The rise in US maternal mortality: the cause will surprise you

Mother Headstone

Recently, two important papers were published that shed a great deal of light on a previously murky topic, the US maternal mortality rate.

Up to this point the observed increase in maternal mortality has been difficult to parse because the new US death certificate, redesigned to capture more instances of maternal death, was only gradually adopted by the states. Is the observed incidence real or simply the result of better record keeping? A superb analysis by MacDorman et al. makes it clear that the increase is real,  albeit only a fraction of the apparent rise.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The women most in need of highly technological medical care are failing to get it.[/pullquote]

But, as another study makes clear, the rise in US maternal mortality is NOT the result of poor medical practice or overuse of medical technology. Maternal mortality is closely tied to race and socio-economic status. Often the women most in need of highly technological medical care are failing to get it.

The MacDorman study is entitled Is the United States Maternal Mortality Rate Increasing? Disentangling trends from measurement issues.

Studies based on data from the 1980s and 1990s identified significant underreporting of maternal deaths… To improve ascertainment, a pregnancy question was added to the 2003 revision of the U.S. standard death certificate…

However, there were delays in states’ adoption of the revised death certificate … This created a situation where, in any given data year, some states were using the U.S. standard question, others were using questions incompatible with the U.S. standard, and still others had no pregnancy question on their death certificates.

Due in part to the difficulties in disentangling these effects, the United States has not published an official maternal mortality rate since 2007…

Now that the standard has been adopted in all states, the authors were able to correct the data to take into account previous underreporting during the years before an individual state adopted the revised death certificate standard.

What did they find?

Most of the observed increase in US maternal mortality can be ascribed to changes in the death certificate, but not all.

…[C]ombined data for 48 states and DC showed an increase in the estimated maternal mortality rate from 18.8 in 2000 to 23.8 in 2014 – a 26.6% increase.

The authors conclude:

Clearly at a time when WHO reports that 157 of 183 countries studied had decreases in maternal mortality between 2000 and 2013 (21), the U.S. maternal mortality rate is moving in the wrong direction. Among 31 Organization for Economic Cooperation and Development (OECD) countries reporting maternal mortality data, the U.S. would rank 30th, ahead of only Mexico.

Curiously the authors did not address perhaps the most pressing question about US rank. They’ve just shown that prior to the changes in the death certificate, the US failed to capture a substantial portion of maternal deaths. We were ranked higher internationally then because we weren’t providing accurate statistics. Yet the authors assume that maternal mortality rates in all other countries are accurate. Is that assumption justified? Have we fallen in international rankings simply because our maternal mortality statistic are more accurate than other countries? I’m not familiar enough with the individual maternal mortality assessments in other countries to answer that question, but perhaps they are.

The increase, however, is real and that is deeply troubling. What’s going on?

To answer that question, Amirhossein et al. compared maternal mortality rates by state in a just published study, Health Care Disparity and State-Specific Pregnancy-Related Mortality in the United States, 2005–2014.

They found tremendous variation in mortality rates between states.

…There was a significant correlation between state mortality ranking and the percentage of non-Hispanic black women in the delivery population. Cesarean deliveries, unintended births, unmarried status, percentage of non-Hispanic black deliveries, and four or less prenatal visits were significantly (P<.05) associated with increased maternal mortality ratio.

As the authors explain:

Although the United States has a higher rural population than many European nations, such factors are present to an even greater degree in Canada, which is even more rural, yet has a maternal mortality ratio of 10 per 100,000 live births.Furthermore, our data failed to identify a statistical correlation between statewide maternal mortality and either rural status or poverty.

Immigration has also been cited as a factor in this trend. However we found lower mortality for Hispanic women who make up the majority of recent immigrants…

The high U.S. cesarean delivery rate has also been invoked as an explanation for increased mortality, yet our data demonstrate only a weak correlation of mortality with cesarean delivery. Furthermore, previous work has demonstrated that this correlation does not reflect causation—the overwhelming majority of maternal deaths associated with cesarean delivery is a consequence of the indication for the cesarean delivery, not the operation itself.

Although medical factors such as hypertensive disease, diabetes, tobacco use, and obesity have been shown to be correlated with increased maternal morbidity, statewide population differences in rates of these conditions were not significantly correlated with mortality ratios.

Not surprisingly, the authors conclude:

First, states that may pride themselves on the intrinsic quality, leadership, organization, and funding of obstetric health care in their state based on national maternal mortality ratio rankings must realize that in many instances, such favorable rank simply reflects a different proportion of non-Hispanic black patients in the population rather than intrinsically superior medical care

Second, health care statistics that do not adjust for these important demographic factors are of little significance in judging the intrinsic quality of available health care in an individual state. Most importantly, these data strongly suggest that racial disparities in health care availability, access, or utilization by underserved populations are important issues faced by states in seeking to decrease maternal mortality. Ethnic genetic differences may also be involved. In addition, the potential role of unconscious (implicit) bias in this significant racial disparity must be considered. (my emphasis)

A startling example:

We note that although Washington, DC, has the highest maternal mortality ratio in the nation, non-Hispanic white patients in this district have the lowest mortality ratio in the United States. Excellent care is apparently available but is not reaching all the people.

These findings have important implications for international rankings that don’t adjust for demographic factors. The US has the highest proportion of non-Hispanic black women of any industrialized country. Our relatively poor ranking on maternal mortality may have little to do with the quality of US obstetric care and depend largely on access to it.

The rise in US maternal mortality may be much smaller than it originally appeared, but it is rising nonetheless and that calls for a vigorous response. We need to ensure that the women most likely to die from pregnancy related causes have access to the care that prevents maternal deaths.

149 Responses to “The rise in US maternal mortality: the cause will surprise you”

  1. MWguest
    September 27, 2016 at 10:42 am #

    And this:

    A woman dies of massive PPH after an unassisted home birth with twins, but it was “the system’s” fault. It’s stunning how these natural birth supporters make maternal death not the fault of foolish and reckless decisions and ideology – but of the “system” that won’t support them!

    It is highly unlikely this woman would have died in a hospital.

    • MichelleJo
      September 27, 2016 at 11:30 am #

      It’s clear that the mother died, but I just don’t understand the rest of the stuff she wrote. She is powerless over birth, and then it was because no-one knows how to treat PPH, only hospitals know… I give up. Not worth the time to work it out. Has she offered to help the father who has been widowed because of people like her waffling on absolute nonsense.

      • kilda
        September 27, 2016 at 11:50 am #

        from what I could see, her point was that the hospital made a terrible mistake by separating her from the babies. She thinks that if midwives had been there, they would have kept her with her babies and kept the oxytocin flowing with skin to skin contact and nipple stimulation, and that would have resolved the hemorrhage.

        And that it’s all the fault of the hospital/medical establishment because if they would have supported her desire for a vaginal birth they wouldn’t have gone unassisted.

        Which is sort of like a blind person saying “Since the state won’t give me a driver’s license for no good reason, I have no choice but to drive without a license!” Or “since no one will sell me a parachute to jump off that building, I have no choice but to jump off without one!”

        • corblimeybot
          October 1, 2016 at 7:46 pm #

          There are some other mothers who I know, who I don’t bother talking to anymore. Because they all think that if the “medical establishment” doesn’t give them the ass-kissing birth that they want, it’s clearly the medical establishment’s fault if someone dies at one of their idiot homebirths.

        • Daleth
          October 3, 2016 at 11:36 am #

          from what I could see, her point was that the hospital made a terrible mistake by separating her from the babies

          I wish there were comments allowed on her page so people could rip her a new one for her dangerous ignorance. My god, if you have a PPH at home and have to be rushed to the hospital, you’d be lucky to survive at all–the time it takes to get to medical care is easily long enough to die.

        • AA
          October 3, 2016 at 11:50 am #

          The mother was hemorrhaging so severely that she had to be resuscitated upon arrival at the hospital. Yet the writer wants to focus on the “mama-baby syste.” as an alternative to the Big Bad Hospital System. Writer has a business working as a childbirth educator. Sick.

    • AA
      October 3, 2016 at 11:03 am #

      “I spoke to numerous midwives and learned what they would do in
      the face of the great H: Hemorrhage. This is information from people
      who focus on how to support the mama-baby system to stop bleeding first
      and foremost. Only as a last ditch effort do they apply heroic techniques that take
      the system over. I think this wisdom should be spread far and wide!”

      A woman DIES and her takeaway message is that “heroic measures” should be last resort?

      • Azuran
        October 3, 2016 at 11:51 am #

        Even worst. A woman died, and she’s saying that they should teach people to avoid the measures that would have saved her life.

      • Squillo
        October 3, 2016 at 1:55 pm #

        Funny, but the CA guidelines issued to improve maternal mortality rates note that early, effective treatment is essential. They specifically recommend not spending time on treatments that don’t seem to be working; in other words, don’t wait to apply “last-ditch” efforts: if a shot or two of Pit (or whatever the first-line tx is) doesn’t work well immediately, be ready to transfuse and/or go to OR immediately afterwards.

        Or, to put it another way, Just Stop the Fucking Bleeding Now.

      • Daleth
        October 3, 2016 at 2:29 pm #

        She’s an idiot beyond words.

        That said, I do wonder why no hospital would let the mother attempt a VB. Where was she? When I was expecting mono-di twins (which are much higher risk than the more common type of twins, di-di), my MFM’s kept pressuring me to attempt a VB, and I didn’t even have a “proven pelvis” (the twins were my first babies). I insisted on a scheduled CS. With mono-di twins you have to labor in an operating room in case an emergency CS is needed, so I guess mono-di VB is only available in a high-resource hospital, but most twins are fraternal (so by definition not mono-di) and I think it’s only mono-di moms who are advised/required to labor in an OR.

        Just wondering if she was in a low-resource area, or if she had complications beyond twin pregnancy alone that made doctors unwilling to take the risk of attempted VB.

        • guest
          October 3, 2016 at 5:38 pm #

          There’s a line in the write-up of the birth that the twins shared a placenta, which would make them mono-di or even mono-mono (she never mentions whether they shared an amniotic sac or not). I’m assuming neither twin was breech since the first one was born within half an hour of labor starting and the second five minutes later, but who knows. We have a dearth of medical information and a whole lot of stupid speculation on the part of the natural birth warrior friend.

          • Daleth
            October 4, 2016 at 2:02 pm #

            Oh, so this mom had the same complication I did after birthing mono-di twins: massive PPH because wombs with near-term twins in them are stretched beyond belief and mono-di placentas are very often HUGE, so when they detach from the uterine wall, massive bleeding occurs? I wonder why I didn’t die? Oh right–because I was already in the hospital, with an IV port in my hand “just in case,” when the hemorrhage started. And I was on monitors, so as soon as my blood pressure tanked a team of doctors and nurses burst into my room, RUNNING.

            So I only went into hypovolemic shock after losing 25% of my blood, whereas she died and left her babies motherless.

            This is why we have “interventions,” people. So that women and babies live who would otherwise have died.

  2. New Mom
    September 26, 2016 at 1:05 pm #

    Slightly OT: I haven’t seen any data on this, but I’m sure increasingly limited access to abortion doesn’t help. Even if there is a clinic near by, it can be cost prohibitive.

    The moral high-horse is a LUXURY many people can’t afford.(not that I think there’s anything immoral about abortion)

    • Roadstergal
      September 27, 2016 at 12:50 pm #

      Both abortion, and affordable and accessible contraception.

      • Casper
        September 27, 2016 at 5:42 pm #

        ‘Cause…condoms are impossible to find, and not readily available at Target, Walmart, Walgreens, Rite-Aid, CVS, etc. etc. etc. etc?

        • demodocus
          September 27, 2016 at 5:43 pm #

          A) condoms break more easily than iuds or the pill
          B) Some men refuse to wear them and the woman may not be able to tell him no, or he won’t listen.

          • Casper
            September 27, 2016 at 5:44 pm #

            Women need to get a backbone…just sayin’…

          • demodocus
            September 27, 2016 at 5:47 pm #

            Easy for an outsider to say, but if she’s being emotionally abused and manipulated, it’s very difficult to “get a backbone”

          • Casper
            September 27, 2016 at 5:49 pm #

            Yes – – she’s probably living in poverty as well. There are about a million problems right there. That doesn’t mean, though, that anyone who wants to buy a box of condoms finds it impossible.

          • Azuran
            September 27, 2016 at 6:38 pm #

            And what do you have against making more effective and easier means of contraception more available to women?

          • Casper
            September 27, 2016 at 7:00 pm #

            Oh, I think the unavailability and expensiveness of contraception is exaggerated. Like I said, most anybody can find it at Target, Walmart, etc. And now since everyone has / is supposed to have health insurance, other forms can be accessed at the doc.

          • swbarnes2
            September 27, 2016 at 7:19 pm #

            What people are supposed to have access to, and what they actually have access to can be two very different things.

          • Azuran
            September 27, 2016 at 7:36 pm #

            You really need to get out more if you think that everyone has health insurance and affordable access to a doctor and prescription contraception.
            They should, but they don’t.
            And lets not even start with the HORRIBLE sex ed in the USA. How are people supposed to get proper contraception if they don’t even know it exist?

          • Casper
            September 27, 2016 at 7:40 pm #

            Hmmm.Why do people *need* prescription contraception?

          • Azuran
            September 27, 2016 at 7:41 pm #

            Because they don’t want to get pregnant.
            Why should condoms be the only available option? We have many others, more reliable and easier to use form of contraception. Why shouldn’t people have the right to use them?

          • Casper
            September 27, 2016 at 7:44 pm #

            They’re not the only available option. I never said they were. They are the most easily available option. If people want another option, then yes, they are going to have to go to a medical provider. They have the right to get them, but they have to make an effort, same as going to the doc for any other medical reason (flu shot, sinus infection, pinkeye, etc.). I never said people don’t have the right to use them. It just takes a bit of effort.

          • Azuran
            September 27, 2016 at 7:51 pm #

            What you fail to understand is that for some people, it requires more than ‘a bit of effort’
            In some places, getting a doctor’s appointment can take months. People might not have health insurance (because no, not everyone in the US is covered) They might have shitty insurances with high copay that they cannot afford. They will need to take a day off that they cannot afford to take or cannot even take because they might lose their job in order to go to the appointment, they might not have a mean to physically get to a clinic.
            You think the answer is ‘well they can use condoms’ Well, guess what, people in those situations are also most likely the ones who lack the proper education about properly using those. And they still have a chance of failure. And when they fail, those same people are unable to either get an abortion or proper medical care.

          • Casper
            September 27, 2016 at 7:56 pm #

            Oh dear! How do these folks get through life in general? How the hell do they do their tax forms? How do they get a job to begin with? How do they land somebody by whom they might get pregnant? In the meantime, since it’s damn near impossible for them to get prescription contraception, what are they gonna do? !

          • Azuran
            September 27, 2016 at 8:02 pm #

            You really need to check your privilege.

          • Casper
            September 27, 2016 at 8:04 pm #

            People living in poverty have difficult lives. If they don’t have access to medical care, their lives are even worse. Let’s not just pretend it’s all about contraception – – it’s so much more. Now with the ACA, why don’t people living in poverty have access to medical care?

          • Azuran
            September 27, 2016 at 8:13 pm #

            Because even with the ACA, many people still cannot register for it, or fall in cracks of the system, or make just enough money to not be able to register, but not enough to pay for other form of insurance, or can only afford shitty ones.
            And that still doesn’t help them actually getting to an appointment in a clinic if they can’t afford to take an unpaid day off, don’t have a car and no access to public transportation.
            Is contraception the only problem of poverty, of course not. But ending up with an accidental pregnancy is a very effective way to ensure you are never getting out of it.

          • Casper
            September 27, 2016 at 8:22 pm #

            So, better to just use a condom, yes?

          • Azuran
            September 27, 2016 at 8:31 pm #

            No, better make all contraception methods more available to everyone.
            Even with perfect use every single time, condoms alone still have a 2% pregnancy rate per year. But when used in the real world, by real people, the risk of pregnancy can get much higher.

          • Casper
            September 27, 2016 at 8:33 pm #

            More available? There are actual medical reasons that a doc has to fit / prescribe these, yes?

          • Azuran
            September 28, 2016 at 8:04 am #

            You act like it’s the moon. It’s not rocket science, just make medical access more available, like by not allowing hobby lobby to stop covering contraception in their health care plan, and stop doing dumb stuff like defunding planned parenthood over fake pro life propaganda.

          • Sonja Henie
            October 3, 2016 at 4:59 pm #

            Please educate yourself on these issues.
            “The Obama administration on Friday announced rules that will allow women to get birth control at no cost, even if they work for employers that don’t provide it because of religious objections.

            The rules put forward by the Department of Health and Human Services allow religious nonprofits and some for-profit companies to notify the federal government about their religious objections and to request opting out of providing coverage for contraceptives. The agency then will notify health insurance companies, and enrollees in the plans will receive separate payments for contraceptive services. There will be no additional cost to the employer or the employee.”

          • Roadstergal
            October 4, 2016 at 2:15 pm #

            Yes, there was that. And then there was Zubik v. Burwell, where the litigants didn’t want to sign that bit of paper saying sluts don’t get no contraception through them, because then they would be able to get contraception anyway and that offended the litigant’s Sincerely Held Religious Beliefs. And that one has been punted, so that form of denial is presumably still going on.

            So, no, it’s just not that easy.

          • Sonja Henie
            October 4, 2016 at 3:21 pm #

            I agree. It’s hopeless. We should just quit trying.

          • Roadstergal
            October 4, 2016 at 3:23 pm #

            As I noted above, that’s the exact opposite of what I’m saying.

            We have pilots that give contraception directly to women that work great. They should be funded.

          • Sonja Henie
            October 4, 2016 at 4:33 pm #

            You don’t understand sarcasm, or frustration.

          • Bombshellrisa
            September 27, 2016 at 8:37 pm #

            The failure rate with typical use is too high for most people to feel comfortable relying on. It does depend on the situation, someone who is planning on having other children might be comfortable with that rate since they are prepared to have more kids anyway. For someone who knows that they won’t be ready to have a child or other children for years, a condom wouldn’t be a reasonable form of birth control.

          • Sonja Henie
            October 3, 2016 at 4:55 pm #

            Please stop with this dis-information about contraceptive coverage of US insurance.

          • Nick Sanders
            October 3, 2016 at 5:09 pm #

            They’re poor, not stupid.

          • Sonja Henie
            October 3, 2016 at 4:54 pm #

            If you have insurance, including Medicaid, you’re covered 100%. The rest, yes, is true.

          • Azuran
            October 3, 2016 at 8:54 pm #

            as you said ‘If’
            Not everyone is covered.

          • Sonja Henie
            October 3, 2016 at 9:19 pm #

            True, that. However, that’s much different than saying that your insurance might not cover contraception.

          • Charybdis
            October 3, 2016 at 12:26 pm #

            You can need prescription contraception for other reasons than just preventing pregnancy. Regulating irregular periods, lightening very heavy periods, cramp reduction, hormone imbalances/swings, PCOS, things like that. Sometimes the birth control facet is not the primary reason women use prescription contraception, as it has other uses.

          • Wren
            October 3, 2016 at 12:30 pm #

            In fact, until I was married I always used another method alongside the pill. I used the pill for other reasons the vast majority of the time I used it.

          • guest
            September 27, 2016 at 7:57 pm #

            Hmmm, why do trolls pretend they don’t know very well the reasons why?

          • Casper
            September 27, 2016 at 7:58 pm #

            Rhetorical question! Look it up!

          • Charybdis
            September 27, 2016 at 8:00 pm #

            Because the prescription contraception options are far and away the most effective and reliable. And most women are not wanting to risk getting pregnant by using less effective methods, but may not have any choice in the matter, especially where cost is a factor.

          • Sonja Henie
            October 3, 2016 at 4:42 pm #

            Are you a US citizen living in the states Azuran? Because I got the idea from somewhere that you live in the UK.

          • An Actual Attorney
            October 3, 2016 at 6:49 pm #

            There are still plans not covered by this. And many places in the US where you just can’t get to a prochoice provider who would prescribe.

            And that brou-ha-ha you mention sort of proves the point. Rush said, and apparently his many many followers believed, that a woman would only need to take a pill each time she had sex, so the only reason to take a pill every day was because a woman was a slut having sec every day.

          • Sonja Henie
            October 3, 2016 at 6:54 pm #

            The only plans not covered by the ACA are the plans that were grandfathered in in 2010, which are very few.

            I don’t know what point you think Limbaugh proves other than he’s ignorant.

          • An Actual Attorney
            October 3, 2016 at 6:59 pm #

            It proves that our sex ed in this country sucks eggs if enough people believed it that he got traction. I actually don’t think he’s ignorant: I think he laughs all the way to the bank. But he could run with that stupid idea because all those people who listen to him thought he made sense.

          • Sonja Henie
            October 3, 2016 at 7:07 pm #

            Oh, for God’s sake! What is your experience with sex ed in the US?

          • An Actual Attorney
            October 3, 2016 at 7:16 pm #

            Me? I’m an American. I had sex ed in America. It sucked. Almost everyone I know had sex ed in America. Of those, almost everyone says their sex ed sucked. All our kids have sex ed in America. It’s bad. People I know talk about sex a lot, because sex is interesting. And lots of people don’t know lots of basics. I’ve had sex with more than my share of Americans, and a lot of them were stupid when it came to what happened one the sperm was spilt.

            What is your omniscient experience? Why does it trump mine? Or the obvious reality that Rush Limbaugh didn’t understand (or pretended not to) the very basics of how birth control pills work — and he made a lot of hay doing so. Or that Hobby Lobby which took the ACA to SCOTUS based its entire argument on a misunderstanding of how birth control and abortion work, and almost no one noticed?

          • Sonja Henie
            October 3, 2016 at 7:33 pm #

            Can the snark for starts.

            My “omniscient experience” is my kids’ experience in high school. They had a great program, 10-15 years ago.

            Yes, I think Limbaugh was just pretending. So did a lot of other people, IMO.

            I think Hobby Lobby was wrong, but the feds did find a way to work around the SCOTUS decision. Almost no one noticed? I get 160,000 hits about it on Google. It was on all the major networks, in all the political magazines-msnbc,WaPo, ABC, Politifact, CNN, LA Times, HuffPo,NPR, US News, Fox News, Mother Jones, USA Today, Christian Science Monitor, New Republic, Time, Newsweek, The Daily Beast and many others.

            Why are you so hostile?

          • An Actual Attorney
            October 3, 2016 at 7:41 pm #

            Why are you? Pointing out you are wrong is not hostile.

            I’m glad your kids’ experience, in one high school, maybe two or three, was great. But you don’t speak for all Americans. And maybe I’m mad because so much American sex ed sucks so much, and lives get destroyed because of it.

            My comment about Hobby Lobby wasn’t about the fact of the case, but about that they got the facts about how bc works wrong, which got barely any press. You get those google hits for the case itself, and that a lot of people think it was wrongly decided. You didn’t seem to understand what I was saying, or perhaps I was not clear.

            While we’re on the subject, for others who want to be amused about how bad typical sex ed is in the US, I recommend Alice Dreger’s tweet storm. Her views on NCB notwithstanding, I nearly peed myself laughing so hard.
            It’s worth looking up the whole thing.

          • Sonja Henie
            October 3, 2016 at 7:50 pm #

            If you don’t think the term “omniscient experience”isn’t hostile when asking me about my experience in sex ed is hostile, you have another think coming.

            How do you KNOW that “so much American sex ed sucks so much”? What is your expertise in this area?

            So this Alice Dreger’s kid’s school had a speaker on abstinence only. A lot of schools do that to give “equal time”.

          • JoeFarmer
            October 3, 2016 at 8:08 pm #

            “If you don’t think the term “omniscient experience”isn’t hostile when
            asking me about my experience in sex ed is hostile, you have another
            think coming.”

            Agree 100%.

            “So this Alice Dreger’s kid’s school had a speaker on abstinence only. A lot of schools do that to give “equal time”.”

            I scanned a little bit of her tweet storm and it was pretty hilarious!

            What was the name of that group that was pushing the whole abstinence pledge thing a few years ago with dads giving their teenage daughters “purity rings”. A major face-palm concept…

          • KeeperOfTheBooks
            October 3, 2016 at 8:20 pm #

            For the little it’s worth, DH and I belong to a religion that considers sex before marriage a no-no for a variety of reasons, and we both still want to vomit at the whole Dad-giving-daughter-a-purity-ring thing. BLEARGH.

          • JoeFarmer
            October 3, 2016 at 8:24 pm #

            Ya, that whole thing struck me as creepy and weird, besides the obvious of never having the slightest chance of being effective.

          • KeeperOfTheBooks
            October 3, 2016 at 9:07 pm #

            Precisely. It’s creepy to the Nth degree.

          • Sonja Henie
            October 3, 2016 at 9:10 pm #

            I can’t remember. I do recall it didn’t work too well. I can see stressing abstinence “for now” for the younger kids.

          • JoeFarmer
            October 3, 2016 at 9:29 pm #

            I agree, but with every generation, physical maturity seems to come earlier. Our little one (who we are raising on behalf of a completely irresponsible extended family member) is in 6th grade and is way, way more worldly than my wife or I were at that age. More worldly than our kids were even, too. And it was scary how worldly our kids were at the time.

            We’re more of the, “you own your body” school of thought not because it’s new-agey, but telling an 11-year-old, “no” just because is as about as effective as telling a 15-16-year-old, “no” just because, a generation ago.

          • Sonja Henie
            October 3, 2016 at 9:42 pm #

            This link is from 2003, but it does show that the age of menarche hadn’t changed much over the previous 30 years.

          • JoeFarmer
            October 3, 2016 at 10:01 pm #

            That’s somewhat comforting to know, thanks. It could just be my wife and me getting old. But when your 5th grader comes home and throws out a couple tampon jokes…

            It’s good we have more open communication these days. One of my early jobs was working at a drug store and we’d get in trouble if we didn’t double-bag the feminine hygiene products. Which made me laugh at the time, but it was serious bidness.

            As hard as I try to keep up, I’m probably suffering from generation gap. But our boys, who have become de facto uncles, had the same WTF look as I did when a number of the 5th grade girls wore heels to the elementary school graduation ceremony. So there’s that…

          • Sonja Henie
            October 4, 2016 at 10:18 am #

            I got my first pair of heels in 6th grade, for my grandmother’s funeral.

          • FormerPhysicist
            October 4, 2016 at 1:17 pm #

            Yeah, well how about when your 5th-grader comes home and needs a tampon. So, I prefer that 5th-graders know about them.
            (And, yes, if you are on swim team you do need one with more than the lightest spotting.)

          • Erin
            October 4, 2016 at 1:40 pm #

            I did a lot of babysitting as a teenager (awesome form of contraception btw) and one of the little girls I looked after started her periods at 7. She understandably thought she was bleeding to death and worse, was ashamed of it.

          • FormerPhysicist
            October 4, 2016 at 2:06 pm #

            That’s horrid.

          • Erin
            October 4, 2016 at 3:16 pm #

            It broke my heart.

          • Michael McCarthy
            October 3, 2016 at 8:16 pm #

            and a lot of them were stupid when it came to what happened one the sperm was spilt.

            Speaking of stupid. When do sperm split?

          • An Actual Attorney
            October 3, 2016 at 8:19 pm #

            Spilt, not split. Probably a poor attempt to sound more high class in a comical way. Spilled, that is post ejaculation. Bad comedy I readily cop to.

          • Michael McCarthy
            October 3, 2016 at 8:48 pm #

            my bad.

          • JoeFarmer
            October 3, 2016 at 8:29 pm #

            LOL! Not much biology pre-req for lawyering these days…

            I’m sure there’s some variation on an old banana joke in there somewhere…

          • Bombshellrisa
            October 3, 2016 at 9:08 pm #

            One of the programs in our local public school system is a workshop for girls only. A feature of that workshop is a part where women who had sex before marriage talk to the audience about their shame in what they did and encourage the girls in the workshop to be “women of grace” and abstain from sex until marriage. No equivalent workshop is held for boys and the current sex ed program is abstinence only. It should be noted that many of the parents don’t allow their kids to attend the school sex education classes and prefer to teach their kids about sex at home.

          • Sonja Henie
            October 3, 2016 at 9:17 pm #

            That does sound pretty awful. My kids’ program did stress that the only way to totally avoid the risk of pregnancy was abstinence, but they discussed the whole gamut.

            There is no national sex ed program. Each district has their own. Some states require it, some don’t. Some allow opt-outs.

          • Nick Sanders
            October 4, 2016 at 3:16 pm #

            The only sex ed I remember getting was a couple of days in middle school health class where they showed us slides of advanced stages of untreated STDS while telling us that was what could happen if we had sex. Nothing about how to use contraceptives, how pregnancy worked, or even how to talk to a doctor about sex in any way. Just “If you think you want sex, remember these horrible pictures of crotch rot”.

          • Charybdis
            October 4, 2016 at 5:05 pm #

            Mainly, that if you don’t talk about it at all and insist that abstinence is the only sex-ed class allowed in school, then kids won’t have sex. Cast it as “self-respect” and “purity until marriage” and toss some fundamental religious overtones on it. The old “you want to give yourself to your marriage partner as a fresh piece of chewing gum, just unwrapped after the wedding, not a flavorless, already-been-chewed-by-one-or-more-people piece of gum” tripe. The “protect your whole heart so you can give your whole heart and body to your marriage partner” tripe. Sex outside of marriage makes you a sinner, unclean and unworthy.
            Now, I live smack dab in the Bible Belt, Oklahoma, to be specific.

            We will only have ONE insurer in the healthcare marketplace/exchange for 2017 and they are raising their rates by 76%. As for the Medicaid expansion, that was shot down and a further 25% reimbursement rate cut is on the line because of the lack of federal funding from ACA.

            Being in the middle of fundamental
            Christian mindsets here, there is a lot of flak for Planned Parenthood and making birth control difficult to get.
            A minor can get a prescription for birth control without a parent’s permission, under one or more of the following situations:

            is married
            is or has ever been pregnant
            All other minors must get a parent’s permission to receive a prescription for birth control. Additionally, physicians may (but are not required to) inform minors’ parents/guardian, even those who fulfill one or more of these situations.

            If you go to a Title X clinic, your appointment will be completely confidential, including your billing and your records.
            Title X clinics provide sexual and reproductive health care to the public (girls, boys, teens and adults). Title X clinics offer many services, including prescriptions for the Pill, pregnancy option counseling, and testing for pregnancy and sexually transmitted infections, including HIV.
            These clinics charge on a sliding-scale fee basis, and you can pay in cash. If you pay for your visit by using your family’s health insurance, then your parents are likely to see the bill when it arrives in the mail.

            To make sure your visit is confidential, tell the clinic staff how to contact you about test results and future appointments without your parents knowing.

            Find a Title X clinic near you here or call 1-800-230-PLAN (7526) for the nearest Planned Parenthood Health Center.

            In the eyes of the law, teenagers of certain ages cannot consent or agree to sex until they reach a specific age. This is called the “age of consent.” These laws are meant to protect minors from being manipulated or forced into sex with older people.

            Get familiar with these laws, so you and your partner know what is or isn’t legal in your state. Keep in mind that the laws may be different depending on the type of sexual behavior—vaginal, anal or oral—and the gender of your partner.

            In Oklahoma, you can legally consent to sexual intercourse when you become 16 years old.

            Sex ed Rights
            Oklahoma state law does not require sexuality education. Local school boards decide whether or not to teach sex ed, which subjects this education must cover and the grade level in which topics are introduced.
            If sexuality education is taught, then abstinence must be covered and stressed as the only completely effective protection against unplanned pregnancy, sexually transmitted diseases, and HIV/AIDS.
            Teaching about contraceptives, such as condoms, the Pill, or the Patch, is not required.
            Oklahoma chose not to receive federal funds for abstinence-only-until-marriage programs in the Fiscal Year 2010.
            HIV/AIDS and Other STDs Education

            Oklahoma state law requires STDs and HIV/AIDS education.
            The information provided must be medically accurate.
            Abstinence must be taught as the only completely effective protection against unplanned pregnancy, sexually transmitted diseases, and HIV/AIDS when transmitted sexually.
            Teaching about contraceptives, such as condoms, the Pill, or the Patch, is also required.
            HIV/AIDS education classes are required to teach teens “among other things, engaging in homosexual activity is primarily responsible for contact with the AIDS virus.” Think this law is discriminatory? Check out the Gay, Lesbian, and Straight Education Network (GLSEN) website to see how you can help change this policy.
            Although notified, you do not need your parents’ permission to participate in sexuality education or HIV/AIDS education classes. But your parents can take you out of the classes if they object to what is being taught.

            So yeah, effective contraception can be a bitch to obtain, no matter what the ACA says.

          • Roadstergal
            October 4, 2016 at 2:26 pm #

            When my OB installed my Implanon, she mentioned that you needed to have a separate training on installation and removal. I live in the Bay Area, so I haven’t had trouble finding someone to do it, but is it harder to get LARC in areas where there aren’t a lot of providers?

            And does ACA cover it? They’re generally more expensive than oral contraceptives, in my experience…

            I don’t pretend LARC is the end-all-be-all for contraception, but the reality is that the poorer you are, the more vulnerable you are to not being able to get refills for an oral contraceptive, missing a dose, having your kids flush them down the toilet for funsies, having a partner steal them, etc. And for teens, if the parents don’t approve, it is REALLY HARD to even get an appointment and/or get to the pharmacy for a pickup/refill, so if you can have a ‘one and done’ for 3-5 years, you’re going to have less risk of unwanted pregnancy.

          • Roadstergal
            October 4, 2016 at 2:01 pm #

            Unless providing you with contraception would violate your employer’s Sincerely Held Religious Beliefs.

          • Sonja Henie
            October 4, 2016 at 3:17 pm #

            Again, untrue. The HHS figured out a way around that. I posted a link yesterday. Here it is again:
            “The rules put forward by the Department of Health and Human Services
            allow religious nonprofits and some for-profit companies to notify the
            federal government about their religious objections and to request
            opting out of providing coverage for contraceptives. The agency then
            will notify health insurance companies, and enrollees in the plans will
            receive separate payments for contraceptive services. There will be no
            additional cost to the employer or the employee.”

            It really looks like you’re trying to find reasons why people can’t avail themselves of contraceptive services instead of trying to help them find such care.

          • Nick Sanders
            October 4, 2016 at 3:18 pm #

            And have you seen the number of people that lost their shit over that ruling and vowed to stop those rider plans from happening? Including a number of employers and state legislators.

          • Sonja Henie
            October 4, 2016 at 3:19 pm #

            Ok, let’s just stop trying to help people get contraceptive services. It’s obvious (from these posts) that it’s hopeless! /s

          • Nick Sanders
            October 4, 2016 at 3:20 pm #

            I’m not sure how that’s your takeaway from me, Roadstergal, Azuran, or anyone here but Casper.

          • Sonja Henie
            October 4, 2016 at 3:26 pm #

            Because the first three of you talk about how terribly, terribly difficult it is to procure such services. If I say one positive thing, it’s “yes, but; yes, but, yest, but”. I don’t know how many people know it’s available under the ACA. I think that should be emphasized. Heck, if you’re paying for insurance, like a lot of young women are, you should try that for coverage FIRST!

          • Roadstergal
            October 4, 2016 at 3:49 pm #

            No, we don’t think it’s impossible. We think – and have said in this conversation! – that it’s better than it was before, but still has a lot of room to be better. That’s not Obama’s fault; I was around in the ’90s, I remember the shitstorm Hillary Clinton got for trying to get a public option going. This is the best that we could get passed, and again, better than before, but that doesn’t mean that we should stop trying to improve it, and that doesn’t mean there aren’t programs in place, right now, that need funding and aren’t getting it.

          • Sonja Henie
            October 4, 2016 at 4:33 pm #

            I have not expressed any opinion disagreeing with the above. The three of you have simply been talking about how difficult it is to get these services. Well, you did give a little talk about moral high ground and we need a UHC, which isn’t going to help anyone right now, also that discussion about the pilot program in CO, which I support, though I think they’re taking too much credit for the drop in teen pregnancy in CO w/o providing documentation.

            This all started because someone who does not live in the US said that US insurance might not cover contraception. That is simply untrue.

            I find it rather ironic that I’m not all that great a supporter of the ACA, but I find myself defending it. How many people work for Hobby Lobby or the Little Sisters of the Poor? The majority of women who are insured have contraception coverage! What’s wrong with giving out that information?

          • Azuran
            October 4, 2016 at 4:40 pm #

            I never said it’s impossible. I said that for SOME people, it can still unfortunately be very hard.

          • Sonja Henie
            October 4, 2016 at 4:49 pm #

            You also said that people with “shitty” insurance might have to pay high co-pays which, despite all the other problems pointed out by others regarding insurance in the US, is untrue.

            I don’t believe all the silliness I hear about health care in Canada; you would do well to do the same about care in the US; ;plus, don’t believe all the stuff you hear about sex ed in the US being all “abstinence only”.

          • Azuran
            October 4, 2016 at 5:29 pm #

            You really think in absolutes do you. All insurances will not cover 100% of the fee to see a doctor to get the prescription and then assume 100% of the cost of every single contraceptive.
            Maybe they theoretically should, but it practice it doesn’t work like that.
            But go ahead, if you have question about health care in Canada, I’ll be happy to answer them without being an ass to you.

          • Sonja Henie
            October 4, 2016 at 5:59 pm #

            “All insurances will not cover 100% of the fee to see a doctor to get the prescription ”
            Please tell me how you know this? It’s the law. Yes, the naysayers on here, who really don’t want to help anyone, just pontificate, talk about those who work for religious companies, but for everyone who has ACA-compliant insurance, the insurance does indeed cover that doctor’s visit.

          • Sonja Henie
            October 4, 2016 at 6:06 pm #

            No, thank you.

          • Roadstergal
            October 4, 2016 at 3:22 pm #

            ?? That’s the exact opposite of what I’m saying. I’m saying that programs that give free contraception directly to women, particularly poor women, should be funded.

          • Sonja Henie
            October 4, 2016 at 6:04 pm #

            Again, you don’t understand sarcasm, even noted in this post.

          • Sonja Henie
            October 4, 2016 at 3:30 pm #

            No, actually. Could you provide some evidence?

          • Sonja Henie
            October 4, 2016 at 4:24 pm #

            #1 followup:
            “Both sides will claim victory Monday. Women will not lose the right to
            contraception and the Little Sisters will not pay massive fines. The
            real winner is the high court, which will not dissolve in a mess of
            partisan bickering as it did after Hobby Lobby.”

            #2: “The Obamacare birth control mandate, which promises access to FDA-approved contraceptives at no charge from the pharmacy or doctor’s office, is imperfect in practice, the survey shows. Although access to no-cost contraception has significantly increased since this part of the Affordable Care Act took effect in 2012, health insurance companies still restrict access to some forms of birth control.

            The survey also found that it’s difficult for many women to
            understand what their health plans cover, and to compare one plan to another when choosing what insurance to buy.

            Women who believe they have inappropriately been denied coverage for contraception can seek help. For those who get their insurance from an employer, a human resources professional may be able to explain the health plan’s benefits and intervene with the insurer. Health insurers themselves can assist in some cases, such as when a pharmacy incorrectly charges a copayment. Additional information and guidance is available from organizations such as the National Women’s Law Center and Planned Parenthood Action Fund.”

            OK, I can buy that; the mandate is imperfect in practice. I can also buy that many women don’t understand what their plans cover, which is what I’ve been trying to clarify!

            #3. An opinion piece. Interesting, but an opinion piece.

          • Roadstergal
            October 4, 2016 at 3:21 pm #

            Yes, you posted that yesterday, and I noted that employers with SHRB are refusing to sign the waiver that would let their employees get contraception.

          • Charybdis
            September 27, 2016 at 7:55 pm #

            Right. Back when I was on the pill, it was $25/month, with insurance. When I had to access it for awhile from Planned Parenthood (right out of college and off parent’s insurance) it was $10/month, but you could only get 3 month’s worth at a time. I’m allergic to the spermacides used in condoms, vaginal contraceptive film, contraceptive jelly/foam, so that removes them from the list of options. Even if they were an option, they are messy and aren’t the most effective birth control options out there.

            Diaphragms and cervical caps require the use of contraceptive foam/jelly and they have to stay in place for a period of time after sex. They need to be fitted by the OB and they can become less effective if you gain/lose weight or if there are cracks, rips or tears in them.

            IUD’s are the best of them all, in my opinion, but they are expensive. My Mirena is in the neighborhood of $500-600, and I think the Paragard copper IUD is a bit pricier than that. (Anyone know?) They have to be inserted by an OB, as do the contraceptive implants. I don’t know about Depo-Provera, if it is still a thing, but it required an injection every 3 months, at the doctor’s office.

            Just because you have insurance, it does not guarantee that the co-pays will be easily covered, or that the prescription coverage will be any good. And the fact that reliable, dependable female contraception is expensive, even with insurance coverage can make it hard for people to cover the costs.

          • Sonja Henie
            October 3, 2016 at 5:02 pm #

            “Just because you have insurance, it does not guarantee that the co-pays will be easily covered, or that the prescription coverage will be any good.”

            Actually, it pretty much does guarantee that. The ACA isn’t perfect, but it’s been good for contraception.
            “Plans in the Health Insurance Marketplace must cover contraceptive
            methods and counseling for all women, as prescribed by a health care

            Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider — even if you haven’t met your deductible.”

            No co-pays or co-insurance, even if you haven’t met your deductible.

          • Roadstergal
            October 4, 2016 at 2:37 pm #

            “when provided by an in-network provider”

            Yet another example of some devilsome details. I agree wholeheartedly that the ACA is better than how things were before, but I maintain that there are still huge gaps that women are regularly falling into, and that a public option that fully covers all contraceptive options without restrictions would not only be morally right, but cost-effective in the long run.

            They’ve tried it in Colorado. It worked.

            “The private grant that funds the state program has started to run out, and while many young women are expected to be covered under the health care law, some plans have required payment or offered only certain methods, problems the Obama administration is trying to correct. What is more, only new plans must provide free contraception, so women on plans that predate the law may not qualify. (In 2014, about a quarter of people covered through their employers were on grandfathered plans, according to the Kaiser Family Foundation.)

            Advocates also worry that teenagers — who can get the devices at clinics confidentially — may be less likely to get the devices through their parents’ insurance. Long-acting devices can cost between $800 and $900.

          • Sonja Henie
            October 4, 2016 at 3:14 pm #

            I’m no huge fan of insurance companies. I’ve had my issues with them both as a health professional and a consumer. I do think it is important to dispel the idea that insurance might not cover contraceptive services. For most people, that’s the best option for paying for contraception.

            I’m not particularly moved by arguments implying some moral high ground, sorry.

            “I maintain that there are still huge gaps that women are regularly falling into”
            What evidence do you have for that?

            The number of grandfathered plans is dropping. I couldn’t find a number for 2015, but there’s this:

            And yes, I am familiar with the Colorado program.

          • Roadstergal
            October 4, 2016 at 3:19 pm #

            “What evidence do you have for that?”

            The fact that both Colorado and St Louis saw substantial uptake of LARC and drastic reductions in unwanted pregnancy (particularly teen) when they offered LARC for free.

            That, to me, means that women really want LARC and can’t get it. What does it mean to you?

          • Nick Sanders
            October 4, 2016 at 3:26 pm #

            Then there’s also the big gender-indifferent gap that myself and I would assume many others find themselves in: living in a state that rejected Medicaid expansion and not making enough to afford even the least expensive plans on the Federal marketplace. The only subsidy available to me is an income tax rebate, and I don’t earn enough to have a taxable income in the first place. And theres nothing I can do but vote blue and hope in vain that people around here come to their senses.

        • Roadstergal
          October 3, 2016 at 4:26 pm #

          Oh LOL, I didn’t see this the first time around.

          Condoms require the cooperation of your partner, and even the Pill is vulnerable to partner sabotage (and if you think that doesn’t happen, you live in a very pretty bubble). And the condom is not the most reliable BC, even when used properly.

          When they made LARC free for low-income women – one trial through Washington University in Saint Louis and one through Colorado – they saw a substantial reduction in both pregnancy and abortion. What that clearly showed was that a: women were previously unable to get the BC they wanted and b: when the cost barrier was removed, they jumped at the chance.

          I stand by my statement. Poor women shouldn’t be denied the LARC that I get just for being lucky to be in a good SES bracket. Even if you don’t support that from a basic humanitarian standpoint – which I do – the cost of funding LARC vs the cost of unwanted pregnancies (unable-to-be-provided-for children or botched abortions from back-alley providers that is also the reality for far too many women in the US today) is worth it from a simple accounting standpoint.

          • Casper
            October 4, 2016 at 12:49 pm #

            Hah – this just in:
            “According to the findings,
            the dual-hormone oral forms of birth control — a popular choice among
            American women — increased a woman’s chances of taking antidepressants
            by 23 percent.
            Yet the
            statistics among the younger population — the 15- to 19-year-olds — were
            even more startling. Those taking the oral combination pills were
            diagnosed with depression at a 70 percent higher rate than nonusers. And
            the rate of depression nearly tripled among the teen girls who were
            using the patch or vaginal rings.”

          • Roadstergal
            October 4, 2016 at 1:59 pm #


            If there’s truly a ‘there’ there that isn’t correlation without causation, that speaks even more to the benefit of LARC.

          • Casper
            October 4, 2016 at 2:34 pm #

            Did you read this part?
            “Those taking the oral combination pills were
            diagnosed with depression at a 70 percent higher rate than nonusers. And the rate of depression nearly tripled among the teen girls who were using the patch or vaginal rings.”

          • Maud Pie
            October 4, 2016 at 2:43 pm #

            If you want people to read it, post a link.

            You apparently failed to grasp Roadstergal’s distinction between correlation and causation, nor did you consider the possibility that girls who obtained contraceptive prescriptions saw healthcare providers, which increased the likelihood of a diagnosis of depression over girls who might not have seen providers.

          • Roadstergal
            October 4, 2016 at 2:50 pm #

            I think I found the link:

            It’s an interesting study, but I find nothing in it to support Casper’s assertion that condoms are sufficient birth control for everyone, or to counter my assertion that access to both oral contraception and LARC (but particularly the latter) is sorely lacking in the US and improving access and funding would benefit the country overall and have a positive effect on the subject of this post.

          • Nick Sanders
            October 4, 2016 at 3:08 pm #

            Chances of taking antidepressants ≠ chances of being depressed. In addition to the greater likelihood of access to diagnostic and treatment services pointed out by @michellecaprara:disqus, the term “antidepressants” is a misnomer. They treat a variety of things involving neurotransmitters, not just depression. I’ve been on SSRIs since I was 10 or so, but the only episode of depression I ever had was a few months in my early 20s.

          • Roadstergal
            October 4, 2016 at 3:17 pm #

            It’s also really hard to avoid other correlations. Frex, teenagerhood comes with a risk of depression. :p Also, both SSRIs and oral contraception are used to treat PMDD. They didn’t control for that, only PCOS and endometriosis.

            They excluded women who were pregnant and six-months post-partum from analysis. So prevention of PPD by prevention of unwanted pregnancy isn’t captured.


  3. AA
    September 26, 2016 at 11:04 am #

    If you look at the comments for this report that was published in news source,s you’ll inevitably run into comments that we need more midwives to facilitate out of hospital birth.

    Uh….what? It’s very clear that for cardiovascular disease in pregnancy, planned OOH birth is not appropriate.

    • MWguest
      September 26, 2016 at 11:44 am #

      It’s the myth that *WILL NOT DIE* among midwives (CPMs and their ilk, mainly) that the reason women die in pregnancy and during birth is due to evil modern medical interventions.

      They will not let this go. It is fantastically insane.

  4. Stephanie Rotherham
    September 24, 2016 at 9:26 am #

    OT: Hooray for head colds that come on quickly(!) Lots of fun, especially when I discover how much my sinuses hurt and I can’t swallow. I’ve taken paracetamol and am going to stock up on remedies; I get one or two colds a year, always. Wonder why…. Maybe because I wasn’t breastfed(?)

  5. baileylamb
    September 23, 2016 at 10:07 pm #

    The solution to the problem is probably getting more minorities into med schools and obstetrics. I’m not just pulling that from thin air. OSU did a symposium on the local PBS about the local maternal and neonatal mortality rate, and how to address the issue.

    • Gatita
      September 24, 2016 at 10:18 am #

      I wonder if the Obamacare Medicaid expansion will eventually help bring these numbers down as more black women will have access to prenatal care and healthcare in general.

    • nomofear
      September 24, 2016 at 12:44 pm #

      Watched an amazing docu on PBS on this a few nights ago.

  6. MWguest
    September 23, 2016 at 1:51 pm #

    Indie-birther who “walked the walk” of unassisted birthing died last week at 4 weeks postpartum of an apparent pulmonary embolism. Now, this can kill people who are receiving adequate medical care. Cant imagine that a lack of prenatal, intrapartum, and postpartum care helped.

    Will the freebirthers admit that pregnancy in itself is risky?

    • MWguest
      September 23, 2016 at 1:55 pm #

      Oops. Not a PE. Correction posted by Maryn Green from Indie Birth in the comments:

      …”She did not pass away due to a pulmonary embolism. Close. But I don’t want women to maybe correlate her labor of Luna now 3 weeks old to a fear of home birth. Sara was passionate about birthing without fear. Sara’s lungs were clear. The cause of death was something called, and forgive my spelling. Hemoperitoneum with ruptured aorta.”

      • Heidi
        September 23, 2016 at 2:03 pm #

        So it looks like that condition can be caused by a uterine rupture. Is that person trying to say it definitely wasn’t caused by home birth?

        • Montserrat Blanco
          September 23, 2016 at 2:08 pm #

          Not likely due to an uterine rupture. More likely due to aorta aneurism that broke 4 weeks postpartum. Some aneurisms do rupture, most likely due to excessive growth. The aneurism growth can be increased due to hypertension and probably the pregnancy with the increased blood flow to the womb did not help. It is highly likely that an aortal aneurism would have been picked up by a pregnancy ultrasound, in the first trimester my doctor took a quick look at my liver, kidneys and abdominal area, so a big aneurism, those that are likely to rupture would have probably been picked up.

      • Amy Tuteur, MD
        September 23, 2016 at 3:12 pm #

        A spontaneous ruptured aorta? That’s extremely unusual unless the patient has an underlying collagen disorder.

        If she had an expanding aortic aneurysm, it could potentially have been diagnosed with appropriate medical care.

    • MI Dawn
      September 23, 2016 at 3:50 pm #

      That website is just scary.

    • lilin
      September 23, 2016 at 4:02 pm #

      A quote from her site, “She self-lessly educated women in her community about their options, and personally “walked the walk” by trusting her body in a way that is so beautiful and rare.”

      Oh my god. I don’t know what’s scarier, the fact that the woman died and the author of the piece can’t comprehend that “trusting” her body killed her, or the fact that this woman who sat around refusing to get the medical needed to save her “educated” others to do the same.

      This is so horrible. It’s actually a cult. ‘She died, sure, but the important thing is she trusted herself enough to die rather than get help and told others to do the same!’

    • Anna
      September 24, 2016 at 9:24 am #

      People just don’t get how serious this is and how many things can go wrong. They can go wrong WITH medical care, imagine the odds WITHOUT. 800 women die giving birth all over the world daily. It’s a village. 99% die in poor countries. In western countries people want to trust nature thus increasing maternal mortality. Not to mention that many western “birthers” (horrible word by the way, that’s their attitude to women, birthing machines) are in their thirties, overweight and with medical issues already. What do they expect?

      • MWguest
        September 24, 2016 at 11:30 am #

        It’s horrible.

        Trusting birth and her body to be perfect did not help this woman. And seven children lost their mother.

        But the Indie Birth Association will cling to its flawed ideology of trusting birth to all extremes that kills mothers and babies.

        You would think a woman dying would jar these people into some humility. And maybe some acknowledgement that bodies aren’t perfect. But nah.

  7. MaineJen
    September 23, 2016 at 1:40 pm #

    “We note that although Washington, DC, has the highest maternal mortality ratio in the nation, non-Hispanic white patients in this district have the lowest mortality ratio in the United States. Excellent care is apparently available but is not reaching all the people”

    Terrible. Never have I seen a better argument for “socialized” medicine. Getting excellent care should not depend on how big your pocketbook is.

    • An Actual Attorney
      September 23, 2016 at 5:27 pm #

      Unfortunately, it’s much more complicated than that. The People’s Republic of the DIstrict of Columbia pretty much has a socialized medical system available. The lack of care has less to do with inability to pay for services, than it does with everything else that makes accessing the care so difficult.

      • DelphiniumFalcon
        September 23, 2016 at 6:15 pm #

        I’m curious if some of this is a lack of transportation for the poorer residents of the area. Asking because a friend of mine lives in North Carolina and mentions the surrounding states and well as NC itself don’t have the best transportation infrastructure.

        Could some of the disparity between the rich who can go where they please and poor who have more difficulty be mitigated by developing tests that can be taken to neighborhoods with poor transportation options like a kind of mini-health fair? This wouldn’t fix everything because there’s social issues to overcome like distrust (deservedly so lately!) of people not of their socioeconomic class just waltzing into their neighborhoods.

        • An Actual Attorney
          September 23, 2016 at 6:24 pm #

          Oh, that’s definitely part of it. Transportation justice is a huge issue. And low wage jobs aren’t known for making it easy to go to medical appointments. If you get paid hourly, you don’t get paid if you aren’t there, so do you get money to feed the kids you have, or do you take time off? And there’s the distrust, and there’s the racism endemic in everything.

          It’s just that these issues are so easily hidden with averages. But if you think about it, Hillary Clinton lives in DC. Her life is very different than a poor black woman, on public assistance trying to make ends meet and keep her kids safe and out of jail.

          • Roadstergal
            September 27, 2016 at 5:19 pm #

            ” And low wage jobs aren’t known for making it easy to go to medical appointments”

            I wonder if that helps to explain the differences between Hispanic and non-Hispanic immigrants that the study notes. At least around here, the Latino families tend to live as very extended families in one house, which must make it a bit less horrific to work around job schedules – if one kid needs to go to the doctor’s, the more people in the household, the greater the chance that one has a break to take the kid in?

        • demodocus
          September 23, 2016 at 8:07 pm #

          its 45 minutes to go visit my ob (though only 15 for my pcp) by bus, and they’re fairly straight shots Then there’s the waiting since the bus is hourly

          • guest
            September 23, 2016 at 10:26 pm #

            It took me 50 minutes to an hour to reach my midwives (same for hospital and MFM – they were near each other), and that’s living in a city with one of the most extensive public transpo systems in the world. It would have been much faster by bike, but I’m terrified of traffic. Can’t afford taxis. I chose the hospital because it was the closest to my home!

          • demodocus
            September 24, 2016 at 8:47 am #

            Yeah. same reason why we chose our docs. But they don’t send any of the specialists that close. My kids’ ped is down the hall from the ob

        • Cody
          September 25, 2016 at 4:00 pm #

          When socio-economic status is a factor it could also be that these women have shedules that just aren’t as flexible. If you have a good corporate job, your employer probably isn’t going to give you such a hard time about taking off work to go to your doc. You might even have paid time off. If you are broke and working one or two jobs for far less money, you might have employers that consider you replaceable if you miss a shift and you might not be able to afford to take time off.

  8. lawyer jane
    September 23, 2016 at 12:33 pm #

    The DC stat hits close to home … what can be done?

    • Sarah
      September 23, 2016 at 12:53 pm #

      Yeah that’s pretty fucking outrageous.

    • FormerPhysicist
      September 23, 2016 at 4:01 pm #

      Echoing, but lamely.
      What can reasonably be done? I’m up for a little more than facebook ‘slactivism’ but this isn’t my passion. Just want to do a little something. Help a little, not ignore the issue. I feel a little guilty being honest, but throwing it out there because I’m sure there are others like me.

    • An Actual Attorney
      September 23, 2016 at 5:08 pm #

      Sadly, this is the story of DC, home to some of the most powerful and best educated women in the world, and some of the least powerful and least educated women in the US. It shows up in all the public health statistics. Often averages of the “DC population” hides the truth in the middle of a table somewhere.

      It doesn’t help that DC also has the highest incarceration rate in the world. It’s a major destabilizer and health risk.

      CM Alexander, who was a weak CM even before she became a lame duck, is the chair of the committee on health. Let’s hope someone stronger takes it over in January.

    • Platos_Redhaired_Stepchild
      September 24, 2016 at 1:12 am #

      Statehood. That would be a good start.

  9. CSN0116
    September 23, 2016 at 12:04 pm #

    I always teach my students not to be woo’ed into the, “America has deplorable infant and maternal mortality rates compared to other industrialized nations — we suck!” mantra. The _mean_ sucks, yes. But you have to break that baby down.

    It actually only sucks for some.

    For others — rich, white women living in the US — well, they experience some of the lowest rates in the world.

    Medicine is not the problem here, social inequality is.

  10. no longer drinking the koolaid
    September 23, 2016 at 11:48 am #

    Recent maternal death in Michigan. Home birth mother with eclampsia.

    • MI Dawn
      September 23, 2016 at 3:39 pm #

      Oh my god. That’s horrible. Do you have a link?

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