Friday, June 5, 2009
For a couple months now I've been sitting on what I think is a huge story, trying to figure out a way that I could frame it for a national magazine. Other journalists are catching on now (there will probably be a story in the LA Times in a few weeks or so - and I'm going to do a story for KALW) so I'm going to break the news here.
Since 1997 the chances of dying in childbirth have doubled in California. When health officials working with the state showed these graphs to a group of obstetricians there were shocked gasps from the audience. New York's numbers are similar and there's enough evidence to convince me that this is a national trend. The usual suspects (older, sicker, fatter, poorer women) only account for a small part of the increase in California. No one has pinned down the root cause of the rest yet. But investigators say there's one obvious place to start looking. What else has changed significantly in childbirth? We're now delivering almost a third of kids by Cesarean. Cesareans are pretty safe as major surgeries go - but if you look at the long term risks (rather than just the immediate risks) they become less appealing. If you have another baby after a Cesarean (and especially after multiples) you have a chance of developing an abnormal placenta attachment like placenta accreta. The placenta can grow through the old C-section scar and send blood-seeking tentacles out into the organs. OB's say they are seeing an epidemic of these conditions - 8 to 10 times the number from a decade ago. They are hugely dangerous - and if they don't kill they can cause severe damage (often requiring hysterectomy). For every woman that dies there are 50 that suffer debilitating injury.
There's pretty good evidence that too much birth tech is hurting women. However - there are some very influential people (at the National Quality Forum and Berwick's Institute for Healthcare Improvement) who are working on this. In the next decade I suspect we will see a sea change in the way that this country does birth. Even conservative OBGYNs (those in the know) have been telling me that low tech, high touch is the wave of the future. They don't care that they sound like hippie midwifes. Natural - it seems - is the new high tech.