Why does US have such a high infant mortality?

[Merely]

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im a med student and were learning about this in class but i dont understand how we could have worse outcomes compared to so many other less advanced countries? thanks for insights

 

[SurfingDoctor]

Why Is Infant Mortality Higher in the United States Than in Europe?

Multiple reasons: preterm birth, postnatal outcomes, definitions and statistical collection of said deaths.

 

[Shufflin]

we're a fatter people.

could that have something to do with it?

 

[Obnoxious Dad]

we're a fatter people.

could that have something to do with it?

Europeans smoke like chimneys. Does that matter?

 

[Shufflin]

Europeans smoke like chimneys. Does that matter?

Nope. Because most women who smoke in Europe stop smoking while pregnant. You can't stop being obese while pregnant now can you, and the last I checked diabetes wasn't good for babies.

 

[Obnoxious Dad]

Why is America's Infant Mortality Rate so High? - Matt Palumbo
Coyote Blog » Blog Archive » Why Does The US Appear to Have Higher Infant Mortality?
The zombie infant mortality explanation

 

[anonperson]

im a med student and were learning about this in class but i dont understand how we could have worse outcomes compared to so many other less advanced countries? thanks for insights

I still take OB call for the health system I am employed at so I do cover unassigned patients. Here is a list of patients off the top of my head that will mess with our statistics.

Patient from an Asian country came to US specifically to deliver. She had 2 prior C sections. Came to the hospital with severe abdominal pain at 38 weeks.
Had a ruptured uterus with a dead baby. We saved her life. Of course it is a fetal demise and we will get dinged for it.

Numerous patients from south of the border (Mexico, El Salvador, Guatamala etc) with no or limited prenatal care dropping in to the local hospital with major obstetric complications (pre eclampsia, diabetes, etc)

Patient with limited pre natal care and meth use with a placental abruption and fetal demise.

As alluded to earlier, patients are getting fatter/sicker/older which does not bode well for pregnancy outcomes.

I had a 22 year old patient who was pushing 300lbs! This is not unusual either. Obese patients have worse obstetric outcomes, increased rates of fetal demise, increased rates of birth defects etc but we still get dinged for it.

I delivered a patient who went into spontaneous labor at 23 weeks of a ~400gm infant. They wanted everything done so the neonatologist and team was present for deliver and proceeded with an aggressive resuscitation. Baby was alive last I checked but it doesn't look good.

So patients with limited or no prenatal care come to the US specifically to deliver and some will have bad outcomes that we basically absorb. I can guarantee you no one from the US is going to China/Jpaan/Mexico/France etc to deliver.

 

[calvnandhobbs68]

I still take OB call for the health system I am employed at so I do cover unassigned patients. Here is a list of patients off the top of my head that will mess with our statistics.

Patient from an Asian country came to US specifically to deliver. She had 2 prior C sections. Came to the hospital with severe abdominal pain at 38 weeks.
Had a ruptured uterus with a dead baby. We saved her life. Of course it is a fetal demise and we will get dinged for it.

Numerous patients from south of the border (Mexico, El Salvador, Guatamala etc) with no or limited prenatal care dropping in to the local hospital with major obstetric complications (pre eclampsia, diabetes, etc)

Patient with limited pre natal care and meth use with a placental abruption and fetal demise.

As alluded to earlier, patients are getting fatter/sicker/older which does not bode well for pregnancy outcomes.

I had a 22 year old patient who was pushing 300lbs! This is not unusual either. Obese patients have worse obstetric outcomes, increased rates of fetal demise, increased rates of birth defects etc but we still get dinged for it.

I delivered a patient who went into spontaneous labor at 23 weeks of a ~400gm infant. They wanted everything done so the neonatologist and team was present for deliver and proceeded with an aggressive resuscitation. Baby was alive last I checked but it doesn't look good.

So patients with limited or no prenatal care come to the US specifically to deliver and some will have bad outcomes that we basically absorb. I can guarantee you no one from the US is going to China/Jpaan/Mexico/France etc to deliver.

Unless you can pull out some statistic that tells me that these people from other countries delivering their babies in the US makes up a significant portion of the deliveries every year (and that they have a significantly higher complication rate than our own obese, relatively advanced maternal age, multiple comorbid population), that shouldn’t even be put out there as an issue.

I too can give you plenty of anecdotal examples of perfectly healthy non-citizen patients as well who had perfectly healthy babies (especially in the Hispanic population actually).

 

[anonperson]

Unless you can pull out some statistic that tells me that these people from other countries delivering their babies in the US makes up a significant portion of the deliveries every year (and that they have a significantly higher complication rate than our own obese, relatively advanced maternal age, multiple comorbid population), that shouldn’t even be put out there as an issue.

I too can give you plenty of anecdotal examples of perfectly healthy non-citizen patients as well who had perfectly healthy babies (especially in the Hispanic population actually).

Lol. Ok bro. Ignore the guy who is actually working firsthand in the labor and delivery setting .

Not only do we contend with our own unhealthy population (fat, old, drug use, diabetic, hypertensive) but we have people coming from OTHER countries who come to the USA for the express reason to deliver a kid (so they can get citizenship/better health care etc).

These are patients from China, Hong Kong, Mexico, El Salvador etc . These additional patients will invariably have there own set of issues and in MY experience, they are not in the best of health. You can believe me or not, but I experience it firsthand. I have no reason to lie or embellish the truth.

We do 3500 deliveries a year. This is a average sized community hospital in CA. There is enough medical tourism from patient coming in from China, Mexico etc that the hospital has cash prices for a vaginal delivery, c section etc for patients. At least 10% of the patients are cash pay and they account for a decent number of issues (at least 2 fetal demises in the last 12 months, numerous hemorrhages-potentially due to herbal medication use etc).

This is a not so commonly discussed issue in a lot of places. It isn't discussed as much because the hospital is collecting easy cash with no insurance interference and they aren't interested in rocking the boat. Go to any reasonably busy labor and delivery in CA/NY/TX etc and you will see this firsthand.

How common do you think a term fetal demise is? About 2 to 5/1000. Having this patient roll into labor and delivery for example f#cks up the stats for my particular hospital. I know it screwed my stats as I never had a fetal demise. I was just the sucker who was on call.

You think patients from the USA are going elsewhere to deliver? No. They stay here and then we get the pleasure of people from out of the country rolling in as well.

You have to be ignorant to think this isn't an issue because it plays a role.

 

[SurfingDoctor]

Just as a point of clarification, stillbirth and fetal demise don’t count in infant mortality rate even in the US. That is a separate metric.

 

[anonperson]

Just as a point of clarification, stillbirth and fetal demise don’t count in infant mortality rate even in the US. That is a separate metric.

True. But it just helps show that the stats can get grossly inflated by factors outside of anyone's control.

 

[pedssped]

Race plays a HUGE role here. Big differences in both infant and maternal mortality between black vs. non-black. Not necessarily a scientific journal here but reputable: Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis

 

[oldbearprofessor]

This is an issue that should be seen as a primary medical issue but has become very politicized as both discussions often held about it and even some of the links and posts above show. From my perspective, having done lots of global health related neonatology and practicing in a public health care setting continuously as a neonatologist for over 30 years, there are many reasons, the least of which is bad statistics or excessive NICU care, etc. Regardless though, I wish there was more emphasis on solving the problems leading to this, which relate largely to prenatal issues than to fighting about the exact number. We need as a society to support the "first 1000 days" and study the issues related to excess perinatal and early childhood mortality.

 

[Dusn]

I think it's a good public health question but you're looking in entirely the wrong place for answers. Look at the fast-food industry and diet in the US compared to the other countries with better health outcomes; the hospitals and doctors are less important.