Why Are Stillbirths Increasing in the U.S.
Reporter Duaa Eldeib is a Pulitzer Prize finalist for her work in covering stillbirths in a series of articles for ProPublica. Eldeib reports that in the U.S., there are around 20,000 stillbirths per year. She reports a “cascade of failures” causing the U.S. to lag behind other developed nations in reducing the stillbirth rate. Other developed countries do far better at preventing stillbirths than the U.S. does.
According to ProPublica, one U.S. senator described the stillbirth rate as “shocking” while another said we should be doing “everything to prevent” Americans from experiencing stillbirth. But what would that be? The NIH released a report that agreed with the ProPublica article, calling the rate “unacceptably high” and even issuing a “series of recommendations” to reduce these numbers by trying to fix the problem by funding yet another committee to study the issue.
For many people, the causes of stillbirths remain elusive and mysterious. We have government groups, insurance companies and ACOG (American College of Obstetricians and Gynecologists) all wondering what’s happening and all doing their own kinds of speculation and “investigation.”
There is no shortage of explanations and excuses. To paraphrase the ProPublica article, ACOG has done very little to decrease the stillbirth rate. I have also not seen much information from ACOG with specific plans for decreasing maternal mortality rates. Eldeib says ACOG has one paragraph on decreasing the stillbirth rate and doesn’t have much more on decreasing the maternal mortality rate because ACOG says it doesn’t have “enough information.” Most people would expect the professional group for obstetricians to be the leaders in the movement to decrease maternal mortality and the stillbirth rate.
Those looking for causes of our high numbers of stillbirths suggest that the U.S. healthcare system has better recording policies than other countries so our numbers appear to be higher than those of countries. Others say that recordkeeping is flawed because states vary in the way stillbirths are recorded.
It’s time to stop fiddling with the quality of the stillbirth data and start looking for the real reasons the U.S. stillbirth rate is so high.
From 1980 to 2000 I delivered 6000 babies with no maternal mortalities. I also successfully managed pregnancies for patients who had experienced previous stillbirths or repetitive miscarriages. I didn’t seek that practice. It came to me. All I needed was to have a few successes. Women told their neighbors who in turn told their neighbors. At that time there were no Maternal Fetal Medicine specialists in North Dakota and only a few in Minneapolis.
Yes, we know about risk factors. That hasn’t brought the number of stillbirths down. No one seems to be looking at the real reasons the U.S. healthcare system has failed to reduce stillbirths.
First and foremost, the physician needs to know and understand patients. The patients need to trust their doctors. Years ago, I saw most of my patients for every visit and I was present for their deliveries. I think a critical need in the efforts to reduce stillbirths requires a good relationship with a good provider. One who happens to be your main provider and is NOT dismissive. First and foremost, your doctor needs to believe you and take you seriously when you tell your physician about your concerns.
You will need to find a provider you like and trust. You may have to interview several physicians until you find one you feel comfortable with. You should have one phone number that allows you to reach help with your concerns any time of the day or night. You should know the telephone number of the hospital labor and delivery floor. Sometimes labor and delivery units do not want to see you if you are less than 20 weeks pregnant. For your entire pregnancy, you should have a number where you can get help whenever you need it.
The care of pregnant women has been disrupted by corporate medical decisions about how to treat women in labor and delivery. One of the problems we have today is what we call the “dock and deck” which means that in a given time period a single doctor stays in labor and delivery and delivers all of the babies born during that shift.
This destroys the very important relationship of trust with your physician, especially important in labor and delivery. There were times my patients said they just couldn’t take the pain of their labor any longer. I was there to let them know that I thought they could. And most of the time they could. This worked because I had grown to know my patients throughout their pregnancy and they trusted me.
When women see numerous providers throughout their pregnancy, there is no basis for trust. All these providers have in common is a patient’s chart. They don’t necessarily have a relationship with the patient. Dr. Arti Masturzo writes about the need for having a relationship with your physician has been replaced with technology for conversation with your physician. The patient relationship with their doctor seems like such a simple thing that no one is paying any attention to the fact that this is the keystone to a physician’s ability to treat a patient successfully in any practice, not just obstetrics. When you have a lot of people taking care of you, it’s hard to find anybody who is in charge. With my patients I knew who was in charge and so did they.
So, what do we need to do to decrease the maternal mortality rate as well as the stillbirth rate? It’s not ChatBot, an electronic medical record, or a revolving door of “providers.” You need one doctor who believes what you are telling them and who is willing to be your first and best advocate.
If you enjoy my Substack articles, you might also enjoy my interviews with other physicians and health care providers on doctales.com.