Re: Maternal Mortality Rate In U.S. Highest In Decades [long]
From: Akilah (acopening1979@yahoo.com)
Mon Nov 26 03:50:35 2007
I would like to talk to the woman who is doing the quilt. She mentions
my sister's name and I have seen pictures of the quilt and my sister's
peice. Please contact me. My family would be interested in speaking
with you. Her name was InaMarie Stith- Rouse.
At Wed, 5 Sep 2007, Ina May Gaskin wrote:
>
>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
>>>
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