept, or leave [PODCAST]

      The Podcast by KevinMD | Podcast
    • A doctor struggles to provide mental health care in Appalachia

      Ryan McCarthy, MD | Physician
    • Burnout on the U.S.S. Enterprise

      Arthur Lazarus, MD, MBA | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 28 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Less-Frequent Surveillance Mammo Feasible in Older Breast Cancer Survivors
  • AI and Breast Cancer Screening; Cancer After Treatment for Sickle Cell
  • Yes, Conversion Therapy Efforts Still Exist in Medical Practice
  • Bilateral Mastectomy Not Tied to Better Survival in BRCA1-Positive Breast Cancer
  • FDA Inspections of Foreign Drug Manufacturers Haven't Bounced Back After Pandemic

Meeting Coverage

  • Less-Frequent Surveillance Mammo Feasible in Older Breast Cancer Survivors
  • Bilateral Mastectomy Not Tied to Better Survival in BRCA1-Positive Breast Cancer
  • Is Omitting Radiation Therapy in Low-Risk Breast Cancer a Good IDEA?
  • Study Supports ADC as a New Option for Endocrine-Resistant Metastatic Breast Cancer
  • Maintenance Pembrolizumab-Olaparib Fails to Boost Survival in TNBC
  • Most Popular

  • Past Week

    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • The dark role of science, medicine, and tasers

      L. Joseph Parker, MD | Physician
    • From fishing licenses to gun control

      Mitch Bruss, MD | Policy
    • 3 key things to do before year end to reduce taxes

      Amarish Dave, DO | Finance
    • Tips for success as a plastic surgeon [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physicians turn feelings of frustration and powerlessness into purpose and hope

      Kim Downey, PT | Physician
  • Past 6 Months

    • Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

      Catherine L. Chen, MD, MPH | Physician
    • The erosion of compassion in medicine

      Daniel Luger, MD | Education
    • Emergency department burnout: a cry for change

      Anonymous | Conditions
    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • Pain medicine realities: beyond the opioid crisis

      Richard A. Lawhern, PhD and Stephen E. Nadeau, MD | Conditions
    • When medical protocol meets family concerns

      Richard Young, MD | Conditions
  • Recent Posts

    • Tips for success as a plastic surgeon [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why write? Physicians share their stories of healing through writing.

      Kim Downey, PT | Physician
    • A complex patient interviews a retired physician

      Ann McColl and James Whitlock, MD | Conditions
    • Navigating life’s crossroads: Change, accept, or leave [PODCAST]

      The Podcast by KevinMD | Podcast
    • A doctor struggles to provide mental health care in Appalachia

      Ryan McCarthy, MD | Physician
    • Burnout on the U.S.S. Enterprise

      Arthur Lazarus, MD, MBA | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Are hospitals a dangerous place to have a baby?
28 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...