Summary of Maternal and Infant Mortality Rates in the US Are Alarmingly High – New Study Sheds Light Why:
A recent study by researchers at Boston University School of Public Health and Harvard-affiliated Beth Israel Deaconess Medical Center found that the average length of US pregnancies declined by 0.6 weeks from 1990 to 2020, and is shorter than pregnancies in England and the Netherlands. The study also suggests that the US could enhance maternity care outcomes by reducing medical interventions during childbirth, as hospital-based births largely occur during standard working hours for clinical staff, whereas births at home peaked in the early morning hours. The authors suggest an organizational shift that places less emphasis on active, clinical management of labor and allows the birthing process to take a natural course.
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US Could Enhance Maternity Care Outcomes by Reducing Medical Interventions during Childbirth, Study Finds
Maternal and infant mortality rates in the United States continue to be alarmingly high compared to other wealthy nations and European countries. In light of these statistics, a recent multi-country analysis of the average pregnancy length and timing of birth in the US, England, and the Netherlands suggests that the US could enhance maternity care outcomes by reducing medical interventions during childbirth.
The Study and Findings
A new study from researchers at Boston University School of Public Health and Harvard-affiliated Beth Israel Deaconess Medical Center compared gestational age patterns and timing of home and hospital births in three high-income countries with differing maternity care models. The US heavily relies on obstetricians and clinical interventions, while England and the Netherlands primarily use midwives for low-intervention care.
The findings show that the average length of US pregnancies declined by 0.6 weeks from 1990 to 2020 (from 39.1 to 38.5 weeks) and is shorter than England and the Netherlands. In 2020, only 23% of US births took place at 40+ weeks, compared to 44% in the Netherlands and 40% in England. The gestational age pattern for home births was the same in all three countries.
Reduced Medical Intervention Is Key
The authors say their findings suggest the US maternity care models could benefit from an organizational shift that places less emphasis on active, clinical management of labor and allows the birthing process to take a natural course. Currently, American hospitals may be designed to prioritize the convenience of clinicians more than the needs of people giving birth. The paper is the first international study using large datasets to compare gestational age and birth timing in three high-income countries; most prior research has focused on data from individual hospitals or countries.
“The alarmingly poor results of the US maternal health system demand greater attention to its design. Our study shows that American hospitals may be designed to center the convenience of clinicians more than the needs of people giving birth,” said Dr. Neel Shah, chief medical officer of Maven Clinic and a visiting scientist at BIDMC.
Redesigning the Birth Experience
“Our multi-country analysis shows that the US is an outlier in gestational age distribution and timing of low-intervention hospital births. There’s a lesson to be learned from countries with more positive maternity outcomes than the US in having hospital staffing and operational plans conform more closely to the natural patterns of birth timing and gestational age rather than try to have birth timing fit organizational needs,” said study lead and corresponding author Dr. Eugene Declercq, professor of community health sciences at BUSPH.
In conclusion, the natural birthing process should be respected as much as possible, allowing for medical intervention only when absolutely necessary. This will reduce the average length of pregnancies and enhance overall maternal health outcomes.
