Rising Maternal Mortality:
My friend has written to point of some new information on maternal mortality.  According to Nathaniel Johnson of California Watch on February 3, 2010 the number of women in California who have died because of complication directly related to pregnancy has tripled over the last ten years.  This had been known but not announced.  It may be more widespread than just in California.  The rise has been attributed to an increase in the prevalence of obesity, to an increase in the number of Caesarian sections and simply to improved statistics.

A specific investigation was done headed up by Dr. Elliott Main of California's Department of Public Health.  He found that obesity was a factor, as were the number of older mothers and the number of fertility treatments. These, however did not account for the entire rise.  No mention was made in the California Watch article about a change in the socioeconomic status of pregnant mothers, but I would presume that was looked into.  A fifty percent rise in the number of Caesarian sections was found, but the impact of that has still to be worked out. 

The number is still relatively small.  According to the Washington Post it is about 600 maternal deaths a year in the United States.  That is not to say that the rate is lower than it is in other rich country.  But the question was raised whether that number was so small that it all might be random fluctuation.  Well the standard deviation in a sample of 600 is about 24.5.  That means the number could bound around the average by that much without meaning anything.  Even a bounce of 50 could occasionally happen.  But for the number to triple from 200 to 600 is not plausible.  There must be a cause. 

Of course the cause that nobody is going to consider, for now at least, is that just as male development is less complete on average than it was several years ago, perhaps female development is also less complete on average.  The implications for a male might simply be reduced fertility and perhaps a more docile temperament.  (That’s in case anybody out there thinks women are docile.  Anyway, they live longer.)  For a woman it might mean that her pelvis did not develop as completely.  This could mean that a Caesarian section was needed. 

When you look at the x-ray of a woman’s pelvis and try to decide whether she is going to have any trouble delivering a baby by the normal route, there are three landmarks to measure.  One measurement is the inlet to the true pelvis.  Another is the distance between the ischial spines and the distance between the ischial tuberosities.  Back when I was doing such work we thought that the distance between the ischial spins was the most important measure.  However, it can be a little difficult to see them clearly and know exactly where to measure.  The easiest measure is the pelvic inlet, and that might serve as a surrogate for female development. 

Anybody with access to a large clinical film archive could do it.  That, of course, would require institutional review, but all they would worry about most likely would be whether you actually knew how to measure the pelvic inlet and whether the privacy of the patients was going to be respected. 

Given the films and permission, it would just be a matter of running through a few hundred pelvic studies of women and recording the measurements and the ages of the women.  Then you would lump them by age and take the average measurements and graph those numbers against each other.  Then you would know whether, in the population you were looking at, the female pelvis was getting smaller. 

Thereby might hang your biggest problem.  You would want to find a population in which the birth rate was falling rapidly and gene pool size was rising but there was little migration in or out. 

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