It's no secret that medical costs in the United States are among the highest in the world, yet our healthcare system is far from the highest quality. Lesser known is the crisis in childbirth: that our maternal mortality rate is actually steadily increasing. Medical malpractice attorneys at Pintas & Mullins explore this quiet crisis and why it is particularly affecting southern states.
A woman giving birth in the United States is three times more likely to suffer fatal complications than in the United Kingdom, and twice more likely than in Saudi Arabia. The U.S. is actually the only advanced country in the world with a rising maternal death rate - more than 18 women died for every 100,000 births in 2013. In Mississippi, 40 of every 100,000 women die in childbirth.
The most frequent causes of maternal mortality are high blood pressure, obstructed labor, heavy bleeding, and other preventable causes. Far too many women lack access to regular check-ups or do not have health insurance. More than 100,000 people in Mississippi do not even have access to insurance after the state decided not to expand Medicaid.
Some experts believe racial discrimination plays an important role in poor healthcare for expectant mothers in the south. This point is reinforced by a troubling statistic: in Mississippi, nearly 55 black women die in childbirth for every 100,000 births, compared to just 30 white women.
Although the quality of care women receive is decreasing, the cost of care is sharply increasing. The average cost of delivery in the U.S. has tripled since 1996, costing more than $50 billion per year. Childbirth is the single largest category for hospital payouts in almost every state.
Insurance companies are aware of the rising costs of maternal care, informing hospitals that action must be taken to curb costs. One of these hospitals, Hoag Memorial Hospital Presbyterian in Orange County, California, was warned that its maternity costs were too high and was at risk of being cut from its insurance network. Driving the high costs was the increasing frequency of Caesarian sections.
In 2012, about 38% of all births performed at Hoag Memorial were C-sections (compared to the state average of 33%). Over the next three years, the hospital dropped its C-section rates to about 33% overall, and to 25% for low-risk births. Hoag also increased the percentage of natural births among women who previously had C-sections.
Increasing the number of natural births and decreasing C-sections results not only in lower costs, but better health outcomes for mothers and babies as well. Of course, in many cases C-sections are necessary and in the best interest of the mother and child, such as when the baby is in breech position. Over the past few decades, however, the sharp rise in C-sections has not been driven my medical necessity, but by other factors - namely, doctor time constraints.
Government agencies like the CDC and Medicaid are pushing to reduce C-sections that are not medically necessary. Non-profits, such as the March of Dimes, have launched educational programs that encourage women to wait for natural labor, and physician groups have proposed several ways to reduce C-section rates.
Hoag told The Atlantic that changing the mindset of doctors was the focus of the change. The hospital took records of each doctors' C-section rate and shared this data with all doctors in the department. Names were not withheld, so it was evident to all who was operating far above or below average. OB-GYNs at Hoag said that knowing the hospital was monitoring C-section rates changed how they thought about their practice and discouraged them from using C-sections as a crutch.