In this country, women die far too often during childbirth because ultimately, women’s health isn’t valued. Case in point, placenta accreta. In a normal pregnancy, the placenta develops inside the uterus, attaches to the uterine wall, and then is flushed out of the body after the birth.1 However, with accreta, which doctors believe is most often caused by scarring from prior cesarean sections, the placenta sticks around and embeds.
In the 1950s the condition was extremely rare, only occurring one in 30,000 deliveries in the US. But today, thanks to the huge rise in C-sections it happens more like one in every 500 births. And one in 14 American women with accreta will die.
“Childbirth is one of the most common reasons women go into hospitals, and yet the American health care system handles complicated pregnancies with a stunning lack of preparation and precision. Put simply, women who give birth in the US have a greater risk of dying relative to other rich countries — and the problem has been growing worse at a time when America’s peers have continued to make pregnancy safer.
Maternal mortality — defined as the death of a mother from pregnancy-related complications while she’s carrying or within 42 days after birth — in the US soared by 27 percent, from 19 per 100,000 to 24 per 100,000, between 2000 and 2014.” 2
That number is more than three times the rate of the United Kingdom and about eight times the rates of Netherlands, Norway, and Sweden. And, it’s estimated that 60 percent of these deaths are preventable.
However, though the mortality rate has been going up nationally, California has made amazing progress and now fewer and fewer women are dying in childbirth. And in large part, that’s due to Dr. David Lagrew, an OB-GYN and founding member of the CMQCC (California Maternal Quality Care Collaborative).
Lagrew moved to Southern California for a medical fellowship in 1984 and it was there that he encountered his first case of placenta accreta, something that stuck with him:
“It was just blood everywhere. The lady ended up getting over 50 units of blood.”note]MSN, June 29, 2017.[/note]
The hospital didn’t know how to the handle the bleeding and Lagrew watched the mother go limp and die on the operating room table. Around that same time, a paper had been published in the journal Obstetrics and Gynecology, establishing the connection between the exponential rise in C-section rates and placenta accreta cases.
“Lagrew thought that if he could gather data on doctors’ C-section rates, and educate his fellow clinicians about how many they were doing and the risks of unnecessary surgeries, he might be able to reduce C-sections that aren’t medically indicated — and complications like placenta accreta.”note]MSN, June 29, 2017.[/note]
By 1989, Lagrew was appointed medical director at Saddleback Hospital in Laguna Hills, and his new approach to education worked. Within 5 years the C-section rate at Saddleback was halved. Since then he’s been able to do the same thing at the eight hospitals where he’s worked and at hundreds more in the state through the CMQCC.
In our country, we are more unhealthy, more overweight, and have more chronic health problems- and our maternal mortality rates aren’t being helped by that fact. However, working with the CMQCC is helping to drive that number down.
But we need to do more. In the U.S. we don’t have national health policies around improving maternity health care. Adam Sonfield, senior policy manager at the Guttmacher Institute said, “There are a lot of areas where America’s policies are less protective [for mothers] than they are in Canada, Europe, and other developed countries. Being able to take time off from work to go to the doctor, and having child care to make sure you can go to that doctor, and making sure you have affordable transportation to go to that doctor.” That tends to be more difficult for American moms. We still have much work to do.
However, California has shown that even with the messy system we currently have, progress is possible. And they’ve shown the rest of the country “what happens when people care about and organize around women’s health.” 3 And our women and children- all of them- deserve better.