Infant mortality and the Amish

[MamaBearTeacher]

Is it true that Amish have lower rates of infant mortality? If so, why?

[poppy]

How would we even know?    Do the Amish regularly comply with scientific studies?  That must be irritating.

 

[regentrude]

Unclear, since there are no official statistics on this about the Amish.

There seem to be old data indicating it might be lower 

 

 

Official vital statistics are not compiled separately for the Amish. The only published statistic on Amish infant mortality of which we are aware, 20.9/1,000 livebirths during a period from 1925 to 1965, compares favorably with infant death rates for the US white population at the time (3)

 

This study from 1994:

https://www.ncbi.nlm.nih.gov/pubmed/8296784

 

concludes similar mortality rate to comparable demographic, despite higher prevalence of risk factors.

 

 

 

Despite a higher prevalence of several risk factors for perinatal and infant death among the Amish, neonatal and infant death rates for Geauga Settlement Amish have been very similar to the corresponding rates for white children in rural Ohio and the state as a whole

[Meriwether]

How would we even know? Do the Amish regularly comply with scientific studies? That must be irritating.

What must be irritating?

[Clemsondana]

I thought that I remembered from my genetics classes that the Amish were great for genetics studies because they have big families and know their family history (there are other groups that fall into that category, too). I looked it up and there are lots of links about it. This is not related to the OP, but is in answer to Poppy's question.

 

http://ddcclinic.org/research/amishpartnership.html

[poppy]

What must be irritating?

 

To be the subject of frequent scientific studies ....  I'm picturing a bunch Amish people filling out several surveys with the same questions: how  many babies did you carry to term, what was  your age at first pregnancy, etc.   It's an odd thing for a group that generally eschews highly medicalized pregnancy and childbirth.

[TechWife]

To be the subject of frequent scientific studies .... I'm picturing a bunch Amish people filling out several surveys with the same questions: how many babies did you carry to term, what was your age at first pregnancy, etc. It's an odd thing for a group that generally eschews highly medicalized pregnancy and childbirth.

Although, the Amish have participated in many studies through the years, from what I understand. They don’t eschew modern medicine in general.

[DesertBlossom]

The US has one of the worse infant mortality rates among industrialized nations. I think modern medicine does some amazing things but I suspect that some of our standard interventions are not helping.

[Mergath]

The US has one of the worse infant mortality rates among industrialized nations. I think modern medicine does some amazing things but I suspect that some of our standard interventions are not helping.

 

I don't think it's the interventions so much as the drastic disparity of care between certain populations. From what I've read, if you're a minority and are low-income, you might as well be giving birth in Sudan or something.  

[poppy]

I don't think it's the interventions so much as the drastic disparity of care between certain populations. From what I've read, if you're a minority and are low-income, you might as well be giving birth in Sudan or something.  

 

Yeah, the the risk isn't equal across categories, and more interventions aren't the risk factor.  It's money and / or race.  It's more dangerous to give birth in West Virginia  than in California. And black mothers risk is more than twice that of white women, for no obvious one reason.

 

I wonder if that's equally true in countries with socialized medicine and heterogeneous populations?

[Farrar]

My midwife had trained in part with the Amish... or with Amish midwives or something? I'm not totally clear because it's so far back now. But I remember her talking a little about the midwifery care.

 

As I understand it... a lot of our infant mortality rates (which aren't awesome for a developed nation) come from lack of proper care or inappropriate interventions at the wrong times or poverty and/or poor diet. While the Amish wouldn't benefit from medical advances and interventions when they are needed, they also wouldn't suffer from any of those things - not poor diet and certainly not lack of care or attention to birth. The whole midwifery model is so strongly based in that sort of close attention.

 

If the statistics are similar, my guess would be that it's because those things balance each other out.

[Laura Corin]

Yeah, the the risk isn't equal across categories, and more interventions aren't the risk factor. It's money and / or race. It's more dangerous to give birth in West Virginia than in California. And black mothers risk is more than twice that of white women, for no obvious one reason.

 

I wonder if that's equally true in countries with socialized medicine and heterogeneous populations?

This gives figures by ethnic group in the UK. 

 

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/childhoodinfantandperinatalmortalityinenglandandwales/2015

 

This is by class.  This is a campaigning site but the figures are official (if a bit old):

 

http://www.poverty.org.uk/21/index.shtml

Edited February 5, 2018 by Laura Corin

[kiwik]

Yeah, the the risk isn't equal across categories, and more interventions aren't the risk factor.  It's money and / or race.  It's more dangerous to give birth in West Virginia  than in California. And black mothers risk is more than twice that of white women, for no obvious one reason.

 

I wonder if that's equally true in countries with socialized medicine and heterogeneous populations?

 

 

There are definitely variations is outcome across different populations and areas in NZ even though we have universal healthcare.  I am not sure they are quite as extreme but they are there.  

[BlsdMama]

Our Amish here are often delivered by traditional doctors and in traditional hospitals.  My own OB delivers Amish women.  However, they do usually go home immediately after birth and not wait 24 or 48 hours, etc.  We see them at hospitals, etc.  

[Katy]

There's probably a lot to be said for large families paying close attention to pregnant women when they need help, traditional diets, and active lifestyles that naturally incorporate plenty of low-intensity exercise too.

[shawthorne44]

Our Amish here are often delivered by traditional doctors and in traditional hospitals.  My own OB delivers Amish women.  However, they do usually go home immediately after birth and not wait 24 or 48 hours, etc.  We see them at hospitals, etc.  

 

Honestly, that might be a tiny benefit to the babies.  I've only had the one baby, but immediately after I swore that for the next baby I'd go home as soon as I could walk to the restroom.  

[Mergath]

So for those of you who are talking about their traditional diet being a big factor, the Amish don't eat that differently from the rest of us. Obviously this varies between groups and families, but we have a decent Amish population where I live, and if you look in their carts at Walmart, they buy the same processed crap as the rest of us. ;) If you've ever looked through a cookbook of Amish recipes, they aren't like, "Go outside and slaughter a cow, then harvest some kale from the garden..." They're more like, "Mix a can of this with a can of this and a bag of instant rice."  :lol:

 

They're definitely far more active than the average American, though. And have a bigger support system and closer familial ties, which I'm sure makes a difference.

[Reefgazer]

Also, the US will try and intervene in seriously ill/very premature children when other countries will not.  This drives up our infant mortality rate on paper, whereas other countries don't record those deaths as infant mortality, but rather as stillbirths, which makes their infant mortality rates look lower.

The US has one of the worse infant mortality rates among industrialized nations. I think modern medicine does some amazing things but I suspect that some of our standard interventions are not helping.

 

[Katy]

So for those of you who are talking about their traditional diet being a big factor, the Amish don't eat that differently from the rest of us. Obviously this varies between groups and families, but we have a decent Amish population where I live, and if you look in their carts at Walmart, they buy the same processed crap as the rest of us. ;) If you've ever looked through a cookbook of Amish recipes, they aren't like, "Go outside and slaughter a cow, then harvest some kale from the garden..." They're more like, "Mix a can of this with a can of this and a bag of instant rice."  :lol:

 

They're definitely far more active than the average American, though. And have a bigger support system and closer familial ties, which I'm sure makes a difference.

 

Interesting.  We have more Mennonites near where I live now, and while I've noticed plenty of canned cream of something casseroles, a fair amount of them seem pretty aware of avoiding processed foods entirely.

[fairfarmhand]

I’d say it would be due to overall healthier lifestyle plus a greater familiarity with infants and proper infant care. Also greater familial and community support.

 

 

Sent from my iPhone using Tapatalk

[TravelingChris]

I just found out last week that with preemies in NICU, the odds are worse for white baby boys and the best for black baby girls.  It goes from worse to best with white males, white females, black males, black females.  I have no idea why that is the case.  In my state, we have a fairly high infant mortality and I think that is mainly due to long distances to proper medical care for large parts of the population who live more rurally,  As someone else said, WV has high infant mortality too and is an even more rural state than mine.

[regentrude]

Also, the US will try and intervene in seriously ill/very premature children when other countries will not.  This drives up our infant mortality rate on paper, whereas other countries don't record those deaths as infant mortality, but rather as stillbirths, which makes their infant mortality rates look lower.

 

Is this true for the highly developed countries of, say, Western Europe? because infant mortality in the US is way higher than there.

https://www.healthsystemtracker.org/chart-collection/infant-mortality-u-s-compare-countries/#item-infant-mortality-higher-u-s-comparable-countries

 

27 years ago, German doctors fought very hard to keep my 3 months premature niece alive who was born at 2 lbs - back then the absolute limit of survivability.

I cannot speak for other countries, but at least in Germany, doctors do try to save at risk newborns, with comparable technology - so I doubt the big difference comes from not intervening hard enough in premies.

Edited February 5, 2018 by regentrude

[regentrude]

Yeah, the the risk isn't equal across categories, and more interventions aren't the risk factor.  It's money and / or race.  It's more dangerous to give birth in West Virginia  than in California. And black mothers risk is more than twice that of white women, for no obvious one reason.

 

I wonder if that's equally true in countries with socialized medicine and heterogeneous populations?

 

Even with access to health care, you have cultural differences, and certain demographic groups are more likely to smoke, more likely to be overweight, more likely to have poor nutrition, less likely to seek early prenatal care - even if care is free at the point of service.

[Katy]

I just found out last week that with preemies in NICU, the odds are worse for white baby boys and the best for black baby girls.  It goes from worse to best with white males, white females, black males, black females.  I have no idea why that is the case.  In my state, we have a fairly high infant mortality and I think that is mainly due to long distances to proper medical care for large parts of the population who live more rurally,  As someone else said, WV has high infant mortality too and is an even more rural state than mine.

 

 

Being a white male preemie is a risk factor for most of the frequent causes of infant mortality.  We've had a few medically fragile foster infants here, and even though they all had vastly different diagnoses, looking up risk factors for each thing, being a white male was always a higher risk.  

 

If I was to guess, I'd say it probably had to do with slavery.  Black people are at higher risk for some things - like high blood pressure - due to how difficult it was to survive months at a time in ships, for example.  All of those negative consequences also conveyed survival benefits in certain scenarios.  I bet we simply haven't identified the genetic factors involved yet.

 

ETA:  All of which is to say that perhaps we'll discover that the specific risk genes involved aren't common in that small population of Amish.

Edited February 5, 2018 by Katy

[shawthorne44]

The International infant mortality comparisons are meaningless because they are comparing Apples and Oranges.  Several countries don't count it as a live birth unless the infant survives for several days, which is when an infant is most likely to die.  

http://www.nationalreview.com/article/276952/infant-mortality-deceptive-statistic-scott-w-atlas

[TechWife]

Also, the US will try and intervene in seriously ill/very premature children when other countries will not. This drives up our infant mortality rate on paper, whereas other countries don't record those deaths as infant mortality, but rather as stillbirths, which makes their infant mortality rates look lower.

Other countries record live births as stillbirths? How is this a thing?

In the US, a stillbirth is the death of a fetus after 20 weeks gestational age, before or during delivery. Is it the “during delivery†that is, perhaps handled differently? Also, how is death determined at the time of delivery in the US? Elsewhere? Absense of Respiration, heartbeat, a combination? What is the classification if a baby is delivered with no respirations, no heartbeat, but a heartbeat is established and then lost again soon thereafter? Is that a stillbirth or a live birth with a fetal demise?

 

I realize you might not have answers to these questions and that there is an entire set of ethical concerns surrounding treatment of preterm newborns. For the purposes of this discussion I’m just pondering how various scenarios are classified for statistical purposes.

 

There is some interesting info about risk factors here, as well. I can see where the Amish might have fewer of the risk factors listed here.

https://www.cdc.gov/ncbddd/stillbirth/facts.html

 

Oh, wait. I found some more info about definitions. It seems they vary by state. Here are the definitions from my state:

Live birth defined:

‘‘Live birth’’ means the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, which, after such expulsion or extraction, breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. (Administrative Procedure 7G, .0102 (5))

Fetal death defined:

‘‘Fetal death’’ means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. (Administrative Procedure 7G, .0102 (6))

When fetal death reporting is required:

Each spontaneous fetal death occurring in the State of 20 completed weeks gestation or more shall be made on a form prescribed and furnished by the State Registrar. (Section 130A-114a, General Statutes)

Induced termination of pregnancy defined:

Induced termination of pregnancy means the purposeful interruption of pregnancy with the intention other than to produce a live-born infant or to remove a dead fetus and which does not result in a live birth. (Handbook on the Reporting of Induced Termination of Pregnancy in North Carolina)

When induced termination of pregnancy reporting is required:

The Department of Human Resources shall prescribe and collect on an annual basis, from hospitals or clinics where abortions are performed, such representative samplings of statistical summary reports concerning medical and demographic characteristics of the abortions provided as it shall deem to be in the public interest. (General Statutes 14-45.1c)

 

That helps me understand some more. Here’s the link in case anyone is interested:

https://www.cdc.gov/nchs/data/misc/itop97.pdf#page50

Edited February 5, 2018 by TechWife

[happypamama]

I just found out last week that with preemies in NICU, the odds are worse for white baby boys and the best for black baby girls. It goes from worse to best with white males, white females, black males, black females. I have no idea why that is the case. In my state, we have a fairly high infant mortality and I think that is mainly due to long distances to proper medical care for large parts of the population who live more rurally, As someone else said, WV has high infant mortality too and is an even more rural state than mine.

Wimpy white male syndrome — yep.

 

Many of the Amish around here have homebirths. Two of my midwives have worked a lot with plain communities. I don’t know their mortality rates though. They use the hospital when necessary. There was a plain family’s baby in the NICU next to ours.

[creekland]

The International infant mortality comparisons are meaningless because they are comparing Apples and Oranges.  Several countries don't count it as a live birth unless the infant survives for several days, which is when an infant is most likely to die.  

 

http://www.nationalreview.com/article/276952/infant-mortality-deceptive-statistic-scott-w-atlas

 

This seems to be good reasoning, but is accounted for in these published studies and shown not to account for all that much of the difference:

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058/

 

"The US has higher infant mortality than peer countries. In this paper, we combine micro-data from the US with similar data from four European countries to investigate this US infant mortality disadvantage. The US disadvantage persists after adjusting for potential di erential reporting of births near the threshold of viability. While the importance of birth weight varies across comparison countries, relative to all comparison countries the US has similar neonatal (<1 month) mortality but higher postneonatal (1-12 months) mortality. We document similar patterns across Census divisions within the US. The postneonatal mortality disadvantage is driven by poor birth outcomes among lower socioeconomic status individuals."

[Callie]

So for those of you who are talking about their traditional diet being a big factor, the Amish don't eat that differently from the rest of us. Obviously this varies between groups and families, but we have a decent Amish population where I live, and if you look in their carts at Walmart, they buy the same processed crap as the rest of us. ;) If you've ever looked through a cookbook of Amish recipes, they aren't like, "Go outside and slaughter a cow, then harvest some kale from the garden..." They're more like, "Mix a can of this with a can of this and a bag of instant rice." :lol:

 

They're definitely far more active than the average American, though. And have a bigger support system and closer familial ties, which I'm sure makes a difference.

Definitely this. My shopping cart is almost always healthier than the Amish or Mennonites in my town.

[maize]

My BiL was born prematurely in another country (unnamed because I don't feel like pointing fingers).

 

The medical staff said he wouldn't survive and put him in a room without any care to let him die.

 

His dad snuck him out of the hospital and took him to a neighbor to nurse until his mother was released from the hospital (I think they kept her at least a week).

[Sandwalker]

Is this true for the highly developed countries of, say, Western Europe? because infant mortality in the US is way higher than there.

https://www.healthsystemtracker.org/chart-collection/infant-mortality-u-s-compare-countries/#item-infant-mortality-higher-u-s-comparable-countries

 

27 years ago, German doctors fought very hard to keep my 3 months premature niece alive who was born at 2 lbs - back then the absolute limit of survivability.

I cannot speak for other countries, but at least in Germany, doctors do try to save at risk newborns, with comparable technology - so I doubt the big difference comes from not intervening hard enough in premies.

Here in the US, if the fetus is 20+ weeks old, it's considered in infant mortality statistics. From my understanding, many countries use 24 weeks or even 28 weeks as the cutoff for considering it infant death rather than a miscarriage. Of course everyone tries to and often does save 22+ weekers, it's the counting of them in the statistics that is different.

[creekland]

Here in the US, if the fetus is 20+ weeks old, it's considered in infant mortality statistics. From my understanding, many countries use 24 weeks or even 28 weeks as the cutoff for considering it infant death rather than a miscarriage. Of course everyone tries to and often does save 22+ weekers, it's the counting of them in the statistics that is different.

 

It's still accounted for in the study I posted.  Most of the difference comes between 1 month and 1 year.  < 1 month is similar across countries once the difference is worked in.  It's quite significant after that.

[DesertBlossom]

My BiL was born prematurely in another country (unnamed because I don't feel like pointing fingers).

 

The medical staff said he wouldn't survive and put him in a room without any care to let him die.

 

His dad snuck him out of the hospital and took him to a neighbor to nurse until his mother was released from the hospital (I think they kept her at least a week).

😨

 

Wow. Good for him for sneaking him out. Even if a baby actually has zero chance of surviving, they deserve to spend all their living moments snuggled in someone's arms.

[kiwik]

Our Amish here are often delivered by traditional doctors and in traditional hospitals. My own OB delivers Amish women. However, they do usually go home immediately after birth and not wait 24 or 48 hours, etc. We see them at hospitals, etc.

Here people are pressured to leave within 24 hours. I think they would have liked me to leave the day ds8 was born but I insisted on staying one night. With ds10 they reluctantly let me stay the full 5 days after the c section because there was no one at home.

[kiwik]

Here in the US, if the fetus is 20+ weeks old, it's considered in infant mortality statistics. From my understanding, many countries use 24 weeks or even 28 weeks as the cutoff for considering it infant death rather than a miscarriage. Of course everyone tries to and often does save 22+ weekers, it's the counting of them in the statistics that is different.

NZ uses 20 completed weeks of pregnancy or 400 g.

[Tangerine]

So for those of you who are talking about their traditional diet being a big factor, the Amish don't eat that differently from the rest of us. Obviously this varies between groups and families, but we have a decent Amish population where I live, and if you look in their carts at Walmart, they buy the same processed crap as the rest of us. ;) If you've ever looked through a cookbook of Amish recipes, they aren't like, "Go outside and slaughter a cow, then harvest some kale from the garden..." They're more like, "Mix a can of this with a can of this and a bag of instant rice." :lol:

 

They're definitely far more active than the average American, though. And have a bigger support system and closer familial ties, which I'm sure makes a difference.

My mom buys yogurt from an Amish family. But only plain, because they flavor them with kool-aid.

[mom@shiloh]

Two of my friends are midwifes who do only home births and the majority of their births are Amish.  As far as I'm aware, the Amish do not carry health insurance and the cost of giving birth at a hospital without insurance is prohibitive for most. 

[TechWife]

Two of my friends are midwifes who do only home births and the majority of their births are Amish. As far as I'm aware, the Amish do not carry health insurance and the cost of giving birth at a hospital without insurance is prohibitive for most.

Their community steps in and pays bills when necessary. Also, in many states, pregnant women can get Medicaid if they qualify. My understanding of their beliefs is that they prefer for the community to pay, but the Medicaid option is there as well. Edited February 6, 2018 by TechWife

[lexi]

Wimpy white male syndrome — yep.

 

Many of the Amish around here have homebirths. Two of my midwives have worked a lot with plain communities. I don’t know their mortality rates though. They use the hospital when necessary. There was a plain family’s baby in the NICU next to ours.

Lol! My son was nicknamed “wimpy white boy†in the NICU. Drs told me if he had been a black female he would have been fine. At the time it annoyed me but I’ve since read a lot research that supports this. I still don’t quite understand why this is true though. It was interesting to read though.

And most of the Amish around here have Home births with midwives. My midwife works with Amish families.