I was reading an article that ranked USA 169th in infant mortality rates, and was surprised that America is far behind other developed nations. I'd like to hear some thoughts on this from American nurses working in this area as to why.
The article suggested that part of the reason had to do with so many births being induced to fit into a schedule, and it was ultimately tied into saving money.
It's the first I've heard anything about this, so your thoughts welcome.
Specializes in Medical-Surgical/Float Pool/Stepdown.
ok....but how does this relate to the topic of infant mortality?
I'm assuming that convenience can cause increased risks such as increased infant mortality. Seems like an easy connection to me when working with any surgical Pt. There are always risks involved with operations and I'm assuming those risks naturally increase with the increase of unneeded C-sections. It's like "electing" to get a total knee repair done and then having the joint become infected even though all was done as it was suppose to be.
I absolution LOVE this response. It is so true. People at the top of the socio-economic ladder who live healthy lifestyles and have relatively easy access to the finest health care our country can provide have great outcomes.
However, the "freedoms we enjoy" in America include the freedom to fail ... to be poor ... to be uninsured ... to live an unhealthy lifestyle ... to have minimal access to any health care ... etc. We are one of the most diverse nations in the world -- perhaps THE most diverse. Those countries with the best health care outcomes are more homogeneous populations who are all covered by government health care plans. They include very few people without good access to good health care.
I absolution LOVE this response. It is so true. People at the top of the socio-economic ladder who live healthy lifestyles and have relatively easy access to the finest health care our country can provide have great outcomes.
However, the "freedoms we enjoy" in America include the freedom to fail ... to be poor ... to be uninsured ... to live an unhealthy lifestyle ... to have minimal access to any health care ... etc. We are one of the most diverse nations in the world -- perhaps THE most diverse. Those countries with the best health care outcomes are more homogeneous populations who are all covered by government health care plans. They include very few people without good access to good health care.
Excellent point.
I think combined with the perception of our "freedoms" from other countries, along with the huge income divide that begets health disparity is a HUGE factor in producing unfavorable outcomes in our country.
Specializes in NICU, PICU, Transport, L&D, Hospice.
Part of this seems obvious to me.
In many/most industrialized countries poor women have good access to early and comprehensive prenatal care. In the USA that access is completely dependent upon income, access to health insurance, and geographical access to Women's Reproductive Health Clinics. We have stood by and watched while state governments have worked dilegently to shut down such clinics because they are opposed to abortion. In some areas of some states now, poor women must travel unacceptable distances to receive affordable prenatal care.
For those anti-abortion legislators the health outcomes of those poor women and their children are not as important as the few abortions performed at the clinics. Further deepening the failure, those same folks are too often also trying to prevent those poor women and adolescents from obtaining affordable birth control.
I'm assuming that convenience can cause increased risks such as increased infant mortality. Seems like an easy connection to me when working with any surgical Pt. There are always risks involved with operations and I'm assuming those risks naturally increase with the increase of unneeded C-sections. It's like "electing" to get a total knee repair done and then having the joint become infected even though all was done as it was suppose to be.
Fair enough....but is this an assumption (that a greater percentage of C-sections correlates to a greater percentage of infant mortality) or something more concrete, factual?
I realized that your post about a 50% C-section rate meant that you believed that this translated into a higher mortality rate.....but I am curious as to whether it's actually true.
Perhaps (and this is not factual, it's nothing more than guesswork, tagging onto the guesswork already posted) C-section births result in higher-risk infants in general, and THAT means higher infant mortality. IOW, if they had not had C-sections, the babies might not have even made it to the live birth stage....and the numbers are higher for infant mortality but not for the reasons we think.
Someone said something about how the US saves babies as young as 22 weeks, and certainly a live birth for such severe premies is going to skew the numbers of mortality when many of those babies eventually succumb. They wouldn't have lived at all elsewhere.....but they DID live here.....so therefore the numbers of infant mortality get ramped up along with it.
A previous poster also pointed out the percentage of c-sections her hospital does. Someone did not see how that is related but the US does have a higher rate of elective c-sections done and people are beginning to notice a trend with these babies having more problems than those who are allowed a natural course of pregnancy and delivery.
Is this a documented trend, that babies born via C-section have more problems surviving infancy than those who were born lady partslly? And if so....the question begs to be asked how many of these C-section births would not have even resulted in a live birth in the first place if they had been born "naturally".
I'm not condoning convenience births via surgery. I AM concerned that there seems to be a view that correlation DOES equal causation, ie: there are more C-sections and we have higher infant mortality therefore C-sections increase infant mortality.....and I don't believe this is supported by evidence.
I believe there are multiple and varied reasons why the US infant mortality rate is higher than elsewhere, the GREATEST of these reasons being the US's ability to "save" premature infants that will end up dying before too long. These babies would never have had a chance in other countries, and would have died before becoming a "live birth" statistic, inflating the infant mortality rate.
Is this a documented trend, that babies born via C-section have more problems surviving infancy than those who were born lady partslly? And if so....the question begs to be asked how many of these C-section births would not have even resulted in a live birth in the first place if they had been born "naturally".
I'm not condoning convenience births via surgery. I AM concerned that there seems to be a view that correlation DOES equal causation, ie: there are more C-sections and we have higher infant mortality therefore C-sections increase infant mortality.....and I don't believe this is supported by evidence.
I believe there are multiple and varied reasons why the US infant mortality rate is higher than elsewhere, the GREATEST of these reasons being the US's ability to "save" premature infants that will end up dying before too long. These babies would never have had a chance in other countries, and would have died before becoming a "live birth" statistic, inflating the infant mortality rate.
It's the elective c-sections I'm talking about. Those that are done because an ob is going on vacation, to a conference or the mom "just cannot stand being pregnant one more minute". That's the reality of it in the very recent past. That's why there is talk about changing the definition of term. People were pushing the limits "well if 38 weeks is term then 37 is close enough to do the c-section" and the outcome has been babies born too early who do not transition well and need support that they would not have needed had nature been allowed to take it's course. There is more than just a correlation with these. I don't have time to do the research at the moment but I will look it up.
Any L/D nurses who can step in an give us your opinion?
It's the elective c-sections I'm talking about. Those that are done because an ob is going on vacation, to a conference or the mom "just cannot stand being pregnant one more minute". That's the reality of it in the very recent past. That's why there is talk about changing the definition of term. People were pushing the limits "well if 38 weeks is term then 37 is close enough to do the c-section" and the outcome has been babies born too early who do not transition well and need support that they would not have needed had nature been allowed to take it's course. There is more than just a correlation with these. I don't have time to do the research at the moment but I will look it up.
Any L/D nurses who can step in an give us your opinion?
Interesting thoughts. Oh, don't make yourself crazy looking things up (I never ask people to look up something I could do on my own, that's lazy!).....I'm mostly wondering out loud.
I wasn't aware of elective C-sections being any more hazardous to a baby's survival than a lady partsl birth is all I'm thinking. Maybe it is....and if so....why? Is it really because they are intentionally born premature? And maybe it's not.....and convenience can be scorned as another entitlement some prima donnas have...but it isn't any more of a problem for survival than another route.
Many states have put in regulations on elective C sections. The doctor needs to justify a C section before 38 weeks. It prevents the elective c section for convenience (going on vacation, tired of being pregnant, etc) before 38 weeks gestation.
Many states have put in regulations on elective C sections. The doctor needs to justify a C section before 38 weeks. It prevents the elective c section for convenience (going on vacation, tired of being pregnant, etc) before 38 weeks gestation.
Yes that's true but the question that remains is "why"? If you are at a delivery hospital ask some of your colleagues who have been at this a bit longer if they noticed a trend with elective c-section babies having increased risk of complication.
I wasn't aware of elective C-sections being any more hazardous to a baby's survival than a lady partsl birth is all I'm thinking. Maybe it is....and if so....why? Is it really because they are intentionally born premature? And maybe it's not.....and convenience can be scorned as another entitlement some prima donnas have...but it isn't any more of a problem for survival than another route.
Good food for thought!
Actually it's been known forever that lady partsl deliveries in the absence of an emergency are overall better for the babies. A lot of fluid gets squeezed out of their lungs as they pass through the birth canal. I can't tell you how many term/near term babies I've transported with TTN/respiratory distress and the prevailing thought was it was a complication of being born via c-section. The other problem is that when people start pushing the boundaries you may get a near term baby with premie lungs that would have been fine if allowed to "cook" a little longer.
AJJKRN
1,224 Posts
I'm assuming that convenience can cause increased risks such as increased infant mortality. Seems like an easy connection to me when working with any surgical Pt. There are always risks involved with operations and I'm assuming those risks naturally increase with the increase of unneeded C-sections. It's like "electing" to get a total knee repair done and then having the joint become infected even though all was done as it was suppose to be.