What is the Leading Cause of Maternal Death in the US?

http://www.hackensackumc.org/cap/

Hackensack University Medical Center has opened a Center for Abnormal Placentation.   I am sure that most people are unaware of abnormal placentation, which occurs when the placenta implants abnormally and can be incredibly risky to the pregnant woman’s life.  Placenta accreta is the leading cause for Maternal death in the United States.  When a placenta accreta forms, it triggers a process called neovascularization which is the excessive formation of blood vessels.  These vessels can cause the woman to hemorrhage uncontrollably when the healthcare provider attempts to deliver the placenta.  The biggest risk factor for placenta accreta is a previous cesarean section and the risk increases with the number of previous C-sections.

The following is another Committee Opinion from ACOG, the same type of publication they recently published about waterbirth. http://m.acog.org/Resources%20And%20Publications/Committee%20Opinions/Committee%20on%20Obstetric%20Practice/Placenta%20Accreta.aspx?IsMobileSet=true

The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Researchers have reported the incidence of placenta accreta as 1 in 533 pregnancies for the period of 1982–2002 (5). This contrasts sharply with previous reports, which ranged from 1 in 4,027 pregnancies in the 1970s, increasing to 1 in 2,510 pregnancies in the 1980s (6, 7). Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either anterior or posterior placenta previa overlying the uterine scar. The authors of one study found that in the presence of a placenta previa, the risk of placenta accreta was 3%, 11%, 40%, 61%, and 67% for the first, second, third, fourth, and fifth or greater repeat cesarean deliveries, respectively (8). Placenta previa without previous uterine surgery is associated with a 1–5% risk of placenta accreta.

According to a study in the Journal of Maternal-Fetal and Neonatal medicine, if primary and secondary cesarean rates continue to rise, by 2020 the cesarean delivery rate will be 56.2% and there will be an additional 6,236 placenta previas, 4,504 placenta accretes and 130 maternal deaths annually.

I am happy that Hackensack has developed a program that has been shown to save women’s lives.  I am just perplexed at the fact that this horrible complication of cesarean section is so common that we now have physicians specializing in it.  I know that we need to have a life-saving solution to this complication but I am wondering if the real solution is decreasing the cesarean section rate?

In 2013, the Midwives of New Jersey had a cesarean rate of 7% for women who never had a cesarean and 13% overall.  We use water immersion for labor and birth on a regular basis.  ACOG and AAP have gone out of their way to express their concern about the possible risks of waterbirth while ignoring the monstrously large elephant in the room-CESAREAN SECTION.  Their time would be much better spent addressing this problem.  And leave the midwives alone to continue providing excellent care with amazing outcomes.