As a practicing OB-GYN and chair of the Maine chapter of the American College of Obstetricians and Gynecologists, I wish to respond to Linda Robinson’s July 26 BDN OpEd, “Birthing system values money, convenience over health, safety.”
Robinson correctly notes that maternal mortality is on the rise in our country. In fact, the U.S. is one of the only nations in the world in which the maternal mortality rate, or MMR, actually has increased in recent years. In 2013, the MMR was 18.5 per 100,000 live births. Although this represents a 1.7 percent annualized increase in MMR since 1990, improved identification of pregnancy-related deaths and changes in classification of cause of death may account for some of this rise.
A bigger factor in the increase in the MMR is the health of women when they conceive and during their pregnancies. Women are having babies at a later age, and we have experienced skyrocketing rates of obesity, diabetes and high-blood pressure in women of reproductive age. Opiate dependence is on the rise, locally and nationally, and there has been a corresponding increase in the number pregnancies complicated by addiction. There also are more women than ever before carrying pregnancies initiated with assisted reproductive technologies. All these factors significantly increase the risk of pregnancy complications and maternal mortality.
For these reasons, we need to encourage women to seek prenatal health services regularly from appropriate care providers, including OB-GYNs. Prenatal care can help women and physicians to identify and control conditions that, if left untreated, may lead to poor outcomes during labor and delivery — conditions that can lead to life-threatening complications.
Maine is no exception with regard to health care challenges. Maine has the highest obesity rate in New England, and it has a vulnerable population with high rates of poverty. We also have a substantial number of these high-risk patients living in rural areas with limited access to health care and transportation. Unfortunately, nearly one-third of rural women live in counties with no OB-GYNs at all.
Robinson and I agree that every woman deserves to be cared for, regardless of where she lives. The health care community is working very hard to develop systems such as outreach programs, telemedicine and integrated provider networks to help overcome the financial and geographic barriers women face in the rural areas of our state.
It is well understood in obstetrical practice that vaginal birth can have short-term and long-term benefits for mother and infant, but in certain instances, a cesarean is encouraged or necessary for the well-being of one or both parties. Robinson states that “surgery can save the lives of mothers and babies, but it is by no means the safest mode of delivery,” when in fact there are many medical conditions for which C-sections clearly are the safest mode of delivery. Through her use of such violent language, Robinson inadvertently may be scaring women away from needed C-sections and putting them at significant risk.
In obstetrical care, the goal is always a birth that results in a healthy mother and a healthy baby, and reimbursement and inconvenience are not considerations in good practice. Unfortunately, there can be many challenges for providers — OB-GYNs and certified nurse-midwives alike — to overcome to get women the care they need where and when they need it. But rather than do the women we treat a disservice by scaring them away from the care that they need, I would hope Robinson would channel her energies toward advocating for greater access to services so that more women could obtain much needed care in a safe and appropriate environment.
Dr. Peter Manning is chair of the Maine chapter of the American College of Obstetricians and Gynecologists. He is an OB-GYN who practices with Southern Maine Health Care Women’s Health in Biddeford.