Re: Maternal Mortality Rate In U.S. Highest In Decades [long]
From: Ina May Gaskin (inamaygaskin@gmail.com)
Wed Sep 5 17:54:51 2007
Thanks for that info, Dean. I've been told much the same about
several other states. It makes me wonder what our true death rate is,
when it's already 38/100,000 for African-Americans and that could
represent only 1/3 of the actual.
Ina May
On Sep 5, 2007, at 1:56 PM, Dean Huffman . wrote:
>
> .
>
> Once I practiced medicine in Tokeka, Kansas. While there, I
> received a transport
> of a patient in fulminant pulmonary edema from too much fluid, too
> much MgSO4,
> terbutaline, and ritodrine (does anybody out there remember
> ritodrine). She
> delivered shortly after I discontinued the tocolytics and the
> newborn did well.
> The motehr did not do well, however. She develped ARDS and died
> about a week
> later.
>
> The death certificate was signed by the pulmonologist. I noticed
> that the death
> certificate did not mention pregnancy anywhere, however. I was
> about to call
> the state vital statistics people, but since I was going to attend
> a meeting in
> Wichita about three weeks later, I held off.
>
> At the meeting, I found the lady in charge of Kansas vital
> statistics. I
> mentioned the death and that it was a maternal death. She said she
> knew. When I
> asked her how she knew, she said that she had matched the death
> certificate with
> the birth certificate and therefore was able to identify the
> maternal death.
>
> She went on to say that only about 1/3 of Kansas maternal deaths
> were noted on
> the death certificate. Anotehr 1/3 were found by matching birth and
> death
> certificates and the final 1/3 were found by people calling in to
> notify them
> of the maternal death (as I would have done had I not been planning
> to go to
> that meeting a few weeks later).
>
> In Kansas, only 1/3 of maternal deaths were identified on the death
> certificate.
>
> - - - -
>
> -----Original Message-----
>> From: Ina May Gaskin <midwifeim@earthlink.net>
>> Sent: Sep 5, 2007 12:31 PM
>> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>> Subject: Re: Maternal Mortality Rate In U.S. Highest In Decades
>> [long]
>>
>> 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
>>> given that your understanding is that the maternal mortality rate
>>> is largely underreported--did I get that right?
>>>
>>> Louana
>>
>
|
|
