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This is a protocol issue. The United Kingdom and a few States follow a specific programme which dramatically improves maternal outcomes. The US needs to do two things: capture the data and implement the protocols.

> we should focus on the top 5 because that would have more impact on women's health

Eh, sorry if I'm missing something obvious, but isn't this true? Obviously it's best to pursue everything possible at once, but with limited resources it is optimal to hit them in order of magnitude.

Not if your first question is "why do so many pregnant mothers die during childbirth?" - GP's point is that it's a disheartening realization.

That being said, it's not necessarily true - after all, if X resources would be more effective mitigating cause of death A than cause of death B, then presumably you would want to (from a utilitarian calculus) direct them to A, irrespective of whether A or B causes more deaths.

It's not that the person was wrong, it's that the person saw no difference between an accidental death (#1 cause) and death from pregnancy. Look at these causes, and you tell me which type of death a hospital can best actively prevent as a part of the treatment plan and those measures have the most impact:

#1 Unintentional injuries

#2 Cancer

#3 Suicide

#4 Heart disease

#5 Chronic lower respiratory diseases

#6 Pregnancy complications

Think about which type of young patient comes to them with at minimum of 6 to 9 months of warning, so much time to prepare for the "event". Think about which type of patient can leave the hospital well with a completely normal life expectancy. Out of those #6 death options, pregnancy is the only type of event where, if you survive, you have a completely normal life & life expectancy. Given that, why wouldn't a hospital invest the resource?

https://www.cdc.gov/women/lcod/2014/all-females/index.htm

Pregnancy at least used to be one of the things insurance companies were excited to cover you for. It means you aren't sick, and the more money they spend (and labor is pretty cheap, compared to a lot of health care), the more likely they'll save it in the future by having a healthy mom and a healthy baby. Unhealthy/premature babies can be a huge ongoing expense.

No. Before the ACA pregnant women were specifically excluded without a rider.

Not at all, pre-ACA it was impossible to purchase an individual plan that covered prenatal care and childbirth, they just weren't available. Couple self employed friends had babies during that time and they had to pay for everything out of pocket, tens of thousands of dollars.

Also, being pregnant does not mean you "aren't sick," not sure what gave you that idea.

My bad, I was thinking of employer sponsored healthcare, and I think they usually didn't count labor under the deductible. But yes, buying any kind of healthcare on the public market pre-ACA was terrible.

And I meant that being pregnant is a normal healthy condition, that happens to normal healthy people. Sick people can be pregnant, of course, and sickness can be precipitated by being pregnant (like gestational diabetes), but in general it's something that happens normally, unlike illnesses.

> And I meant that being pregnant is a normal healthy condition, that happens to normal healthy people.

It was normal, until early 20th century doctors (mostly male) decided that the midwives (mostly female) didn't actually know anything about childbirth. To protect women from the "incompetent" midwives, the doctor guild successfully exterminated their competition.

Midwives used to have little tricks for normal pregnancy problems, like how to get a breech baby to turn. Much of the institution's knowledge was lost in the Purge.

I realized a while back that there are two books called The American Way of Birth [1]. The local science library had a copy of the earlier one. This book examines the "medicalization" of normal female experiences.

[1] https://news.ycombinator.com/item?id=13742782

This 2013 NY Times article [2] has a nice summary of the effects of the medicalization of childbirth on the costs thereof:

  [...] Childbirth in the United States is uniquely 
  expensive, and maternity and newborn care constitute the 
  single biggest category of hospital payouts for most  
  commercial insurers and state Medicaid programs. The 
  cumulative costs of approximately four million annual 
  births is well over $50 billion. 
  [...]
  Those payment incentives for providers also mean that   
  American women with normal pregnancies tend to get more of 
  everything, necessary or not, from blood tests to 
  ultrasound scans, said Katy Kozhimannil, a professor at 
  the University of Minnesota School of Public Health who 
  studies the cost of women’s health care.

[2] American Way of Birth, Costliest in the World - http://www.nytimes.com/2013/07/01/health/american-way-of-bir... (this article was probably not directly inspired by either book of the same name)

[minor edits - formatting, etc]

Whether is is "normal" or "happens normally" is not important from an insurance standpoint because from their end its nothing more than a bunch of expensive claims, even "normal" births are just a bunch of expensive claims. Childbirth is a far cry from "pretty cheap," an uncomplicated vaginal birth costs tens of thousands of dollars minimum. You seem to be ignoring months of prenatal care and the care for any pregnancy complications that may come up, of which there are many. Childbirth costs are much more than just the cost of "labor."

The fact you couldn't purchase individual plans that covered these expenses is a huge testament to that. It was so expensive that it required the force of law to get insurance companies to cover them.