The Impact of Cesarean Delivery on Maternal Mortality and Morbidity
Guy I. Benrubi
How a society treats its female population reflects the quality of life in that society. One can assess the overall human condition of a society by the amount of resources dedicated to the well-being, education, and equal civil status of women. Maternal mortality statistics are one of the most direct indicators of the importance governmental and nongovernmental institutions direct toward the well-being of women. Birth is in the most direct interest of a society. Ensuring safe pregnancy and safe birth should be a priority to the safety and protection of its citizenry just as important as internal law and order, border integrity, and disaster protection and response.
One of the measures of “development” worldwide during the 20th and 21st centuries is a consistent and sharp drop in maternal mortality. The drop does not only indicate a medial delivery system that is technologically advanced but also points to the educational, nutritional, and equality achievements in the entity. In Europe and other developed countries during the last 150 years, there has been remarkable progress in the reduction of maternal mortality, yet this goal has not been achieved in the United States.1,2 Maternal mortality is measured by the pregnancy-related mortality ratio, further defined as the number of deaths of pregnant women that are due to a pregnancy complication. The most recent Centers for Disease Control and Prevention (CDC, 2014) report on the current status in the United States is as follows:
“Since the Pregnancy Mortality Surveillance System was implemented, the number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 18.0 deaths per 100,000 live births in 2014. The graph below shows trends in pregnancy-mortality ratios defined as the number of pregnancy-related deaths per 100,000 live births in the United States between 1987 and 2014 (the latest available year of data).”1 (Figure 1-1).
This rise in maternal deaths is magnified by the estimate that approximately 50% of maternal deaths in the United States are preventable.
This question of why in the United States there is such a dramatic increase in the pregnancy-related mortality ratio coupled with the dramatic increase in both technological advances and understanding of pregnancy physiology is puzzling and many are searching for answers. Several authors suggest the following factors3,4,5,6,7,8:
Inconsistency of level of obstetric care in areas of the United States with many sophisticated settings with the latest equipment and most experience practitioners versus other settings where births occur in primitive conditions. Very frequently deteriorating clinical conditions are identified too late. There is a lack of a standard approach mandated either by professional self-regulation or legislative statute.3,4,5
The increasing percentage of pregnant patients with chronic health conditions without access to affordable prenatal care. Hypertension, diabetes, and particularly obesity are on the increase. In the United States, uninsured patients are three to four times more likely to die from maternal complications than insured women. The most effective solution is a healthcare system that provides affordable prenatal care to all pregnant patients. Several states have addressed this problem by expanding Medicaid eligibility to pregnant patients, but there are huge gaps.4,5
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