I’ve been thinking about statistics and mortality — maternal, neonatal and infant. I’ve previously blogged about the CDC stats for 2003-2004, available on the Wonder query, where you can find the cause of death for every infant whose death is recorded, from birth up through age one. What I wonder, though, is whether these statistics even have meaning, or if they are too narrow for real purposes. You see, there is only one cause of death allowed on the death certificate — even if the baby or mother died for a variety of reasons, or a compounding of factors.
For instance, take a baby who was born with Down Syndrome, and because of that genetic defect also had a fatal heart defect. When the baby dies, is the cause of death listed as being due to Downs or the heart defect? — it can’t be listed as both! What about babies that are born premature and end up dying from a lung infection because of their prematurity — is the cause of death listed as prematurity or infection or something related to the lungs? This may have a big impact when looking at small statistics, such as those in the home-birth set. If a breech baby died from birth asphyxia because of complications with a breech vaginal birth, is it coded “birth asphyxia” or “complications from breech birth”? The first makes it look like home birth has excess neonatal mortality in low-risk women; the second makes it clear that this birth is in the higher-risk breech group. While most breech babies will do just fine being born vaginally, some will not.
I will also note that there were several babies born in the 37-42 week group that listed as the cause of death “extreme immaturity”! At term?
Maternal mortality is another term that I have the same difficulties with. You might think that all “maternal mortality” is just “women dying in childbirth”, like what used to happen in the “Dark Ages,” before clean water, antibiotics, blood transfusions, etc. — back when women had vitamin deficiencies that caused pelvic deformity, and doctors proudly refused to wash their hands, and even gloried in their bloody clothes! (Some of these things are still factors in maternal mortality in poor countries around the world.) But maternal mortality includes deaths of women during pregnancy or up to six weeks (or 1 year, depending on the definition) of the end of pregnancy, regardless of how it ended — miscarriage, abortion, stillbirth, or live birth. I don’t think abortion should be counted with maternal mortality; because it’s more precisely “anti-maternal” — it’s the refusal of a woman to become a mother to that child. I’ve read recent statistics that half of Romania’s maternal mortality is due to abortion (which ends about half of all pregnancies there), even though it is legal. “Unsafe abortion” is the fifth leading cause of maternal mortality worldwide, according to the World Health Organization. But, it is counted, so what I want or think doesn’t matter. That’s life.
I know someone who had a near-lethal complication from her C-section (which was necessitated due to preeclampsia that threatened her life or health as well as that of her baby) — her incision became horribly infected; and she also developed blood clots in her legs, which could have traveled to her heart, lungs, or brain and killed her or seriously disabled her. If she had died, would her C-section have even been implicated? Her “cause of death” would have been listed as “infection,” or possibly “stroke” or “heart attack from blood clots”. But the infection was because of the C-section; and the leg clots developed due to being immobile because of the C-section and subsequent infection (having to stay in bed in the hospital). So, had she died, only the immediate cause of death would have been listed, and not the true cause, the underlying reason, which was “complications from a C-section.”
And there is this article, in which the author demonstrates a deliberate under-reporting of maternal mortality, by coding abortion deaths as being due to some factor — any factor — other than abortion:
Furthermore, the cover-up of abortion-related deaths has actually been furthered by the World Health Organization’s coding rule number 12 of the International Classification of Diseases. This rule requires that deaths due to medical and surgical treatment must be reported under the complication of the procedure (embolism, for example) and not under the condition for treatment (elective abortion). According to researcher Isabelle Bégin:
In effect, this makes the “abortion” category a “ghost” category under which it is simply impossible to code a death due to abortion.
If this is true of abortion, I can only assume it to be true of all other types of maternal mortality. The CDC admits at least a 30% under-reporting of maternal mortality (although they don’t specify anything about the unreported or underreported deaths). But when statistics have no meaning, because the true cause of death is vague, obscure, or outright denied, how are things supposed to get any better? If we don’t know the reasons why women or babies die, how can we keep it from happening?
Finally, a few different doulas and childbirth educators on one of my email lists have said that stats at their local hospitals are similarly “scrubbed” as regards C-sections. At first, I wondered how that could happen — after all, it’s “vaginal birth” or “C-section” right? Well, one woman said that if there was a placental abruption, then that is what is put down — “PA” — not C-section. So, the C-section rate looks lower than it really is.