Saturday, August 12, 2017

Space, time and maternal mortality in rural America

That is the subject of the Wall Street Journal's latest installment in its series, "One Nation, Divisible."  The story by Betsy McKay and Paul Overberg is titled, "Rural America's Childbirth Crisis:  The Fight to Save Whitney Brown."  An excerpt follows, with a focus on time, distance and--implicitly--how distance is time.  Certainly that was the case for Whitney Brown, the woman whose death in childbirth was featured to illustrate the perils.
Since the start of the century, it has become more dangerous to have a baby in rural America. Pregnancy-related complications are rising across the U.S., and many require specialized care. For some women, the time and distance from hospitals with the resources and specialists to handle an obstetric emergency can be fatal. 
In 2015, women in rural areas died from pregnancy-related complications at a rate 64% higher than the rate in large cities, a reversal from 2000, when cities suffered a higher rate of such maternal deaths.
The reasons reflect shrinking resources, worsening health and social ills. Most rural hospitals don’t have high-risk pregnancy specialists who can treat sudden complications. Many don’t have cardiologists or anesthesiologists on staff. Making matters worse, rates of obesity, a major risk factor for pregnancy complications, are higher in rural than urban areas. 
Many rural hospitals have eliminated labor and delivery services, creating maternity deserts where women must travel, sometimes hours, for prenatal care and to give birth.
Over the decade between 2004 and 2014, the number of rural hospitals offering such services declined by 15%, compared to a 5% decline among suburban and urban facilities.  Among the reasons for the decline:  the closure of hospitals, a decline in birthrates, and challenges securing malpractice insurance.  The story notes that some women in rural Tennessee get no pre-natal care whatsoever.

The personal face of this story is Whitney Brown, a young woman who died after giving birth by emergency C-section.  She died, at least in part, because she could not be transported quickly enough from the rural hospital in McMinnville, Tennessee, population 13,605, to Chattanooga for specialist care.  One reason:  only two of Warren County's five ambulances were allowed out of the county at any given time, leading to a 3-hour delay in the transfer of Brown, whose heart stopped shortly before she reached Chattanooga.

Incidentally, The Economist has a story this week about the high U.S. maternal mortality rate, compared to other developed countries.

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