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.
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!
There is evidence to support a correlation between c-section delivery and infant respiratory distress. It's thought that during labor, maternal hormones are released that help rid the infant of some fluid in the lungs (we used to think it was 'squeezed out' by lady partsl delivery, but that notion is falling out of favor). Perhaps more importantly, these kids may be delivered too early if their due dates are miscalculated. Babies born even a couple of weeks early are far more likely to have trouble breathing; same problem occurs with elective inductions.
Also, babies born via c-section are less likely to breastfeed immediately after delivery or have skin-to-skin with mom in the first hour of life. Babies who don't do those things are more likely to have difficulty breastfeeding. Since breastfeeding is protective against SIDS and infection, they may be at higher risk for mortality.
The World Health organization recommends that national C-section rates stay between 10-15%. Unfortunately, rates are on the rise in many countries because providers can charge way more money for a C-section than a lady partsl delivery (i.e. a tenfold cost). WHO | Caesarean sections should only be performed when medically necessary
I also agree with PPs that the enormous US wealth and health disparities contribute to our crappy neonatal outcomes. Some of our NICU babies with the worst outcomes (or who never make it to us because they die in the delivery room) are born to moms living in poverty with zero prenatal care, often who are experiencing substance addiction.
No single factor 'leads' to death, per se, but each risk factor stacks the odds further against them.
I wish that it was true that people asking for totally elective c-sections (either the mom or the physician) would have to be any extra costs associated with that choice out of their own pockets -- rather than having it dumped on the 3rd party payer, who then spreads that cost to other customers and/or taxpayers. I'll bet that fewer people would be requesting it if they had to eat the extra costs.
Just a thought ... to reduce health care costs nationwide.
I would think there are probably lots of reasons, but I know that one thing that has always impressed me about post natal care in the UK is the home care. You have nurses coming to your house for X amount of time to check on the baby and on mom. I think it says something. They have longer maternity leaves, etc.
There is evidence to support a correlation between c-section delivery and infant respiratory distress. It's thought that during labor, maternal hormones are released that help rid the infant of some fluid in the lungs (we used to think it was 'squeezed out' by lady partsl delivery, but that notion is falling out of favor). Perhaps more importantly, these kids may be delivered too early if their due dates are miscalculated. Babies born even a couple of weeks early are far more likely to have trouble breathing; same problem occurs with elective inductions.
Also, babies born via c-section are less likely to breastfeed immediately after delivery or have skin-to-skin with mom in the first hour of life. Babies who don't do those things are more likely to have difficulty breastfeeding. Since breastfeeding is protective against SIDS and infection, they may be at higher risk for mortality.
The World Health organization recommends that national C-section rates stay between 10-15%. Unfortunately, rates are on the rise in many countries because providers can charge way more money for a C-section than a lady partsl delivery (i.e. a tenfold cost). WHO | Caesarean sections should only be performed when medically necessary
I also agree with PPs that the enormous US wealth and health disparities contribute to our crappy neonatal outcomes. Some of our NICU babies with the worst outcomes (or who never make it to us because they die in the delivery room) are born to moms living in poverty with zero prenatal care, often who are experiencing substance addiction.
No single factor 'leads' to death, per se, but each risk factor stacks the odds further against them.
Poor little noodles.
Very good point. I meant to mention about hormonal influences on lung maturation but then I thought perhaps that was getting a bit too detailed and was afraid I'd derail the thread.
One thing I've always thought when I heard about elective c-sections being planned for a non-medical reason is if you think you have to check the L/S ratio to make sure the baby is mature enough then maybe you should just not do the section. Why take the risk?
~pedsRN~, I think that would be GREAT! Even just the follow-up phone calls I received after my eldest's birth were incredibly helpful; my assigned lactation consultant shared a wealth of knowledge with me. When I was in OB rotation, I accompanied a postpartum RN for several home visits; we weighed and assessed the babies, watched them feed (breast and bottle), answered questions from mom, referred for other services PRN, etc. Totally fascinating; almost made me want to do L/D/PP nursing myself! It's sad that this seems to be the exception; Call the Midwife makes me want to go back to the clinic/home care model for most patients, not just in maternity!
~pedsRN~, I think that would be GREAT! Even just the follow-up phone calls I received after my eldest's birth were incredibly helpful; my assigned lactation consultant shared a wealth of knowledge with me. When I was in OB rotation, I accompanied a postpartum RN for several home visits; we weighed and assessed the babies, watched them feed (breast and bottle), answered questions from mom, referred for other services PRN, etc. Totally fascinating; almost made me want to do L/D/PP nursing myself! It's sad that this seems to be the exception; Call the Midwife makes me want to go back to the clinic/home care model for most patients, not just in maternity!
I hear ya! We try to do as much education in PP and NICU as we can, but only so much of that is going to stick when that mom is overwhelmed/exhausted/sleep-deprived/hormonal because she literally just pushed a human being out of her body (or had major abdominal surgery).
In theory all of that stuff should be covered at routine follow-up peds visits. Unfortunately, I think that the moms and infants in poverty have a lot of difficulty making to to appointments (d/t lack of transportation, costs, etc.); ironically, they have the greatest need for follow-up because they are at highest risk for poor outcomes. They'd probably benefit most from such home visit follow-ups...
For a while I lived in a low-income South American country and worked at a Well Baby clinic. The nurses provided routine follow-up visits at the office (all subsidized by the government). If a mom and baby missed multiple appointments, the nurses would literally drive/hike up into the mountains to do a home visit. If they can make that happen, surely there's more we can do.
I wish that it was true that people asking for totally elective c-sections (either the mom or the physician) would have to be any extra costs associated with that choice out of their own pockets -- rather than having it dumped on the 3rd party payer, who then spreads that cost to other customers and/or taxpayers. I'll bet that fewer people would be requesting it if they had to eat the extra costs.
Just a thought ... to reduce health care costs nationwide.
I would bet no c section is ever billed as totally elective. Take mom's BP a bunch of times til you stress her out enough to get some high readings and call it something like "borderline pre-eclampsia."
I think it's also worth mentioning the mothers having babies in the U.S. that would never even get pregnant elsewhere, ie, 60 year olds, people with multiple comorbid conditions- thanks to our fertility treatments. Their babies have to be at higher risk.
There are many reasons, as previous posters have mentioned. Better maternity leave, insurance coverage, etc.
Other things that contribute is the lack of education. Sometimes the mom is not keeping up with all the prenatal components. There is a rise in diabetes, obesity, etc that effect the health of the mother and ultimately the health of the infant.
Plus, woman are having babies in at a advanced maternal age, or a very young maternal age. Add on to that women who were not able to conceive before, who are having babies now, thanks to advances in technology. Don't forget about invtro fertilization. And how some women shouldn't be having children, because their bodies won't handle it well. And then there is genetic issues. There are mothers who can't get their tubes tied, because their policy wont cover it, and then there are mothers who are drug addicts, so babies are born with problems. There are various reasons that contribute to it.
One big issue is, in comparing UK/other countries to the America, is that we as a nation has HIGHLY emphasized medical intervention. We treat pregnancy as a disease process. Doctors are trained to see a problem and fix it. Where as in other countries, MIDWIVES are the first source of care, and their training is different from the medical model. They take on low risk patients, and let birth and pregnancy progress naturally. England and other countries are huge on midwives, look at Kate Middleton, she was treated by midwives. I think that we treat birth as such is a huge factor. If you look at studies, c-sec rates go up during times such as 4 pm and 10 pm, why? cause doctors want to get home and eat dinner and sleep. Oh your water hasn't broken? let me rupture your membranes for you.
Lot of hospitals/doctors don't take on a medical approach. I've been so many hospitals where they keep mothers in the beds on continous monitoring,which sounds great, but there is not a lot of evidenced based practice on that. Intermittent monitorring would work fine. Mothers can't walk around, they go on pitocin to augment labor. It speeds up a process that the bpdy is trying to have naturally.
*steps off soap box*
sorry guys, but its a huge issue really, one that I am passionate about.
Its awful that our infant and maternal mortality rates are low as they are. And there is sooo many factors, but I think a big part is that we don't treat pregnancy as it should be. More mothers should have access to healthcare, longer leaves, better education. Post partum care needs to be improved, especially in special cases where there is a young mom, or immigrants who don't have the family support, there should be delayed cord clamping, immediate skin to skin contact, and breastfeeding also need to be stressed WAY more than they currently are.
Its the little things that add up, when you look at the mothers previous health conditions + any pregnancy complications + how we rush the process, it shouldn't be like that at all.
okay officially off the soap box, but i like this thread, more people should be definitely aware
Another point worth mentioning is that in the US--or at least where I live--a pregnant woman does not see her OB until she is already 8 weeks pregnant (barring any complications). By that time, she is 2/3 done with her first trimester, which is the most critical time in the development of the baby. Those women who do not seek out information as to how to take care of themselves and their developing baby during this time are left in the dark and can possibly engage in harmful behavior without knowing it. Also, many women don't even know they're pregnant during this time.
I'm curious how prenatal visits occur in other countries. Anyone?
Good discussion, nursingaround1. Thank you for starting this interesting thread.
That's probably the first time this has been mentioned about a thread this OP has started. What a strange day today is indeed. Anything must be possible.
My bet is on the fact that we can technically push the limits of saving extreme premies. We have the technology but the practical implementation is leaving much to be desired.
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adventure_rn, MSN, NP
1,598 Posts
There is evidence to support a correlation between c-section delivery and infant respiratory distress. It's thought that during labor, maternal hormones are released that help rid the infant of some fluid in the lungs (we used to think it was 'squeezed out' by lady partsl delivery, but that notion is falling out of favor). Perhaps more importantly, these kids may be delivered too early if their due dates are miscalculated. Babies born even a couple of weeks early are far more likely to have trouble breathing; same problem occurs with elective inductions.
Also, babies born via c-section are less likely to breastfeed immediately after delivery or have skin-to-skin with mom in the first hour of life. Babies who don't do those things are more likely to have difficulty breastfeeding. Since breastfeeding is protective against SIDS and infection, they may be at higher risk for mortality.
The World Health organization recommends that national C-section rates stay between 10-15%. Unfortunately, rates are on the rise in many countries because providers can charge way more money for a C-section than a lady partsl delivery (i.e. a tenfold cost). WHO | Caesarean sections should only be performed when medically necessary
I also agree with PPs that the enormous US wealth and health disparities contribute to our crappy neonatal outcomes. Some of our NICU babies with the worst outcomes (or who never make it to us because they die in the delivery room) are born to moms living in poverty with zero prenatal care, often who are experiencing substance addiction.
No single factor 'leads' to death, per se, but each risk factor stacks the odds further against them.
Poor little noodles.