Authors: Mickey Huff
We find a useful comparison in the United Kingdom where, for decades, the Confidential Enquiry into Maternal and Child Health (CEMACH) has been publishing a large report titled
Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer
(formerly titled
Why Mothers Die)
every three years. The book details all of the causes of maternal deaths—devoting a chapter to each of the leading causes of maternal deaths in the four countries that make up the UK—and includes narratives of some of the deaths that are related in such a way as to provide lessons of prevention. Confidentiality of hospitals, mothers, and caregivers is preserved. This example of a well-designed feedback system demonstrates at least one reason why the maternal death rate in the UK decreased during the same period that ours increased.
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How can we know how we are doing if we don’t develop a good system of feedback to inform us?
Former supermodel Christy Turlington Burns became an advocate for better global maternity care after a complication following her first child’s birth prompted her to study why so many women worldwide die around the time of birth from preventable causes, and to make a new documentary
No Woman, No Cry
. When she began her project, she hadn’t expected to learn that the US itself has an unacceptably high rate of maternal deaths. Speaking to Canadian reporters, she told them about how her film covers pregnant women in several parts of the world and added that US statistics on maternal mortality are “quite shocking.” Whereas her remarks were well reported in Canada when her film debuted, there was no mainstream coverage of her film’s release on our side of the border.
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Undaunted, Turlington Burns, who is also spearheading the Every Mother Counts campaign, told Canadians that she was hopeful that the Maternal Health Accountability Act, introduced in the House of Representatives in March 2011 by Representative John Conyers of Michigan, will improve the situation.
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For her hope to be realized, though, it is certain that her efforts will need to receive coverage in the US media.
The primary problem with the mainstream media’s treatment of birth issues here is not that the subject of birth and maternity care is entirely avoided but that apparently every potential story in this area must conform to the standard ideological narrative if it is to be published.
Many elements of the preferred narrative emphasize technology. One prevalent belief is that the greater the application of high technology during the birth process and the more drugs used, the better the birth. Another pair of common beliefs is that newborns hardly ever die when they are born in hospitals, and that home birth is dangerous and shouldn’t be allowed. (The corollary is that newborn deaths following home births are generally the only ones that will receive mainstream media attention, because people here have learned to assume that hospital-born babies never die, although this is hardly the case.) Other myths include: Breech births are only safe when cesarean sections are done; assisted reproductive technologies do not increase risks for mothers; cesarean sections are safer than vaginal births; and once a cesarean, always a cesarean.
Another narrative thread in the coverage of birth in the mainstream media is that the mother is at fault, or is not to be trusted. When newborns do die in hospitals, there’s the widespread belief that their mothers were likely abusing drugs during pregnancy. Other myths include: If mothers or their babies come to harm during the course of pregnancy or labor, it is most likely because the mothers are too old, too fat, or too selfish in seeking their own comfort or “birth experience,” at the expense of their babies; the way labor progresses has little to do with how a woman is treated during her labor, and whether or not she feels secure and respected; it is smart, modern, and safe to schedule births, whether by elective cesarean sections or elective inductions.
The above beliefs serve as an integral part of US birth mythology. They are untrue and lack the support of any credible evidence, and yet each is accepted without question by a huge portion of our population. It is remarkable how closely this framework for filtering stories can be applied to a sampling of stories that received national attention during the last decade or so:
A wire service press release noted how much the US
maternal death rate had improved
over the last century
—a story that was released just after the CDC published its 1998 findings about the lack of improvement in maternal death rates over the previous two decades.
A 1998 press release from the American College of Obstetricians and Gynecologists (ACOG) reversed ACOG’s previous policy that it was safe for women to have a vaginal birth after a previous cesarean in most cases. Although ACOG implied that the reasons for this 180-degree turn were based on scientific evidence, their position statement provided no evidence to support that claim.
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Prevalent reporting of a statement from ACOG reiterated its long-held opposition to home birth while neglecting to supply evidence to support this opinion.
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National radio, television, and news interviews by a former ACOG president, W. Benson Harer, Jr., advanced the idea that abdominal surgery is safer than natural vaginal delivery, without citing any credible evidence for his view. “For the mother, it reduces the damage to the pelvic structures which would lead to urinary or fecal incontinence,” he told the
Boston Globe
. “And, for the [full-term] baby, an elective C-section is probably as safe or maybe even safer than attempting a vaginal delivery.”
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Dr. Robert K. DeMott, chief of staff at Bellin Memorial Hospital, Green Bay, Wisconsin, sharply disagreed with Dr. Harer but did not receive national coverage when he commented: “Patients are being hoodwinked into choosing cesareans by overblown fears of incontinence and other risks associated with trial by labor. Putting it bluntly,” DeMott said, “it’s unethical to recommend a practice that leads to more patient deaths.”
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Dr. DeMott was referring to an increase in maternal deaths.
A deeply flawed but widely reported Canadian study published in 2000 stated that there was a slight increase in newborn deaths following vaginal breech birth, as compared with cesarean section breech birth. This study caused
hundreds, perhaps thousands, of hospitals worldwide to discontinue their policies of allowing vaginal breech delivery,
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and also suddenly stopped the teaching of breech skills to doctors and midwives in many countries. Unfortunately, too many leading obstetricians failed to remember that there will always be some undiagnosed or rapidly progressing breech births, and that every birth attendant, whether midwife or doctor, should receive breech birth training.
This abandonment of essential breech skills has already put an uncounted number of mothers and babies at risk. Angela Wilburn, a mother of twins who lived in Coon Rapids, Minnesota, was just one of them. She gave birth to the first of her twins in 2005 without a problem, but when her second twin’s feet appeared, along with the umbilical cord, her doctor resorted to an emergency cesarean section, apparently unaware that neither the footling breech presentation nor the cord were dangerous to mother or baby in this situation. Ms. Wilburn died from blood loss during the cesarean section.
By 2007, the Dutch Maternal Mortality Committee had already recorded four maternal deaths after elective cesarean section for breech presentation between 2000 and 2002 inclusive. No death after emergency cesarean section for breech presentation was registered during that same period by the committee.
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An internationally reported yet highly misleading and much discredited 2010 study—published in the
American Journal of Obstetrics & Gynecology
(AJOG) and now known as the “Wax paper” because of its principal author’s name—purported to show that home birth isn’t safe for babies. The bundled “metaanalysis” infamously included an already discredited home birth study known as the “Pang study,” as well as other studies that included the following scenarios under the banner of “planned homebirth”: unplanned sudden births at home and in transit to the hospital, premature sudden births, births following pregnancies for which there was no prenatal care, involuntary
home births by mothers in poor health, and other unplanned births without medical assistance. The Wax study also included, as was noted in a letter to the journal, “mistakes in definitions, numerical errors, selective and mistaken inclusion and exclusion of studies, conflation of association and causation, and additional statistical problems,” causing many critics to demand the journal publish a full retraction. Critics noted especially the press release advertised data from about 500,000 births, while the text of the study actually stated that the neonatal death rates they used to support their claim were drawn from only 50,000. Incredibly, the Wax study attempted to fluff its credibility by adding a large Dutch study, but then ignored that study in the tabulation of results related to neonatal mortality.
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A home breech birth attended by a midwife, which resulted in a newborn death and criminal charges against the midwife, received national coverage.
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In more than thirty years of close media scrutiny, I cannot remember a mainstream news account of a newborn death from a hospital birth that received national coverage. It’s nearly impossible for people to find out that breech babies born in hospitals by C-section sometimes die.
Except for the Angela Wilburn death, each of the above stories received wide coverage by well-known media outlets. But during the same period, several rather shocking stories that should have been reported nationally were not; they didn’t conform to the acceptable stereotypes that I described earlier in this chapter. Here are some that would have made interesting reading for the general public:
Seven North Carolina obstetricians and an ultrasound technician managed to misdiagnose a false pregnancy in late 2007, something that was only discovered when the woman’s abdomen was cut open for a cesarean section. Not one of them seems to have manually checked the accuracy of the diagnosis of pregnancy. This was a case of
pseudocyesis
, or false
pregnancy, a condition that is best diagnosed by manual examination. There is reason for concern that neither of the major obstetrics textbooks studied by doctors-in-training today even mention this once well-known phenomenon, which used to be standard information in all obstetrics textbooks. Because an increasing reliance on ultrasound has convinced many medical schools to give up teaching traditional manual skills, women today who have a false pregnancy may have this kind of unnecessary cesarean section.
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Two teachers who worked at the same small-town New Jersey school died within two weeks of each other in 2007 after cesarean sections at the same local hospital. Later that year, that hospital was given an award by the Johnson & Johnson corporation for “excellence in maternity care.”
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Dr. Charles Mahan, a distinguished Florida obstetrician who has long worked to prevent maternal deaths, wrote in a letter to the editor to a Tampa Bay online news site: “Florida’s maternal deaths are almost twice the rate of the US rates and going up. From 2001 to 2004 the overall maternal death rate in Florida went from 16 deaths per 100,000 live births to 23 deaths per 100,000. The Healthy People 2010 goal was 3.3 maternal deaths per 100,000 births. Florida’s maternal death rate rose from about five times the rate set by the goal in 2001 to seven times that rate in 2003.” Despite its importance, no national media reported this information.
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An article on a landmark home birth study, published in the
British Medical Journal
, demonstrated the safety of home birth attended by Certified Professional Midwives but was followed with only minimal coverage in the mainstream press.
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The deaths of Virginia Njoroge and Tameka McFarquhar, both single mothers who died at home after early release from the hospital, were reported in local media, but did not receive wider media coverage. Each woman had a baby who died of starvation because of the length of time elapsed between their mothers’ deaths and the discovery of their bodies. There is no
way of knowing how many deaths of this kind take place every year, but these two stories let us know how possible it is, given that postpartum home visits are rarely included in the standard maternity care package offered by hospitals.
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Tatia Oden French, her baby Zorah, and Pamela Jean Young Lippert all died because Tatia and Pamela’s obstetricians pressured them into taking Cytotec (generic name: misoprostol) to induce labor when their pregnancies continued a week past their estimated due date. Cytotec was approved by the Food and Drug Administration to prevent gastric ulcers in people who are taking lots of aspirin, but the manufacturer warned from the beginning that it should not be used on pregnant women. Unfortunately, this warning did not prevent a large number of obstetricians from using it regularly to induce labor, ultimately killing more than one hundred mothers in the US, according to the Food and Drug Administration, and even more babies. The major media have so far given little mention to the problems that have surfaced with this use of Cytotec.
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Amnesty International’s damning 2010 report,
Deadly Delivery: The Maternal Health Care Crisis in the USA
, outlined various failures in the way the US health care system treats pregnancy and birth. Despite the worldwide reputation of Amnesty International, this report received surprisingly little national media coverage.
In January 2010, twenty-seven-year-old Amy Lynn Gillespie died of untreated pneumonia. According to the
Pittsburgh Post-Gazette
, she was in jail for “violating the terms of her work release by becoming pregnant.” When she complained that she was having trouble breathing and that she was coughing up phlegm, she was denied diagnostic tests. When it was finally recognized that she was suffering from bacterial pneumonia rather than a simple cold, it was too late to save her life (and that of her eighteen-week fetus). This story remained local.
The cruel practice of keeping women prisoners in shackles
during labor seems never to receive national coverage. It should be obvious that a women in labor is not going to escape custody, so the shackling in these cases is apparently being done with the motivation of further punishing the woman (and her baby) for whatever act resulted in her imprisonment.