Maternal death rates on the rise in U.S. but not in the Yampa Valley
STEAMBOAT SPRINGS — The statistics cited in numerous news stories and studies over the past few years are alarming. According to USA Today, “the U.S. is the most dangerous place in the developed world to deliver a baby.”
The New York Times reports, “women in the United States face a far greater risk of dying from childbirth complications than in many other wealthy countries.”
The American Congress of Obstetricians and Gynecologists reported U.S. maternal mortality rates have increased by approximately 26.6 percent from 2000 to 2014, and Dr. Neel Shah in a Harvard University health blog states that “compared with their own mothers, American women today are 50% more likely to die in childbirth.”
So what is going on?
There are numerous factors and hypotheses cited, but no definitive conclusions. But, what is certain is the need for more attention.
In Colorado, the maternal mortality death rate doubled from 2008 to 2013, rising from 24 women annually to 46 women, according to the Colorado Department of Health and Environment.
In February, the Colorado House of Representatives unanimously passed a bill to create a committee for investigating all maternal deaths in a way that collects honest and accurate information, establishes a cause of death and then immediately make recommendations on how to best prevent that death.
It is in the six weeks after giving birth that a majority of the deaths occur, not during pregnancy or delivery, said Dr. David Schaller, an OBGYN with UCHealth Women’s Care Clinics in Steamboat Springs and Craig.
During the 26 years he’s been practicing in the Yampa Valley, Schaller hasn’t seen a single maternal death.
Official hospital records go back to 2002 and show no maternal mortality events, said UCHealth communications specialist Lindsey Reznicek.I
Heart-related issues are the most common factor in pregnancy-related maternal deaths, Schaller said.
Across the general population, rates of heart disease, diabetes and obesity are also on the rise, Schaller noted. And, more women who have risk factors — whether obesity or age — are getting pregnant, he said.
Hypertension is on the rise, said Heather Yeager, registered nurse and manager of the UCHealth Birth Center, and that condition presents a high risk for maternal mortality.
By nature, pregnancy, delivery and postpartum remains a relatively inconstant and mysterious area of medicine.
“There’s nothing predictable about labor and delivery,” Yeager said.
At the Birth Center, the medical team treats every labor the same, Yeager said.
“If you go in thinking one is not at risk, that will be the one that turns into high risk,” said Yeager, who hasn’t experienced any bad outcomes in her 15-year tenure at the hospital. “We have to be ready for anything.”
Because of the national upward trend of increasing maternal death rates, Yeager said they are being very proactive. For one, YVMC has a sim lab with adult, pediatric, obstetric and infant mannequin. The mannequins react to medication, cry out in pain, bleed, have seizures, heart attacks and respiratory arrests and can develop sepsis.
Noelle, the obstetric mannequin, is used for a number of drills, Yeager said, including hemorrhage, hypertension or shoulder dystocia. Nurses are able to practice delivering in the event a doctor doesn’t make it in time.
Yeager also pointed to the maternal hemorrhage kit, which is at every pregnant patient’s side during delivery
The obstetrics team is also building a hemorrhage risk assessment checklist within the electronic medical record system. Through that, they can automatically calculate risk beginning with the initial OB visit and update the assessment during the pregnancy and throughout the labor process. The patient record will be flagged with a color code — green, yellow, red — depending on risk level.
Another effort underway locally and globally is to reduce C-sections.
In 2018, the World Health Organization for the first time published recommendations on “non-clinical interventions to reduce unnecessary caesarean sections.”
According to the WHO, “a caesarean section is a surgical procedure that, when undertaken for medical reasons, can save the life of a woman and her baby. Many caesarean sections are undertaken unnecessarily however, which can put the lives and well being of women and their babies at risk — both in the short and the long-term. Worldwide, caesarean section rates have been steadily increasing, without significant benefit to the health of women or their babies.”
Like any major surgery, C-sections come with increased risks, including death.
According to Yeager, the primary C-section rate at Yampa Valley Medical Center has been reduced from 45.92% in 2016 to 29.55% in 2018. The goal for 2019 is 25 percent.
And communication, she said, is one of the most important tools — across the hospital as well as between doctors and patients.
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