Response to Lamaze International on U.S. maternal deaths

This week, the U.S. organization Lamaze International issued a press release titled: 'Despite International Decline, Maternal Deaths a Growing Concern in U.S.'.

It states that women can reduce their risk of dying by using healthy birth practices, and lists these 'Six Healthy Birth Practices' as such:

*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

Also in the press release, Lamaze International points to the use of cesarean surgeries or induction without a distinct medical need as increasing the risk of death and injury in childbirth.

The Reality
However, aside from one sentence in the press release that suggests women try to be 'as healthy as possible prior to getting pregnant', there is no acknowledgment of some of the biggest challenges facing maternity care in the U.S. (and indeed many other developed world countries).

Namely: 'OVERWEIGHT', 'OBESITY', 'MATERNAL AGE' and 'BIRTH WEIGHT'.

As long as birth groups like Lamaze continue to ignore these elephants that are sitting squarely in the majority of antenatal rooms, we are never going to help reduce maternal mortality rates. Yes, the U.S. spends a huge amount of money on maternity care and yes, we would expect to see that translate into record low rates of maternal mortality.

Let's be honest
But the fact is that doctors across the country are battling with maternal characteristics that previous generations simply didn't have to. Women are older, women are fatter and women are less ready for LABOR (the definition of which is not always appreciated) than their ancestral and developing world counterparts.

We can have all the money in the world, but if women themselves are not healthy to start with, pregnancy and delivery is going to be more difficult - and indeed more dangerous.

We need to be HONEST with women about their chances of achieving a spontaneous vaginal delivery, and we also need to remember that if a healthy woman WANTS a cesarean delivery, she should not be dissuaded using mortality and morbidity data that is entirely unrelated to her particular circumstances.