We Can Do Better

My last post was about how the U.S. spends thousands of dollars more per person in for health care than our developed and developing nation counterparts, yet we have among the lowest overall life expectancy. I ranted a bit about how our fee-for-service health care payment method is a major factor in our high-spending-yet-poor-outcome health care system.

This is apparent in our maternity care system, as well. In a recent publication for the U.S. Department of Health and Human Services' Centers for Disease Control, we see that the infant mortality rate in the U.S. is 30th among developed and developing nations, coming in ahead of only Slovakia.

According to the report, a significant factor in our infant mortality rates is our high rate of preterm births in the U.S. The report goes on to say that our infant mortality rates for preterm births is among the lowest in the world. In other words, while we have among the highest preterm birth rates, once those babies are born, we are good at helping them survive. These seem to be mixed results - we are good at caring for our littlest babies. At the same time, the report goes on to say that if we had the distribution of births by gestational age of Sweden (i.e. fewer preterm births), we could save 8,000 infant lives each year.

The most disturbing part of the report is our that our infant mortality rates for full term births was the highest among all the countries studied. In other words, we are the worst at ensuring our full-term babies survive.



The summary of the report states that if we reduced our preterm rates to Sweden's level, we would reduce our overall infant mortality rate by 33%. That seems obvious. Full term babies are more likely to do well. But what about our pathetic full-term infant mortality rate? I am not alone in my belief that these poor outcomes are related to our maternity care practices. It goes back to the paying-for-services-versus-outcomes thing. Providers are paid for billable services, things like surgery, medications, inductions, etc... It's also tied to defensive medicine - providing medical care based on a fear of litigation versus what is sound, evidenced-based care.

We know that somewhere between 85-95% of women will give birth most safely if the birth is uninterrupted by devices or drugs. In our country, however, about half (depending on whom you ask) births are induced, many are augmented with Pitocin, nearly all involve some sort of intervention and/or drugs, and over a third are surgical births (two-to-three times what is deemed necessary by the World Health Organization).

It's not women's fault. Our bodies know what to do. We are no different than our European counterparts. Something else is broken.

We can do better.

Full CDC report Behind International Rankings of Infant Mortality: How the United States Compares with Europe (Marian F. MacDorman, Ph.D. & T.J. Mathews, M.S.) available here.