Pregnancy and Birth in the US

 

 

 

 

 

 

 

 

 

The United States, despite being a highly developed country in the Western world, has the worst infant mortality rate*, as well as the second worst maternal mortality rate of the countries listed. What might be a cause of such high rates of infant and maternal death when compared to other developed countries?

Birth and pregnancy in the United States are considered a medical condition, and are usually attended and managed by an obstetrician in a hospital or medical clinic setting. In her 2001 article “Infant Mortality: A Reflection of Quality of Health,” Candyce Berger states that while the United States claims to have far superior levels of health care, the infant mortality rate would suggest another conclusion, especially when compared to other developed nations (227).

As the only developed country that does not provide comprehensive maternal and child healthcare to all citizens, the United States creates a social strata of people who cannot access adequate pre- and post-natal health care, negatively impacting infant and maternal outcomes (Berger, 2001:279). Berger also stresses that at the “root of infant mortality rates” in the United States is the need for policy reform. At this point, while technological improvements will indubitably increase child and maternal health, the true need is for the implementation of guaranteed health care access for pregnancy and birth.

Infant mortality may also be high in the United States due to increased rates of cesarean section. In 2006, the cesarean section rate in the United States was 31.3%, a fifty percent increase in the previous ten years (Malloy, 2009:26). This rate was well above the World Health Organization’s recommendation that rates of cesarean birth be “kept between ten and fifteen percent” (Slessor, 2004).

According to Malloy, recent reports indicated that full-term infants delivered by cesarean section have a higher rate of infant mortality when compared to vaginal delivery. Malloy’s data analysis, as well as recent reports, support an increased risk for “infants delivered at 32 to 36 weeks’ gestation... by primary cesarean section compared with vaginal delivery” (2009:29).

There are also problems with cesarean deliveries before or even at term because of discrepancies in reported gestational age, which is based on date of last menstrual period. As a result, cesarean births even at reported “term” can potentially actually be preterm, and thus increase the risk of infant mortality. Late preterm babies, or those between 34 weeks and 36 weeks “have a death rate three times that of full-term babies” (Krisberg, 2009).

Problems with high infant mortality rates in the Unites States, when compared to other developed countries, are most likely the result of many factors, including high cesarean-section rates and the fact that pre- and post-natal health care is not available to all women.

 

* - Excluding countries that are not on both source lists