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.
As a NICU nurse, I can tell you we push that envelope and are saving more preemies who are barely viable. These kids live for a short time. Many other countries will not resuscitate a 22 weeker, nevertheless a 23 weeker. We have been brought kids that we know aren't quite 22 weeks. 30 years ago, 24-26 weeks was cutting it close for viability, but has technology as taken a turn and become more sophisticated we push the limits. So of course our infant mortality is up.
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.
I appreciate you mentioning this. There are a lot of issues surrounding childbirth, one of which is infant mortality. There are "two Americas." In one, you have Caucasians and Hispanics, and in the other you have Native Americans and African Americans. In the first group you see low infant mortality - 5.4ish/1,000 live births. In the second you see high infant mortality, 8.49/1,000 for Native and Alaskan mothers and 12.4 for African American mothers. Now, the US has about 42 million African Americans, which is a lot of people, meaning whatever is effecting infant mortality in that group is widespread. Personally, I tend to assume it's an access issue, but I'm not an expert.
The other is maternal mortality, and I'm glad someone brought it up. The US may or may not be the only developed country with a rising maternal mortality rate. And, not unexpectedly, there's also a massive difference in maternal mortality by race. So, the earlier comment that the US is both a first world and third world country isn't far off.
As a NICU nurse, I can tell you we push that envelope and are saving more preemies who are barely viable. These kids live for a short time. Many other countries will not resuscitate a 22 weeker, nevertheless a 23 weeker. We have been brought kids that we know aren't quite 22 weeks. 30 years ago, 24-26 weeks was cutting it close for viability, but has technology as taken a turn and become more sophisticated we push the limits. So of course our infant mortality is up.
Do you think though that it is just those micro-preemies that dropped the U.S. to 169th?!?!? I mean obviously it could make a difference but I don't think that's the real problem here.
I think that there are cultural issues at play as well. Many women in developed nations as well as third world nations receive a lot of support. Family and neighbors often step in and help care for mom and baby. They let mom sleep and cook nutritious meals. Nurses and midwives are often sent to homes to check in on families.
I also don't think that the majority of women in the rest of the world are placing their 4- 6 week old infants in substandard childcare and hauling their barely healed butts back to work . In almost all of these countries, more mothers are breastfeeding and for longer amounts of time. I am also curious about the rates of prenatal drug, alcohol, and tobacco abuse in these countries?What about the number of non-accidental head traumas(shaken baby). How about the rate of unmarried teen pregnancies? What about the overall rate of unwanted/unplanned pregnancies?
I have listed many issues that reflect on culture that pushes mothers and babies to the sides and places many of them into danger. Can anyone offer some things that this culture does to support infants' and mothers' best interest? It never seems like policies are created to benefit families, only corporations. It is truly depressing.
I don't think it made it drop that far, but it plays into it more than people think. Many other countries don't save micro-preemies whether it is on their ethics or just lack of capability.
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.
Cesareans do result in higher rates of infant pneumonia and lower rates of breastfeeding success, in addition to higher risk of infection and death in moms. I don't believe cesarean itself is directly, all by itself, linked to infant death. Preterm birth is, however, and so early induction or early cesarean can be directly linked as such. Induction increases risks of rupture, which can lead to death of mom and baby.
I believe our problem in the U.S. Is so incredibly complex that you can't simply pin it on one or two "easy" things. Everyone here who has suggested so,etching has been right to varying degrees. Here is my quick list, although I'm sure I'll forget stuff.
1. Gotta play the crunchy card for all the free birthing crunchy midwives and mamas - in the majority of births, leaving the process of birth alone actually decreases risks of complications. Birth usually requires no intervention. When you add pain meds, induction meds, frequent internal assessments, artificial ruptures of membranes, etc., infection risks to baby and mom increase, and labor's progression can be stalled, or unsafely accelerated.
2. Access to care. Whether it be financially or geography, it lacks for many people.
3. High tech does have its advantages, despite my decrying of it in #1. Babies that wouldn't used to make it are being born to moms who used to not survive it. Fragile babies may survive for a little while, but may eventually pass on.
4. About the disparities in access to care.... The more we limit access to birth control and abortions, the longer lack of access to these things will be reflected in our infant mortality rates. Look.... I'm going to tell you right now that in an ideal world, abortion would never be turned to and babies would be born healthy and loved, to parents hopeful and capable of caring for them. That's not reality. Let's prevent unwanted babies from being created in the first place, and let's allow families the option of ending pregnancies when babies have terminal defects.
5. We are not healthy. Obesity, diabetes, hypertension, we are not healthy.
6. Prenatal education - the reason it is lacking is of course related to some of the stuff already listed.
7. High risk lifestyles - drug usage, communicable diseases, domestic violence, generally risky behaviors, etc.
That's all. I'm sure I'm leaving some other thought up there on my soap box. Thats plenty for now. :)
Please see this table, with data from 2013. Though the table can't be sorted, my eyes counted 37 countries with a neonatal mortality rate of less than the U.S. rate of 4 per 1000 live births. That would rank the U.S. 38th ---- not 169th.
Please see this table, with data from 2013. Though the table can't be sorted, my eyes counted 37 countries with a neonatal mortality rate of less than the U.S. rate of 4 per 1000 live births. That would rank the U.S. 38th ---- not 169th.
The way the table is presented its easy to see how it could be misread if just glanced at. Buuuutttt.. The U.S. does have a frighteningly high infant mortality rate when compared to other developed European countries and I still think it's a good discussion.
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.
"Known forever"? Guess since I have never had anything to do with births outside of my own kids....I'm not one of those "in the know" . It's not an area of nursing I have had any interest in pursuing so not knowledgeable on those stats.
Since my own kids were born via C-section (and not for the convenience).....and are two of the healthiest kids on the planet, suffering zero ill-effects of that birth process and breastfeeding like champs......I didn't realize it was a problem for so many others. It seems it is, and I thank you for the information!
Certainly there are many factors in play to create the statistics. I think the opinions concerning which of the factors is a bigger one, more of a concern depends considerably on which of those factors people are most passionate about.
And regardless of which of the factors are the most problematic....it's clear that we (the US) could be doing better.
. It's not an area of nursing I have had any interest in pursuing so not knowledgeable on those stats.
NicuGal, MSN, RN
2,743 Posts
As a NICU nurse, I can tell you we push that envelope and are saving more preemies who are barely viable. These kids live for a short time. Many other countries will not resuscitate a 22 weeker, nevertheless a 23 weeker. We have been brought kids that we know aren't quite 22 weeks. 30 years ago, 24-26 weeks was cutting it close for viability, but has technology as taken a turn and become more sophisticated we push the limits. So of course our infant mortality is up.