FAQ: Episode 29 – Dr. Amy Tuteur

These were facts in The Business of Being Born press release. I asked Dr. Amy Tuteur in our interview for Podcast Beyond Belief to address these claims…

Is it true that the United States has the second worst newborn death rate in the world?

It’s not true, and this is one of the things that has been used to confuse people and things have been said in a very misleading way. First of all, typically what people refer to when they talk about the US’s poor position is “infant mortality rate”.  Now, infant mortality rate refers to deaths that are birth to one year. That’s a measure of pediatric care. It’s not a measure of obstetric care. According to the World Health Organization, the best measure of obstetric care is perinatal mortality, which is stillbirth plus deaths during labor, and up to 28 days of life. In fact, the Unites States has one of the best perinatal mortality rates in the world. The World Health Organization in their 2006 report shows that it has a lower perinatal mortality rate than Denmark, the United Kingdom, and even The Netherlands, which is the place where they have more home births than anywhere. So, it’s an incredibly misleading statement, and when it comes to obstetric care, the Unites States does very very well.

Is it true that obstetricians rarely see natural births?

Ha! That’s a bunch of baloney too. You know, not everybody is a white American middle class woman. This is the way these people imagine all the people in the hospital are.  The fact is that if you work in any large hospital you see women from other cultures who have different ideas of how birth should be conducted. You see many women who come in late in labor, way too late to get an epidural. I’ve delivered women in the emergency room. Many of my colleagues have delivered in the parking lot. We see plenty of unmedicated births, and some of us, myself included, have had unmedicated births. So, it’s just a bunch of baloney that obstetricians don’t know what an unmedicated birth looks like.

Why is it that the five countries with the lowest rates of infant mortality also have very high rates of midwifery?

First of all, infant mortality is the wrong statistic, but there’s another thing too that they don’t point out. Unfortunately, race is a risk factor for perinatal mortality. Women of African descent have higher rates of premature labor, higher rates of pregnancy complications, and higher rates of perinatal mortality, and that occurs regardless of what country they give birth in. And it actually persists even in women of African descent who are of higher education and higher income levels; they have a much higher rate of problems compared to their economic cohort of other races. The fact of the matter is the countries with the best perinatal morality rates are the whitest countries. If you correct for race, you get a very different picture. The Unites States is the first world country with the largest population of women of African descent, and that has a big impact on our statistics.

Is it true that the WHO reported that the leading cause of maternal death in developed countries is c-section surgery?

No, that is completely not true. There have been a number of studies that have claimed that c-sections increases the rate of maternal deaths. Maternal deaths are very rare. The average person is not at risk for that, and women who die in pregnancy or in childbirth tend to have lots of risk factors. They usually have a serious pregnancy complications, they have eclampsia or preeclampsia, they have preexisting medical problems, they’re very sick to begin with. Generally, as part of treating them, they have a c-section either because the delivery needs to be expedited or they have a heart condition because they can’t withstand the strain of labor. Those are women who are more likely to die, not because they  had the c-section, but because they were at high risk to begin with.