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Re: Maternal Mortality Rate In U.S. Highest In Decades [long]From: Ina May Gaskin (midwifeim@earthlink.net)Wed Sep 5 11:30:49 2007
You got that right, Luanna. From MMWR, CDC, September 4, 1998: "The number of deaths [maternal, which does not include those from domestic violence] attributed to pregnancy and its complications is estimated to be 1.3 to three times that reported in vital statistics records." "Misclassification of maternal deaths occurs when the cause of death on the death certificate does not reflect the relation between a woman's pregnancy and her death. In addition, the inclusion of deaths causally related to pregnancy that occur between 43 and 365 days postpregnancy can increase the number of maternal deaths identified by 5% - 10%." (Here, only the deaths within the first 42 days are counted.) From the Green journal, October 2005: Underestimation of mortality causally related to pregnancy based on ICD cause-of-death codes alone varied from 22% in France to 93% in Massachusetts." Massachusetts, incidentally, is one of the states that makes the most strenuous efforts to improve their reporting. What might the percentage of estimated misclassification be in states that don't try so hard? It's an honor system. No audit is possible. The practical meaning of this is that we are reduced to making guesses, because we lack most of the data that we should have. I'd like to see us value women's lives more highly than this situation indicates. Most states don't have mortality-morbidity review committees; in fact, we don't have as many functioning as we did in the 1970s (when the maternal mortality rate was still on the decline. That decline stopped in 1982, says the CDC. From the CDC's book "Strategies to Reduce Pregnancy-Related Deaths", they write: "There are also specific rules governing coding of causes of death that may leave the coder unable to assign a code that indicates a relationship to pregnancy. Unfortunately, physicians are rarely trained in these rules or in the correct way to complete vital records." For direction in how to do this correctly, go to http://www.cdc.gov/ nchs/about/major/dvs/handbk.htm From CDC, Feb. 2007: "In 2003, only four states could capture information consistent with the standard." What????? Anybody want to help me on this quilt I'm making to build awareness of this problem? I know that many of you must be good at sewing. I already have 16 names for 2007, more than any other year so far (and I only get those which appear in the news). The death I heard about this morning was a mother of 5 who kept telling her doctor that something didn't feel right after her c-section. At autopsy, it was found that she died from gangrene, caused by incomplete removal of her placenta. For a sample of stories, anyone who is interested can google these names: Tameka McFarquhar, Caroline Wiren, Melissa Farah, Valerie Scythes, Galit Schiller, Becky Zalewski, Jasmine Gant, Karen Marie Hubbard, Gwyneth Vives, Tatia Oden French, Sabine Elias, Allison Lanzet, Jennifer Adams + Tripler Army Base, Julie LeMoult, Inamarie Stith-Rouse. Most of these deaths don't fit the stereotype that we've been discussing so far here. Ina May On Sep 5, 2007, at 5:50 AM, westsidebirthservice@juno.com wrote:
> Ina May--where are you on this discussion? Love to hear your stats
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