There’s a very important discussion affecting all patients regarding caregiver hygiene in this post.
To explain this post, let’s review the terms:
- Sepsis in an extreme reaction to infection, basically an “overreaction” by the body’s immune system that damages healthy tissue and organs. It was one of the issues early in the Covid pandemic and it can lead to organ shutdown and death. It’s an extremely serious threat.(1)
- Vaginal birth is a normal process through the birth canal, which can expose the body to infection in a less than sterile environment.
- An “easy fix” is the application of a single oral dose of an extremely common antibiotic that reduces the risk of sepsis and maternal death by 1/3.(2)
Infection is more common in poorer and less developed countries. However, the US Centers for Disease Control reports that sepsis occurs in 10 out of every 100,000 births in the US.(1) Actual figures may be higher, as we’ve learned from Covid to be skeptical of data reported from some states.
The US has the highest rate of maternal death with childbirth among developed countries. The maternal death rate in the US (2017 data) is 19 per 100,000 births, the same as in Latvia, Moldavia, Oman, Romania and Ukraine. There are 50 countries that have better results than the US, the best being Poland, Norway, Italy and Belarus with 2 deaths per 100,000 births.(9) A pregnant US woman can cut her risk almost in half simply by crossing the border into Canada.
The four major causes of the new mother’s death in the US are
- Heart disease
- Stroke
- Infection
- Severe bleeding(3)
Again, according to the CDC, 60% of these deaths are preventable.
Why are infections such an issue?
- Some births occur outside of a hospital or midwife facility, and the environment may not be sterile. Some occur in home, or in a car or airplane. Sterile? Highly unlikely.
- Even in a proper facility, infections can occur if tools aren’t properly sterilized or if personnel fail to follow proper handwashing procedures.
Handwashing has been identified as a major issue in US healthcare facilities.(5, 6, 7 and 8) Teaching hospitals may be better than other facilities in maintaining cleanliness protocols. The EU has its own procedures for ensuring cleanliness, but these procedures are followed only at a few facilities in the US.
The drug for preventing sepsis is azithromycin, which is sold under the brand names Zithromax and Azasite. It’s commonly used to treat middle ear infections, strep throat, pneumonia, intestinal infections.(4) The drug was developed in 1980. The new research shows that a single dose given by mouth cuts the risk to the mother by 1/3. According to GoodRx.com, the cost of a month’s supply of this drug is less than $20.
So now that this is known — although not all ob/gyns will have seen this report — shouldn’t this become a routine procedure? I’m a researcher, not a doctor, but it seems like there ought to be a discussion.
And yes, my wife has had to nag nurses about handwashing between patients. She wants their hads to be clean before they touch her. You should too.
Sources:
- https://www.cdc.gov/sepsis/what-is-sepsis.html
- https://www.news-medical.net/news/20230210/Sudy-Single-dose-of-common-antibiotic-given-during-labor-reduces-the-risk-of-maternal-death-or-sepsis.aspx?utm_source=news_medical_newsletter&utm_medium=email&utm_campaign=women_s_health_newsletter_14_february_2023
- https://www.cdc.gov/vitalsigns/maternal-deaths/index.html
- https://en.wikipedia.org/wiki/Azithromycin
- https://pubmed.ncbi.nlm.nih.gov/23787516/
- https://www.hopkinsmedicine.org/patient_safety/infection_prevention/hand_hygiene.html
- https://pubmed.ncbi.nlm.nih.gov/30237118/
- https://www.cdc.gov/handhygiene/index.html
- https://www.cia.gov/the-world-factbook/field/maternal-mortality-ratio/country-comparison
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