Amnesty International minces no words in its new report on U.S. maternity care. Deadly Delivery: The Maternal Health Care Crisis in the U.S.A., reports that more than 2 women die per day in the United States from pregnancy- or childbirth-related complications, a rate that’s worse than in 40 other industrialized countries. “Preventable maternal mortality
is not just a public health issue, it is a human rights issue,” states Amnesty.

“Women in the USA face a range of obstacles in obtaining the services they need. The health care system suffers from multiple failures: discrimination; financial, bureaucratic and language barriers to care; lack of information about maternal care and family planning options; lack of active participation in care decisions; inadequate staffing and quality protocols; and a lack of accountability and oversight.”

The report profiles several women who died or nearly died because of inadequate, inappropriate, or discriminatory care: one woman dies of a blood clot following a cesarean section, which could have been prevented with simple circulation stockings (a standard prophylactic for other major surgeries); another woman bleeds to death following a C-section, even after she and her husband plead with medical staff to address her troubling symptoms; a high-risk woman experiencing complications late in pregnancy is turned away from a prenatal clinic because she can’t afford a $100 deposit; both she and her baby die after care is delayed.

Each death represents dozens of “near misses” that often leave women in worse health; of the 4 million American women who give birth each year, 1.7 million women experience complications that lead to adverse effects. “The US health care system is failing women,” says Amnesty. Read the full report here.

Investigative journalism lives at California Watch, which published this article about maternal mortality. An independent task force investigating the problem found “the most significant spike in pregnancy-related deaths since the 1930s…it’s more dangerous to give birth in California than it is in Kuwait or Bosnia.” But the state has yet to release a report.

This investigation is not the first to reveal higher than officially reported numbers of deaths, but it appears to have gone deeper than previous reviews in Virginia, New York, and Florida. “The group’s initial findings provide the first strong evidence that there is a true increase in deaths — not just the number of reported deaths.” And unlike previous reviews, it sought to determine causes, which are usually attributed to women: obesity, older mothers, and fertility treatments. The data, however, suggest otherwise, according to Elliot Main, MD, the task force’s lead investigator: “What I call the usual suspects are certainly there,” he told California Watch. “However, when we looked at those factors and the data analyzed so far, those only account for a modest amount of the increase.” What then is to blame for the increase?

Main said scientists have started to ask what doctors are doing differently. And, he added, it’s hard to ignore the fact that C-sections have increased 50 percent in the same decade that maternal mortality increased. The task force has found that changing clinical practice could prevent a significant number of these deaths.

While the findings appear to be languishing with the state department of public health, the Joint Commission, which certifies and accredits hospitals, is taking action. On January 26 it issued an alert, stating: “Unfortunately, current trends and evidence suggest that maternal mortality rates may be increasing in the U.S.”  After receiving the CA task force’s report, the Commission “issued incentives for hospitals to reduce inductions and fight what it called ‘the cesarean section epidemic.’”

With the historic news that a majority of the U.S. workforce is now female, it’s clear that American women have more power than ever before, says OB/GYN and bestselling author Christiane Northrup, MD. But is that power reflected in the healthcare available to women? No, she writes in an essay for Huffington Post, especially when it comes to childbirth:

“Our so-called healthcare system, which is a direct reflection of the beliefs of our culture, sees the female body and its processes (like labor) as an accident waiting to happen…The truth is that labor and birth need not be the emergencies we think they are. And the medicalization of birth actually does more harm than good.”

Northrup criticizes the rising rates of cesarean section and labor induction, and cites the rising maternal death rate. “Studies have repeatedly shown that in healthy mothers with no risk factors, home birth is as safe as hospital birth. Increasingly, savvy women who trust their ability to birth normally [and, we should add, who have the resources] are opting to avoid the hospital altogether.”

Northrup concludes the essay with a call to action: “When it comes to pregnancy and birth, we as a culture and as individuals need to wake up and claim our right to literally birth right!”

Just a week after we learn that babies are suffering from C-sections performed too early — and a large proportion are — another new study finds that serious birth complications are on the rise in U.S. mothers. Nearly twice as many women needed blood transfusions in 2004-05 versus 1998-99, and there were 50% more pulmonary embolisms — life-threatening blood clots that are a direct complication of surgery. There were also more women in respiratory distress and kidney failure following childbirth in the latter group. Researchers made clear that this trend is not related to mothers skewing older in recent years, but rather the rising rate of cesarean birth, which has increased from 21% in 1996 to 31% in 2006. “It was just amazing the consistency,” study coauthor and obstetrician Susan Meikle told the Chicago Tribune, “from vaginal delivery, where the rates [of complications] were lowest, to repeat Caesareans, where we saw an increase, to primary Caesarean delivery, where the increases were the highest.” The overall risk of severe morbidity rose from 0.64% to 0.81%. With 4 million+ births per year, that’s a lot of sick mothers. This is yet more evidence that preventing unnecessary cesareans should be high up on the healthcare agenda.

“No question…the safest way for most first-time mothers to give birth is via an uncomplicated vaginal delivery.” So begins this USA Today article on the rise in cesareans and concurrent rise in maternal mortality. It’s worth reading. And worth considering the fact that some researchers want to conduct a large study comparing women who are selected at random for unnecessary cesareans to women who are selected for planned vaginal birth. Many experts believe that such a “randomized” study is unethical, because there is so much evidence, nicely summarized in the above article, that cesareans pose an increased risk.

Researchers with the World Health Organization published a huge study this week in the British Medical Journal finding that women are twice as likely to suffer serious complications or death if they give birth by cesarean section, even if it is planned prior to labor, and they are five times more likely to have a postpartum infection. Babies, too, are more likely to die or to be so sick that they require a week-long stay in intensive care if they are not born vaginally.

The study of nearly 100,000 births excluded women or infants with underlying health complications or distress during labor so that the outcomes are associated with the method of delivery alone. Researchers found that for women undergoing cesareans, “compared with vaginal deliveries, the risk was three to five times higher for maternal death, four times higher for hysterectomy, and twice as high for being admitted to intensive care and hospital stay more than seven days.” Researchers found that infant death shortly following birth was also more likely among cesarean babies, except those who were breech* (presenting bottom-first rather than head-first).

*Of breech babies, the researchers conclude, “It is clear that these babies, regardless of gestational age, should be delivered by planned caesarean.” This statement will no doubt be challenged by researchers who have demonstrated the safety of breech birth when attended by a provider with expertise (vaginal breech birth requires special knowledge and skills). This study did not account for the qualifications of the birth attendant.

Your uterus: it’s not just for reproducing. In fact, the organ is an integral part of your pelvic anatomy, your sexual function, indeed your whole-body health, throughout your lifetime, according to this vivid tutorial created by the HERS Foundation (Hysterectomy Educational Resources and Services). Women who are weighing the risks and benefits of VBAC v. repeat cesarean (and even women considering a primary cesarean) should especially take a look, as hysterectomy — surgical removal of the uterus — becomes more of a risk with repeat surgical deliveries. Hysterectomy remains the second most common major surgery in the United States.

Scientific American offers a great overview of antibiotic resistant staph infections, also known as “superbugs,” which add risk to any invasive hospital procedure. Consequently, the article leads with a story of a woman who contracted such an infection following a cesarean section, and chronicles her months of painful — and expensive — recovery. The offending bacterium causes 94,000 serious infections in the U.S. each year, resulting in roughly19,000 deaths — more than those caused by HIV, according to a study also published this week in The Journal of the American Medical Association. Read the full article.

News broke with this Associated Press article and is making headlines across the country this week: the rate of women dying in childbirth in the United States has officially increased for the first time in decades. Why? One of the main reasons given by experts is the rising number of cesareans, particularly repeat cesareans. Most shocking element? Black women are nearly four times more likely to die than white women.

Read more about this woman, who died after her labor was induced with the drug Cytotec, which has been implicated in several maternal and baby deaths.