Readers respond to Dr. Louis Weinstein’s Commentary, “What can be safer than having a baby in the USA?”



Political correctness won’t lower maternal mortality

Wow! What a great article! In all honesty, I began reading it reluctantly, expecting to encounter a lot of out-of-touch, politically correct garbage. It drives me crazy that people use these stats on maternal mortality to disparage our care, when people who care for these patients know the role that these mitigating variables (like substance abuse and obesity) play. There is always room for improvement and self-evaluation but, as a society, we need to start being honest and responsible. We need to identify the pertinent issues and stop worrying about offending people.

I recently started a healthy lifestyle and diet program in my office, and the results have been stunning. Not only are women losing significant weight, but the number of medications that have been discontinued in the process is unbelievable. We are conducting a research trial into the effects of this program on polycystic ovary syndrome.

Too many physicians are afraid to confront a patient about the truth and consequences of her body mass index of 35. Too often, those same physicians are quick to hand out prescriptions for expensive medications, thinking they are “fixing” something, when all they are doing is wasting money and generally worsening the patient’s health.

Other countries and cultures have confronted the reality of some of these issues with “forced sterilization” and limits on family size. That sounds terrible, but at some point we have to start facing reality.

Another great example: In today’s paper, an article described people’s protests against a proposed tax on soft drinks. The people said that “groceries” should not be taxed. I think such a tax is a bad idea, but calling a totally nonnutritive, unhealthy beverage “groceries” shows how unrealistic we are about the truth.

Thanks to Dr. Weinstein for standing up and saying something that needed to be said. Anyone who is “offended” needs to get a grip and understand the role of objective evaluation and discussion. Everything needs to be on the table.

Donald J. Debrakeleer, DO
Lansdale, Pa

Change is a long, slow process

How many pregnancies is too many, in Dr. Weinstein’s opinion? Three, four, five, six? Is Dr. Weinstein implying that women need to have a license to have sex? Silly analogy!

I agree that education and contraception are part of the answer, but Dr. Weinstein’s proposed solutions are ridiculous and expensive. Free contraception is a good idea, but who pays for those “vouchers” and the compensation for not getting pregnant?

How long do we pay women to abstain from reproducing? Do we stop payment when they get pregnant? Can we get our money back? The federal government is trillions of dollars in debt, and Dr. Weinstein wants to emulate the Department of Agriculture and pay farmers not to grow corn? We can’t expect women to inculcate values that aren’t there in the first place simply by paying them!

One change is necessary but impossible: development of a long-time perspective. That’s what’s needed for a woman to delay gratification in the near term in favor of long-term benefits, such as financial freedom and personal maturity. A good Jewish mother would do the job. Money won’t do it—only long, long dinner-table conversations about right and wrong.

Stan Franklin, MD
Lewisville, Tex

Maternal mortality is under-reported
and misclassified

A case series of US maternal deaths that I have pulled together over more than a decade indicates that the recent rise in maternal mortality is caused by more than matters of lifestyle. To blame are many variables other than lack of access to prenatal care due to discrimination, transportation issues, and other common problems in the lives of low-income women.

My series of 325 deaths, most of which occurred since 2000, includes many women who had “good” insurance and plenty of prenatal visits. A rather high number of women bled to death in hospital during or following cesarean delivery, and some experienced pulmonary embolism in hospital or after release. Six deaths were related to epidural anesthesia, and quite a few involved ruptured uteri or amniotic fluid embolism following induction. Among the deaths were numerous mothers of multiples.

What’s missing from Dr. Weinstein’s discussion is the 1998 revelation by the Centers for Disease Control and Prevention (CDC) that we have a large degree of misclassification and underreporting of maternal death in the United States. Since this revelation made the news in the late 1990s, the CDC has not been able to claim, with any degree of credibility, that reporting has substantially improved.


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