National Edition

U.S. slips in world ranking as a great place to have a baby

Published: Wednesday, June 11 2014 4:20 a.m. MDT

Jennifer Fontaine kisses her baby daughter, Morgan, at her parents' home in Methuen, Mass. on Tuesday, Feb. 25, 2014. After Fontaine's standard prenatal screening suggested her fetus might have Edwards syndrome, a doctor suggested a fetal DNA test, which suggested her fetus was fine. A simple test that looks for fetal DNA in a pregnant woman's blood is far more accurate at detecting or ruling out Down syndrome and other common chromosome disorders than other screening methods used now, a major study finds.

Elise Amendola, Associated Press

America is slipping as one of the best places to be a mother.

New reports on women and children show that the U.S. has increasing rates of death and trauma due to pregnancy and childbirth, especially compared to European countries.

Somalia is the most difficult country to be a mother, according to a report by Save the Children. Mothers there face a one-in-seven chance of death in childbirth, while women in Finland, which ranked No. 1, have odds of one-in-12,000. The United States falls behind many developed and developing countries, ranking on par with Iran and Romania.

The U.S. is among just eight countries in the world to increase in maternal mortality since 2003 — joining Afghanistan and African countries, according to another report from the University of Washington.

"The U.S. piece was surprising," said Carolyn Miles, CEO of Save the Children. "When we first started doing this study 15 years ago, the U.S. was No. 4, now it has moved to 31."

Leapfrogging and lacking

Some countries have made improvements in the last decade, said Miles, and have "leapfrogged" over the U.S., but the U.S. has also "failed to improve" in some areas.

One of those areas is risk factors: American women are having babies older, having more C-sections and are more likely to have complications due to obesity and diabetes, she says.

The United States ranks third in the world for C-sections, where 30 percent of women have surgical deliveries, according to the World Health Organization. At least 10 percent of American C-sections were "unnecessary," according to the report.

Not all moms in the U.S. are getting equal treatment either, said Miles. In Scandinavia, where health care is universal and most everyone has access, moms fare very well. That's not the same in the United States.

"What is really striking in the U.S. is the inequality," said Miles. In the U.S. 18 mothers died for every 100,000 live births in 2013, which is double Saudi Arabia and Canada, where seven per 100,000 die. That number more than triples for black women in urban America, according to Miles.

"A black woman in New York has a worse mortality rate than a woman in Iraq," she said.

An ounce of prevention

Lack of access to prenatal care and complications from obesity and diabetes top the list of factors to blame for maternal mortality, according to the University of Washington study, but older mothers are not a main cause of the problem. The largest increase in deaths was in women aged 20 to 24.

So what could be causing young women to die in modern American hospitals? One possible factor, said Debra Bingham, vice president of research for the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), is the numbers can be skewed because it's only been in recent years that accurate numbers of maternal deaths have been reported.

"That's important, because if women don't matter enough to carefully count how many die giving birth that's a serious indicator," she said.

Aside from lack of access to care it's hard to pinpoint any one cause, but a rise in obesity and diabetes play a role. Obesity leads to higher risk of hypertension and C-section delivery because the birth canal can be obstructed, said Dr. Donna Harrison, and there's great chance for infection. "When bacteria gets in fat it multiplies more quickly," she said.

Debra Bingham is also concerned about trends to induce early delivery for "scheduling or convenience." AHWONN has launched a campaign called "Don't Rush Me, Let Me Go the Full Forty" to encourage women to complete a full 40 weeks of pregnancy before induction.

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