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Despite International Decline, Maternal Deaths a Growing Concern in U.S.
- Women Can Reduce Their Risk by Using Healthy Birth Practices -
By: Lamaze International
Recent research published in April 2010 in The Lancet  indicates a significant drop in maternal deaths, which is encouraging news for maternal health advocates worldwide. In the United States, however, research shows that the rate of women dying in childbirth has, at best, failed to improve in decades, and at worst, shows signs of increasing in prevalence. 
“For a nation that’s spending more on maternity care than any other nation in the world, the U.S. trend line on mothers’ health is going in the absolute wrong direction,” said Sharon Dalrymple, president of Lamaze International. “The irony is that too much medical care may be fueling the growing number of women being injured or dying in childbirth.”
Most childbirth experts agree that there is a “sweet spot” of safety for medical interventions like induction or cesarean surgery. In countries where too few medical interventions are available, women have increased risk of death in childbirth. However, when otherwise healthy women are exposed to the risk of cesarean surgeries or induction without a distinct medical need, these women also will have an increased risk of death and injury in childbirth.
“The challenge for women and their providers is to find that ‘sweet spot’ and use medical interventions only when they are truly beneficial to mother and baby,” said Dalrymple. “At Lamaze, we’re dedicated to helping women see the role that they can play in protecting their own health, and their baby’s.”
While better record keeping may account for part of the increased rate of maternal deaths in the United States, many experts agree that these data indicate a real increase in the number of women dying in childbirth. During this same time period, the Centers for Disease Control and Prevention identified a 17 percent increase in maternal injuries, which were primarily related to cesarean surgeries.  Additional research also showed that for every 5 percent increase in the cesarean surgery rate, there are an expected 14-32 more maternal deaths and a total of 5,000-24,000 more surgical complications. 
The risk of death following cesarean surgeries is more than three times higher than for vaginal births.  According to an Amnesty International report, American women have a higher risk of dying from pregnancy-related complications than those in 40 other countries and cesarean surgeries are performed in nearly one third of all deliveries in the United States – twice as high as recommended by the World Health Organization (WHO).
“Maternal mortality is not just a third-world problem,” said Debra Bingham, president-elect of Lamaze. “Women in almost every other industrialized nation are better off than American women. It also is alarming that maternal injuries have increased in the United States over the same time period that maternal mortality has more than doubled. Women in the United States expect and deserve better outcomes for themselves and their babies.”
Lamaze teaches women that there are things they can do to reduce the risk of complications, such as being as healthy as possible prior to getting pregnant, getting prenatal and postpartum care, as well as allowing labor to start on its own unless there is a clear medical problem. Lamaze also is encouraging hospital-based clinicians to allow women to move freely in labor. Currently most women’s movements are limited since they are tethered to fetal monitors with cords that are only a few feet long. Additionally women in labor will also benefit from better access to labor support measures. These practices can help reduce the chance of a cesarean surgery, and increase safe and healthy birth outcomes.
To support women in their efforts to have safe and healthy births, Lamaze International developed the Six Healthy Birth Practices based on recommendations by the WHO and backed by extensive research that support a woman’s natural ability to give birth. The Six Healthy Birth Practices are:
•Let labor begin on its own
•Walk, move around and change positions throughout labor
•Bring a loved one, friend or doula for continuous support
•Avoid interventions that are not medically necessary
•Avoid giving birth on your back and follow your body's urges to push
•Keep mother and baby together; it's best for mother, baby and breastfeeding
To learn more about Lamaze’s Six Healthy Birth Practices, please enroll in a Lamaze childbirth education class and visit http://www.lamaze.org/
About Lamaze International
Lamaze International promotes a natural, healthy and safe approach to pregnancy, childbirth and early parenting practices. Knowing that pregnancy and childbirth can be demanding on a woman’s body and mind, Lamaze serves as a resource for information about what to expect and what choices are available during the childbearing years. Lamaze education and practices are based on the best and most current medical evidence available. Working closely with their families, health care providers and Lamaze educators, millions of pregnant women have achieved their desired childbirth outcomes using Lamaze practices. The best way to learn about Lamaze’s steps to a safe and healthy birth is to take a class with a Lamaze certified instructor. To find classes in your area, or for more information visit www.lamaze.org.
 Hogan MC et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet, April 12, 1020.
 Joint Commission. Preventing Maternal Death. Sentinel Event Alert, Issue 44, January 26, 2010. http://www.jointcommission.org/
 Kuklina, EV et al. Severe Obstetric Morbidity in the United States: 1998–2005, Obstetrics & Gynecology, Vol. 113, No. 2, Part 1, February 2009.
 Plante, LA. Public Health Implications of Cesarean on Demand. Obstetrical and Gynecological Survey, Vol.61, No. 12, 2006.
 Amnesty International. Deadly delivery: the maternal health care crisis in the USA, March 2010. http://www.amnestyusa.org/