Revealing the Real Risks: Obstetrical Interventions and Maternal Mortality

By Marsden Wagner
Issue 118, May/June 2003

Recently, a woman in Iowa was referred to a university hospital during childbirth because of possible complications. At the university hospital it was decided that a cesarean section should be done. After the cesarean section was completed and the woman was resting in her hospital room, she went into shock and died. An autopsy showed that, during the cesarean section, the surgeon had accidentally nicked the woman's aorta, the biggest artery in the body, which led to internal hemorrhage, shock, and death.¹

A cesarean section can save the life of the mother or her baby, or both. A cesarean section can kill a mother or her baby, or both. Every procedure or technology used during pregnancy and birth carries risks for the mother and baby. Whether or not to use any procedure or technology will be a judgment based on balancing the chances that it will make things better against the chances that it will make things worse.

We live in the age of technology. Since long before human beings landed on the moon, we have believed that technology can solve all of our problems. It should come as no surprise that doctors and hospitals are using more and more technology and invasive interventions on pregnant and birthing women. Has all this technology solved the problems surrounding birth? Let's look at the record. Is the increasing use of technology saving the lives of more pregnant and birthing women? In fact, the risk of a woman in this country dying from maternal mortality (i.e., causes related to pregnancy) has not decreased in more than 25 years. Each year, nearly 1,000 women die during pregnancy, during birth, or in the first week after giving birth. Nearly half of these deaths could have been prevented with better access to higher-quality maternity care. Hundreds of thousands of other women experience medical complications from pregnancy.²

The data also suggest an increase in recent years in the number of women dying during pregnancy and birth in the US.³ We have known for some time that maternal mortality in the US is underreported--in one state in one year, a third of the maternal deaths had not been reported.⁴ But the latest evidence suggests that "The actual pregnancy-related death rate could be more than twice as high as that reported for 1990."⁵

Why Are More American Women Dying?
It is difficult to pinpoint why more American women are dying before, during, and after giving birth--the data give only the leading or immediate cause of death, not the underlying causes. But if we look at the six leading causes of pregnancy-related deaths in the US, three--hemorrhage, anesthesia, infection--are often the result of invasive obstetric interventions.⁶ For example: Although the immediate cause of death is frequently given as "hemorrhage," in many cases the hemorrhage is associated with cesarean section (as in the case cited in the first paragraph). There is good research, both in the US and the United Kingdom, showing that the maternal mortality rate for cesarean section is four times higher than for vaginal birth.^7-9 The rate of maternal mortality is still twice as high as for vaginal birth even when the cesarean section is routine, or "elective"; i.e., it is not an emergency procedure. With nearly twice as many cesarean sections as are necessary being done today in the US, the procedure could be a significant part of the reason for the country's rising rate of maternal mortality.¹⁰

Another possible cause of rising pregnancy-related deaths in the US is the markedly increasing use of epidural blocks for normal labor pain. Administering an epidural block doubles the risk that the woman will die; "anesthesia complications" are documented as one of the leading causes of maternal mortality in the US.¹¹

There is good reason to believe that other obstetric technologies also contribute to the rising number of women who die during childbirth in this country. Data from the Centers for Disease Control (CDC) show that in the past ten years the number of women given powerful and dangerous drugs to induce labor has gone from 10 percent of all births to 20 percent.¹² In the same ten years, the drug Cytotec, not approved by the FDA for labor induction because of insufficient scientific evaluation of risk--a warning often ignored by doctors--has become the single most popular labor-inducing drug. New scientific data show that inducing labor with Cytotec causes a marked increase in uterine rupture, an obstetric catastrophe in which a quarter of all babies die, many women die as well, and, of the women who survive, almost none can ever have another baby.

Why has the rate of Cytotec-induced labor doubled when the ability of women's bodies to begin labor has not decreased? Further CDC data show that the answer is doctor convenience. In those same ten years, the number of births taking place Monday through Friday greatly increased.¹³ Like taking prenatal X-rays in the 1930s, prescribing the drug di-ethyl-stillbesterol (DES) to pregnant women in the 1950s, and thalidomide in the 1960s, inducing labor with Cytotec in the 1990s is another obstetric intervention that has gone into widespread use without adequate scientific evaluation, with tragic consequences for thousands of women and babies.