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Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees

cdc.gov

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Re: Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees

#81

Post by sgtnoodle »

neves wrote: post #29
andrewla wrote: post #23

This article is disturbing on many levels. The sound bite that the US has a problem with maternity healthcare is ingrained, but this makes me take a second look. First is that we report maternal mortality even when not directly associated with birth -- "Among pregnancy-related deaths with information on timing, 53% occurred 7–365 days postpartum." Is that standard for reporting countries? Is our problem with maternit…

USA is the richest country of the world and does not have paid maternity leave. It is very weird and my hypothesis is that this fact relates to these mental health conditions.

Outside of whatever your employer's policy is, it's a state rather than federal matter. It's perhaps a bit reductive to treat the USA as a whole in terms of healthcare.

I'm about to go on paternity leave in 2 weeks until the end of the year. California will directly pay me some amount for 8 weeks of it due to paying the relevant workers comp taxes. Companies within the state are required to allow at least 12 weeks of unpaid leave. I work for a great, supportive company that will pay whatever the difference is to make my salary whole. In general, I set my own schedule and am able to prioritize my family's well being over work.

My wife's preference is to raise our children, and we're lucky enough to be able to live comfortably on my income alone. Anecdotally, that was the case for our first child as well, and my wife still suffered from rather severe post partum depression a bit less than a year after giving birth.

Re: Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees

#82

Post by pkaye »

yebyen wrote: post #59
nxm wrote: post #37

Earlier quoted context omitted.

At a federal level no, but some states do require many weeks at minimum. I also think 9months is beyond excessive for maternity/paternity leave (father of kids here).

I had a search because I didn't believe that any states required employers to offer paid family leave. Some research revealed that the situation is somehow both better than I thought, and also seemingly much worse than I imagined: https://www.ncsl.org/research/labor-and-employment/state-fam... https://www.zippia.com/advice/average-paid-maternity-leave/ There are a few North Korea comparisons in here that I think are…

California has PFL as part of its state disability insurance.

https://edd.ca.gov/en/disability/Types_of_Claims/

Re: Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees

#83

Post by panzagl »

nsxwolf wrote: post #24
malfist wrote: post #2

Maternity healthcare in the US is one of the worst in the developed nations. And yet we're banning abortion, and doing nothing to fix it. Even WIC has came under attack in the past. Protecting the unborn is very convenient. They make no demands of you. Edit: WIC: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) https://www.fns.usda.gov/wic

Are you saying the solution to maternity related deaths is abortion here? Eliminating maternal death by eliminating maternity? I don't understand.

I think he's pointing to the hypocrisy of political agendas that value the life of a baby more before it's born than after.

Re: Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees

#84

Post by kube-system »

j_walter wrote: post #69
kube-system wrote: post #42

Earlier quoted context omitted.

Drug use is a huge issue in the US, and people who struggle with addiction (and associated mental health) are also more likely to get into situations where unplanned pregnancies happen. This isn't as much of a problem with maternal care as it is a problem with drug addiction, and this is simply the downstream consequence of that.

My mother was a doctor that spent a great deal of time with expectant mothers. Based on her limited but also extensive experience on the subject drug use by the mother caused a significant portion of the mortality in unborn fetuses. This was particularly seen higher in the minority population (Black, Native American, etc.) and she is frustrated when she sees all the statistics that racism is the only reason behind th…

Addiction is a treatable and preventable condition, but addiction is not a choice. These are overwhelmingly not bad people who want to harm their unborn child, they simply do not have the required mental state to choose otherwise.

Re: Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees

#85

Post by robertlagrant »

baby wrote: post #52
echelon wrote: post #46

Earlier quoted context omitted.

> dies 8 days later due to complications But 365 days? That's sounds like it's mental health related. It seems like we should track cause of death so we can have richer and more actionable information. Edit: I didn't mean to imply that this wasn't postpartum depression. I was curious if/why other nations aren't tracking the full calendar year after birth, and if our way of counting prevents us from directly comparing…

Are you a doctor?

Are you? If not, on what basis are you assessing that a doctor is required for this question?

Re: Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees

#86

Post by kevingadd »

mattmcknight wrote: post #64
simonsarris wrote: post #21

Reminder when comparing with other nations that as this study states: "Pregnancy-related deaths occurred during pregnancy, delivery, and up to a year postpartum. " The measure can be very different elsewhere. The WHO defines a maternal death as "the death of a woman while pregnant or within 42 days of termination of pregnancy , irrespective of the duration and the site of the pregnancy, from any cause related to or a…

Also, mental health conditions and cardiomyopathy are "preventable"? Their definition of Preventability stretches credibility- lowering the risk is different from preventing something. "A death is considered preventable if the committee determines that there was at least some chance of the death being averted by one or more reasonable changes to patient, community, provider, facility, and/or systems factors."

You can prevent some mental health conditions by caring properly for the mother, for example a mother struggling to pay rent or unable to access necessary medical care is naturally going to be at higher risk of conditions like depression and if you improve her circumstances it's possible that the depression might at least abate for a while. Lots of people who are managing mental health conditions will spiral if their circumstances get bad enough but will otherwise be OK.

While it's unwise to try and simply reduce all mental health conditions to 'circumstances' or 'chemical imbalance', there are lots of things you can do to keep a person in balance to the point that any latent conditions they have aren't enough of a problem to interfere with their daily lives. Motherhood is already very difficult so it is worthwhile to try and keep as many challenges out of a new mother's life as we can.

Re: Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees

#87

Post by petsfed »

nsxwolf wrote: post #24
malfist wrote: post #2

Maternity healthcare in the US is one of the worst in the developed nations. And yet we're banning abortion, and doing nothing to fix it. Even WIC has came under attack in the past. Protecting the unborn is very convenient. They make no demands of you. Edit: WIC: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) https://www.fns.usda.gov/wic

Are you saying the solution to maternity related deaths is abortion here? Eliminating maternal death by eliminating maternity? I don't understand.

The core of the argument is that for a significant number of these deaths (especially mental health or substance abuse related), if the mothers had been allowed to abort the baby, they would be in addition allowed to get the mental health or substance abuse issues under control.

Of course, they might not get those issues under control. They might still have died of substance abuse or suicide. But the stress of being a new mother is well known (if not well understood or well supported by society or the American medical system - clearly). If a person is already predisposed to substance abuse and/or self-harm, maybe the additional impacts of post-partum mental conditions would push them further down that road.

Especially as it pertains to the maternal-mortality/abortion discussion, I think its important to remember that the would-be mother's material conditions are not guaranteed to be static over the course of the pregnancy and post-partum period. The decision to conceive might be made in accordance with the best possible medical and financial advice, and still result in a bad situation for mother or child at the end of it all.

My wife had a pretty easy time with both of our kids, but I am constantly haunted by stories from folks who made the same decisions we did, and lost mother, child, or both.

Re: Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees

#88

Post by jjulius »

notch656a wrote: post #68
a4isms wrote: post #57

Earlier quoted context omitted.

Postpartum depression[1] is an example of a something that is _both_ "mental health related" and "pregnancy related." https://en.wikipedia.org/wiki/Postpartum_depression

It's interesting they include things such as all suicides as pregnancy related death, though. If someone commits suicide 11 months after the kid is born there's no guarantees the reason was the pregnancy or the kid. It's possible but we can't really say that must be it.

>It's interesting they include things such as all suicides as pregnancy related death, though.

That's not actually the case. If you look through the original linked article for the word "suicide" you come across the following...

>Pregnancy-related deaths determined by the MMRCs to be suicides...

... which, by used of the word "determined" suggests that they're not just assuming all suicides within a year of giving birth are pregnancy related. In point of fact, this is covered at the very beginning:

>Maternal Mortality Review Committees (MMRCs) are multidisciplinary committees that convene at the state or local level to comprehensively review deaths during or within a year of pregnancy (pregnancy-associated deaths). MMRCs have access to clinical and non-clinical information (e.g., vital records, medical records, social service records) to more fully understand the circumstances surrounding each death, determine whether the death was pregnancy-related...

Re: Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees

#89

Post by csdvrx »

saiya-jin wrote: post #45
csdvrx wrote: post #27

It's a theoretical claim (unproved, as acting on a system changes the system) Also, it's missing the crucial implication: at what price? With infinite amount of money, there are many things we could do. We don't have infinite money. Consider how the richest EU state in adjusted PPP per capita (so price levels can't be blamed) is just now barely richer than the poorest US state, in both the median and average Do we re…

Poor is relative. Free education including university for all kids you can possibly spawn, free good healthcare just to name 2 most of the most expensive pain points in existence as american citizen. Your taxes very often directly support killing poor civilians half around the globe, as it has been much of the last 2 decades, for less than 0 added value to anything positive to mankind. Supporting Ukraine is nice and…

> If you get fired, how much support do you get from the state?

A better question is, why should the state support people getting fired?

> If you would travel to those places, you would find stark differences in real quality of life which can't be easily measured by simple aggregate numbers, people's happiness and life satisfaction.

I did: oh yeah it's nice, as a tourist. But here is no amount of money you could pay me to work and live there - and that's assuming the money would make sense on the paper, unlikely given the high taxes while the prices are also high.

The killing factor is the very small amount of private options if you want to avoid dysfunctioning government monopolies.

Re: Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees

#90

Post by disabled »

xyzzyz wrote: post #67
disabled wrote: post #56

The third leading cause of death in the United States is believed to be preventable medical errors. Anyways, I have never been pregnant, but if you saw what happened to me medically this summer, you would be doing everything you could to be leaving the US. Anyways, I am a dual citizen. My other nationality is Croatian, but I don’t plan on living there. Even Croatia, you know which went through a horrific war 30 years…

I imagine life expectancy in Croatia would be much worse than in US if Croatians were as overweight as Americans are, and used hard drugs or lived on the streets as often. Fortunately, Croatians tend to live much healthier lifestyles than Americans, which results in higher life expectancy, despite available medical care being of worse quality.

Thanks captain obvious, what you stated are public health issues. Also, money isn’t everything and unfortunately a lot of Americans use that as justification to keep playing a game that is going to kill them and/or their family member. Way too much is spent on administration of health care plans and nobody is getting good value for their money. We spend the most, and we get the worst outcomes overall of any developed country. Even things we used to excel at we are doing very poorly due to staffing, regulation, and other issues.

Honestly, the quality of care is not OK at all in the US. Just check out r/medicine and r/nursing. We are in for a whole lot of really terrible stuff.

Seriously, if someone in your immediate family gets sick and needs to be hospitalized, stay with them 24/7, even if it means sleeping on the floor. Nurses say they will do the same thing for their family members.

Anyways, I ended up spending 9 weeks in the hospital this summer. It started at a trauma hospital, where I stayed for 18 days. The first 90 hours (3.5 days) they did not even give me any long acting insulin, even though my body does not produce any insulin and I can not metabolize without long acting basal insulin. (I was never on an insulin drip either, and I was never on a high dependency unit where the insulin drip could occur.) My family had to beg and plead with them to give me basic diabetes care, including the long-acting insulin. (I was too, the whole entire time.)

The first week my blood sugars averaged overall around 400 mg/dL (22 mmol/L), and chief trauma resident and trauma fellow were explaining to trauma residents outside of my room when someone with type 1 diabetes is at risk of diabetic ketoacidosis. Such a basic matter.

Anyways the rest of the story is for another time.

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