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.
Thanks for that macawake. Universal Healthcare. This may make the biggest difference. Your maternity and sick child benefits are amazing.
I know, I feel very fortunate.
Do you have a lot of pre-natal drug use in Sweden?
I'm a PACU and anesthesia nurse so this isn't my area of expertise at all but from what I know there aren't many drugs routinely prescribed to pregnant women. Folic acid is recommended when a woman plans on becoming pregnant and I think for the first trimester. Iron supplements are often prescribed for the later part of the pregnancy. Also vitamin B12 for vegans I think.
Pregnancy is regarded as a natural process, not a disease. There are a lot of recommendations about smoking, alcohol, diet and exercise but medications are as far as I know only prescribed if there is a medical indication. Early during the pregnancy the check-ups are about once per month and more frequently as the due date draws near/last trimester. I'm curious, what type of drugs are commonly prescribed in the US?
Thank you, ixchel
Edit: This is in response to Flying Scot's post below: (for some reason my computer is acting up and wouldn't allow me to quote/make a new post).
Okay, now I get it. I blame my sloppy reading on my sleep deprived brain (been on-call, haven't slept in eons). I was really scratching my head trying to figure out what kind of meds the providers were prescribing to pregnant women in the US
I don't have any stats readily available to me but I think that the number of drug addicts who will carry a pregnancy to term and deliver the baby while still actively using illicit drugs is lower here. Of course we also have a problem with illicit drug use and the phenomenon is not unheard of, but I think that the whole thing with a strong social safety net probably helps keep these numbers down.
Macawake, I was talking about illicit drugs. We have rampant heroin, methamphetamine and cocaine problems here in the US. A significant number of our babies are born addicted and have a terrible transition into extra-uterine life if they make it that far. We also have pretty sucky pre-natal care availability to our impoverished population.
Indications for drugs for pregnancy are all dependent on any underlying conditions the women may have...
Folic acid, prenatal vitamins, B12 seem to all match up.
If there is preclampsia, hyptertension, there will be some diuretics to control blood pressure, some tocolytics if they are at risk for preterm labor. When I was on the Labor and delivery floor, mag sulfate was a big one.
But one big thing I noticed, and I'm not sure if they do that everywhere in the US or globally, woman were bound to their beds. They would ask for an epidural soon after being admitted, very few cases they didn't.
I think I saw 1 or 2 women up and walking around to help progress labor, the entire semester that I was there. It was a busy floor.
Rest were all in their beds, because of the epidural. They were getting straight cath because they couldnt walk to the bathrooms. They weren't allowed to drink/eat, incase of an emergency c-sec.
Not a nurse but an administrator in Europe here. As far as I remember from my public health and social medicine classes, it was casually mentioned that the high infant mortality rate in the USA is due to the preterm births.
Not, however, for this reason:
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.
It is my understanding that the time, work and tech that go into saving premature births is among what in the US would be considered "expensive". Premarture births in the US is to a degree correlated with ethnic groups that are cluster in the lower socioeconomic layers, and hence are more likly to be uninsured or underinsured. Would US healthcare institutions be that much more dilligent than European ones in saving babies, when financially much more disincentivized? As opposed to European healthcare workers who have no real reason not to try? This seems unlikly in the extreme to me, all the more so because we would have to be looking at a large and systemic trend to get this kind of result.
It is also worth pointing out that the earliest preterm to survive was James Gill, born in Ottawa, Canada.
What is more, if other nations really did classify more babies as stillborn, which the US would classify as alive and try to save, one would expect the US to do comeasurably better in number of stillbirths, and other nations to register higher numbers of stillborn. Fetal mortality rate. This does not happen.
While the US does not do as badly in stillbirths as in infant mortality, the US is only middle of the pack among developed nations. And many of the nations with low infant mortality rates also record low number of stillbirths.
Further, the US infant mortality rate does not exist in a vacuum. The US maternal mortality rate places fairly close, indicating that it is not due to a registration artifact. Morher left the hospital alive or dead is much less amendable to different registration practices.
Finally, while developing nations can be all over the place in definitions, WHO stats are based on the data submitted to the WHO, and developed countries are actually pretty good about using the WHOs own definitions when submitting the data.
As far as I can remember, the cause of the US high infant mortality is due to preterm births for a different reason: The US simply has a much larger percentage of preterm births than other developed nations. And the difference is significant.
Specializes in NICU, PICU, Transport, L&D, Hospice.
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.
It seems to me that this all became relevant with the Baby Doe laws in the early 80's, didn't it?
ixchel
4,547 Posts
Sweden is beautiful. We talked about Sweden's stats and approach to care for childbearing families in some depth when I got Lamaze certified.