Public interpretation of medical issues rant
I am very frustrated with the message that the general public has heard from the correct critiques of US maternity care. We do have issues with institutional racism, and maternal mortality, absolutely. There are things we need to improve as a system and I'm all for doing that.
But I see so many lay people take the wrong messages away from this awareness of flaws. It makes people hostile and assuming the worst when they come in, and affects how they make decisions.
Maternal mortality in the US is not great. Not all of it is from L&D direct causes - suicide and homicide are a significant reason why the US maternal mortality is high. That goes moreso for black mothers because they are dealing with systemic racism on top of it all. And we talk about how high the c/s rate is, but the truth is we don't know really what the "optimal" rate of c/s should be, we just guess at it, and there are so many confounding factors like age at delivery, chronic health conditions etc.
But the answer to this is not to eschew doctors and medical care, or be oppositional at all times with people or ignore the education that physicians and others have. They are taking metrics they don't understand well and then applying them incorrectly which likely make the outcomes worse. And it's so frustrating.
For example, I know continuous fetal monitoring isn't well correlated with outcomes, but that's mostly because category II strips are hard to determine just how bad it is going to be. We're reasonably sure with category I that the baby is ok. And Category III is pretty clear that the baby is in trouble. But the general public seems to take away the message that there is zero use for fetal monitoring and no data from it is reliable. (please correct me if I'm wrong OB, but from a NICU perspective, category III strips do definitely correlate with babies in trouble)
And then we get a baby who had a flat strip prior to birth (SVD) and has almost no brain activity, because the mom didn't want to get a c/s because she "knows" there are too many c/s and she "knows" fetal monitoring is worthless, so she continues laboring because the baby isn't actively decel'ing, and she is not white so she "knows" the doctors aren't giving her good care because of that.
Now she can't face the possibility that her decision to avoid the "unnecessary" c/s has ended with her child being neurologically devastated. (and honestly, I would worry about suicide in those cases)
It's frustrating and disheartening, especially when you see the babies taking the brunt of this dunning-kruger and I just needed to preach to the choir a little and feel less alone. I'm heartbroken for the families, the babies, and the mothers who think they are doing the right thing but just aren't hearing the right message.
But especially the baby who is motionless with low voltage eeg, non-reactive pupils, now post-cooling, who will likely never open their eyes and see the world.
I don't know how to fix it and it is horrible. 😞