Kaunitz AM, Spence C, Danielson TS, Rochat RW, Grimes DA. Perinatal and maternal mortality in a religious group avoiding obstetric care. Am J Obstet Gynecol. 1984 Dec 1;150(7):826-31. PubMed PMID: 6507508.
We investigated perinatal and maternal deaths occurring among women who were members of a religious group in Indiana; these women received no prenatal care and gave birth at home without trained attendants. Members of the religious group had a perinatal mortality rate three times higher and a maternal mortality rate about 100 times higher than the statewide rates. These findings suggest that, even in the United States, women who avoid obstetric care have a greatly increased risk of perinatal and maternal death.
All reported perinatal and maternal deaths from 1975 to 1982 among Faith Assembly members living in the state of Indiana were verified. Fetal death and the neonatal mortality rate were defined per 1000 live births; perinatal mortality was the combination of fetal deaths and neonatal deaths per 1000 births plus fetal deaths; and maternal mortality was calculated per 100.000 live births. 344 live births were identified in Elkhart and Kosciusko Counties among religious members during this period. 291 of these mothers (85%) did not have prenatal care, the prenatal care for the remaining 53 (15%) was unspecified. The mothers tended to be aged 20-34, white, married, and have minimum of high school education. 21 perinatal deaths were established among this population sample with 12 fetal deaths and 9 neonatal deaths. 11 fetal and 6 neonatal deaths occurred to members residing in the above 2 counties. Trauma or asphyxia at birth (often as a result of umbilical cord problems) and respiratory problems were responsible for most of the mortality. 6 maternal deaths occurred: 4 due to hemorrhage and 2 caused by infection. During this period there was a total of 61 maternal deaths in Indiana, and thus about 9% of maternal mortality occurred among Faith Assembly members (100% vs. 36% deaths caused by hemorrhage and infection). 3 of the 6 church members who died were 35 or older, and 2% of the births occurred to women 35 or older in these countries. The estimated perinatal mortality rate for this group was 45/1000 live births vs. 18/1000 for the whole state, almost 3 time higher. The fetal mortality rate was 32 vs. 9 for Indiana (significantly higher); and the neonatal mortality rate was 17 vs. 9, respectively. The maternal mortality rate was 872/100.000 live births for church members residing in the 2 counties vs. 9/100.000 for Indiana: an astounding ninety-twofold higher rate. The risk of perinatal and maternal death is greatly augmented even in the US when women do not utilize obstetric care.
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