September 3, 2007
Maternal Death In Childbirth On The Rise
By Michael D. Shaw
While many causative factors can be cited, even as this disturbing finding is being analyzed, the U.S. maternal mortality rate rose to 13 deaths per 100,000 live births in 2004, according to National Center for Health Statistics (a unit of the CDC). This shows an upward trend from the rate of 12 per 100,000 live births in 2003—the first time the maternal death rate rose above 10 since 1977.
Perhaps, some of this is a statistical glitch, according to Donna L. Hoyer, Ph.D. of the Center. She notes that in 2003, there was a change in death certificate questions in the nation’s most populous state, California, as well as in Montana and Idaho. As such, more deaths could have been linked to childbirth, enough to account for 2003 rate. Yet, enhanced reporting—even if a scientifically valid reason—should not stop us from investigating other explanations.
Many experts, including Dr. Elliott Main, who co-chairs a panel reviewing obstetrics care in California, blame the high incidence of Caesarean section deliveries, which now comprise 29% of all births. Ironically, Caesareans grew in popularity in the 1970s, promoted as a way of offsetting the risks of vaginal deliveries. Main notes that:
“There’s an inherent risk to C-sections. As you do thousands and thousands of them, there’s going to be a price.”
As with other surgeries, Caesareans come with risks related to anesthesia, infections, and blood clots. Excessive bleeding is one of the leading causes of pregnancy-related death, and women with several previous C-sections are at especially high risk, according to a review of maternal deaths in New York. Blood vessel blockages are among the other leading causes.
Experts also say obesity may be a factor. Heavier women are more prone to diabetes and other complications, and they may have excess tissue and larger babies that make a vaginal delivery more problematic. That can lead to more C-sections. “It becomes this sort of snowball effect,” said Dr. Jeffrey King, an obstetrician who led a recent New York state review of maternal deaths, and who is now medical director of maternal-fetal medicine at Riverside Methodist Hospital in Columbus, Ohio.
The age of mothers could be a factor, too. More women are giving birth in their late 30s and 40s, when the risk of complications is simply greater.
As with many health-related statistics, race and overall quality of care are also factors: Studies have found that the maternal death rate in black women is at least three times greater than is it is for whites. Black women are more susceptible to complications like high blood pressure and are more likely to get inadequate prenatal care. Three different studies indicate that at least 40 percent of maternal deaths, comprising all races, could have been prevented.
The most troubling cases are those with no straightforward explanation:
Tim Davis of Danville, Virginia describes his late wife Elizabeth as the picture of health. Two previous births had occurred without incident, and she was even a YMCA fitness instructor. Still, she died one day after a vaginal birth in 2000, following a normal pregnancy. She suffered a heart attack after a massive blood loss, although it is not clear what caused the heavy bleeding. Davis did pursue legal remedies, in which he settled with the hospital, but lost against the obstetrician. His case could have been hampered by his decision against an autopsy.
Even if the numbers are small, all would agree that women should not be dying from giving birth. Unless rigorously addressed, this trend will likely worsen, especially in light of our collective ignorance about the challenges that confront doctors, patients, and hospitals.