In order to let women die during childbirth, please pay attention to California

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In order to let women die during childbirth, please pay attention to California
When Cayti Kane gave birth through caesarean section last year, her team of doctors was ready.

Kane was diagnosed with a placental implant, which increased the likelihood of dangerous bleeding during childbirth. When this happens, she underwent an emergency hysterectomy. Kane and her son went home healthily.

In the United States, complex high-risk delivery often ends in a tragic manner. An American woman is three times more likely to die from childbirth than a Canadian woman, while a Scandinavian woman is six times more likely to die than a woman. This is a story that NPR and ProPublica have repeatedly heard over the past year, while investigating the alarming rate of maternal deaths in the United States.

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Paying attention to babies during childbirth puts American mothers at risk
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For every woman who died during childbirth in the United States, 70 people will come
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However, despite her risk factors, Kane did one thing for her, which made her childbirth less likely to go wrong: she lived in California – and gave birth.

The country is pushing for accusations of reversing national trends: California has reduced its childbirth mortality by more than half since 2006. This is a state that has the potential to have a major impact: one in eight American-born babies were born there.

Not always.

Debra Bingham was a nurse who was pursuing a doctorate in public health. He held a meeting with state public health officials in 2006, when shocking statistics were released: California women died of childbirth. The ratio has recently doubled.

“This is unexpected, disturbing, and very disturbing,” recalls Bingham, who is now the executive director of the Perinatal Quality Improvement Institute. “We need to understand and really understand why.”

Soon, Bingham’s mission was to bring together key people: nurses, doctors, midwives, hospital administrators and other officials. Together they worked on a statewide effort to keep as many mothers as possible – and understand why so many people died in the first place. To understand this, you must go back more than 60 years.

The Pomona Valley Hospital Medical Center is a member of the California Maternal Quality Care Association and is one of the largest birth centers in the state, serving more than 7,000 babies each year.
Bethany Mollenkof for NPR
a “obviously impossible to reduce” mortality rate

In 1950, the Journal of the American Medical Association, a beacon of medical research, presented a dramatic claim: eventually won the fight to prevent women from dying in childbirth.

“The Daily News is proud of the fact that for the first time in history, the maternal mortality rate of a large country – the United States of America – has been slightly below the minimum level that the death rate per 1,000 live births is clearly unreducible,” the editorial year. Announced on a question.

It goes on to say that only a few countries can achieve such excellent numbers: Sweden, Norway, Denmark, the Netherlands and New Zealand. In the following years, the maternal mortality rate in the United States was considered to be unreducible and even further declined.

But then it stopped.

William Callahan, head of the Maternal and Infant Health Division of the Department of Reproductive Health, US Centers for Disease Control and Prevention, said: “This is a premature declaration of victory.”

Callahan said that after the medical profession announced the victory, the focus changed.

“In the late 1960s and the 1970s, the technology that could take care of the fetus became huge,” Callahan said. “People are becoming very fascinated, able to perform ultrasound examinations, then perform high-resolution ultrasound, perform invasive procedures, stick needles in the amniotic cavity, and everything rotates around the baby.”

As the focus shifts from mother to baby, the trend line is divided. The infant mortality rate is currently at “the lowest level in history”, and maternal mortality has continued to rise in recent years.

Of the 700 to 900 maternal deaths per year in the United States, the CDC Foundation estimates that 60% is preventable.

This is because, as reported by NPR and ProPublica, the US medical system still prioritizes infant survival over maternal health. It assumes that most women who give birth are okay and will approach birth.

‘Practice and practice’

Debra Bingham said that for those women who are not good, a plan needs to be made. She and the obstetrician Elliott Main and others sought to create one.

In 2006, they helped establish the California Maternal Quality Care Collaboration, where Main said that the newly established Maternal Mortality Review Committee was able to learn for the first time each mother died in the past five years.

The staff of the Pomona Valley Hospital Medical Center is conducting bleeding training with a human body model.

The staff of the Pomona Valley Hospital Medical Center is conducting bleeding training with a human body model.
Image source: Bethany Mollenkof for NPR

“Obviously, in some cases, if the care is performed differently, there is a good chance that there will be better results,” says Main, a professor of collaborative medicine and a clinical professor of obstetrics and gynaecology. At Stanford University.

In particular, the committee found that two well-known complications provide the best chance of survival if treated properly: bleeding and pregnancy-induced hypertension, known as pre-eclampsia.

It is estimated that early identification, teamwork and a series of well-rehearsed treatments can prevent the majority of deaths from both complications.

“If you have a cardiac arrest and everyone has their own CPR method, it’s an analogy,” Main said. “We have made great progress in emergency care by adopting some basic standardized methods for emergencies. This is what we are now bringing to maternity care.”

At the Pomona Valley Hospital Medical Center, collaborative members, doctors and nurses are doing this.

She said that Maria Hellen Rodriguez conducted exercises at the Pomona Valley Hospital Medical Center to simulate real obstetric emergencies, so the standard approach became the “muscle memory” of hospital staff.
Bethany Mollenkof for NPR
About one hour east of Los Angeles, the hospital is one of the state’s largest birth centers, serving more than 7,000 babies each year.

Maria Helen Rodriguez, director of maternal and child medical medicine at the hospital, recently conducted a training exercise for nurses and doctors on how to improve the prognosis of women who have had bleeding during or after childbirth. Using a medical mannequin, the team performed simulated bleeding.

Rodriguez explained: “If every woman has to give birth, they may be bleeding.”

The idea that every woman is at risk is a new thinking in the field of obstetrics. Rodriguez said that preparing for the worst is the key to saving the mother.

Rodriguez said: “You need to make sure that you can apply it to your muscle memory. So this happens every time you take care of a patient.”

Hospital staff at the Pomona Valley Hospital Medical Center reviewed video footage of emergency exercises conducted on medical models.
Bethany Mollenkof for NPR
The first is the early innovation of California’s collaboration: the kit contains everything needed to address urgent complications, from checklists to devices to medications.

For obstetric hemorrhage, the kit is a stroller – unlike an ambulance for cardiac arrest. Red, there are five drawers on the wheel, and the bleeding car is filled with all the equipment that doctors and nurses might need in an emergency: checklist, IV tube, oxygen mask, special speculum and Bakri balloon when inserted into the uterus Will put pressure on the blood vessels.

Also, used to measure lost blood: sponges and mats. Traditionally – still in many hospitals – nurses and doctors estimate the amount of blood lost in vision.

The team working on the drill bit at Rodriguez collected sponges and mats to collect the blood and weighed it proportionally. They know the weight of these items when they are dry. Once they subtract the dry weight, they can measure the lost blood more accurately.

The lesson taught over and over is that each team member – a doctor or a nurse – has the ability to change the outcome.

Hospital staff at the Pomona Valley Hospital Medical Center implemented strategies to improve the prognosis of women who had bleeding during or after childbirth.
Bethany Mollenkof for NPR
a ‘very good decision’

Even though she had five caesarean sections before, Cayti Kane had never heard of placenta implants before being diagnosed.

She also does not know that each repeated caesarean section will increase her chances of developing the disease. At the time of placenta implantation, scar tissue on the uterus during previous surgery may allow the placenta from the new pregnancy to grow through the uterine wall, which may result in bleeding.

This disease was once very rare in the United States. In the 1950s, one in every 30,000 people was born. Today, one in every 500 cases of placenta is present. Its rise coincides with an increase in caesarean section, which is six times faster than it was 50 years ago. Today, one-third of babies are born through caesarean section.

A woman has her sixth caesarean section – like Kane – has a higher chance of developing placental implants.

“If I knew it was possible, I would not be able to do this,” Kane said. “I can’t put my life at risk and risk the loss of my mother.”

Cayti Kane was diagnosed with a placental implant, a dangerous complication. But the Pomona Valley Hospital Medical Center is ready. Two weeks later, Kane gave birth to a healthy boy through caesarean section.
Provided by the Pomona Valley Hospital Medical Center
Kane ended up at the Pomona Valley Hospital Medical Center. She lives in Apple Valley, California, in the high desert, more than an hour’s drive from the hotel.

At 30 weeks of pregnancy, she entered premature birth, and when she arrived at the local hospital, her regular doctor was not in town. Kane called it a “very good decision,” and the on-call doctor transferred her to the Pomona Valley because her previous five caesarean sections were associated with risks.

The Pomona Valley is ready to send her delivery. But just as importantly, Kane’s previous small village hospital – also a member of the statewide collaboration – quickly found an unprepared question and sent her to that.

In the Pomona Valley, Rodriguez immediately diagnosed Kane with a placental implant. Two weeks later, Kane gave birth to a healthy boy through caesarean section. As expected, when she bleeds, she is surrounded by a team that can handle it.

From 2006 to 2013, California’s maternal mortality rate fell by 55%. These agreements – checklists, carts, drills and teamwork – not only save women from death, but also greatly reduce the proportion of women who die almost.

A study in the American Journal of Obstetrics and Gynecology found that hospitals that signed kits reduced the incidence of severe maternal diarrhea by nearly 21%. In hospitals that did not participate, this ratio fell by a little more than 1%.

As of June 2018, 88% of birthing hospitals in California have joined, accounting for 95% of all births in the state.

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