In the November 14th, 2023 Journal of the American Medical Association article, “Addressing the Public Health Crisis of Maternal Mortality,” authors Diana W. Bianchi, MD, Janine A. Clayton, M.D., and Shannon N. Zenk, Phd, MPH, RN, note that “The U.S has the highest rates of maternal mortality and morbidity among high-income nations.”
As disquieting as this clinical observation may be, it both:
1. Hugely underestimates the breadth and severity of the problem and
2. Seems oblivious to the obvious explanation and a no less apparent remedy.
United States obstetrical services have not only the highest levels of maternal mortality and morbidity of all the well-to-do medically advanced countries but our newborns share in their mothers’ lethal statistics. In this respect our obstetrical services are uniformly performing so badly that even “undeveloped” and “medically backward” countries enjoy far healthier outcomes than we do.
Unfortunately there’s more bad news: our numbers appear to be worsening year by year.
The simple reason for this dispiriting disparity is that by far the greater number of deliveries performed in the United States take place in institutions that, for all of our efforts, remain petri dishes for a variety of pathogens ready to strike at the most clinically vulnerable – newborn infants and mothers giving birth. Everywhere else in the world births take place where they have for centuries – in the relatively pathogen-free setting of mother’s home.
Hospitals are sanctuaries for the sick and the dying. Giving birth is a normal, ordinarily healthy biological act well protected by nature from all run-of-the-mill ambient pathogens. But Mother Nature is no match for the panoply of microbes inevitably hiding out in even our “cleanest” hospitals.
My medical school fourth year of obstetrical clerkship rotated through the obstetrical department of a Chicago hospital whose Chief of Obstetrics saw the dangers of conducting what should be a normal, life-affirming process in an institution devoted to sickness, dying and death. Now were a pre-natal evaluation of mother to indicate a problem requiring “modern” interventions, she would of course give birth in a conventional delivery room supplied with all the necessary apparatus and special skills that might be needed. Altogether this hospital’s maternal and neo-natal morbidity and mortality was close to zero. Incidentally, every delivery I performed during my clerkship took place on mother’s well-prepared kitchen table – perhaps giving new meaning to the phrase “home delivery.”
