According to a new report, maternal mortality rates have increased in California from 1996 through 2006, the most recent data available. In 1996, for every 100,000 births, there were only 5.6 deaths. That number has jumped to almost 17 deaths in 2006. The national maternal mortality rate was 13.3 per 100,000 in 2006. This makes the US rank 40th in the world in terms of maternal death rates!
Maternal mortality includes all women who die within 42 days of childbirth. While these deaths are very rare, many of them could be prevented. The main causes are hemorrhage, hypertensive disorder, pulmonary embolism, amniotic fluid embolism, infection, and pre-existing chronic conditions (such as cardiovascular disease).
The most common preventable errors that lead to the deaths include failure to adequately control blood pressure in hypertensive women, failure to adequately diagnose and treat pulmonary edema in women with pre-eclampsia, failure to pay attention to vital signs following Cesarean section and hemorrhage following Cesarean section.
According to William Callaghan from the Centers for Disease Control and Prevention (CDC):
“Although the current maternal mortality rate may reflect increased identification of women who died during or shortly after pregnancy, there clearly has been no decrease in maternal mortality in recent years, and we are not moving toward the U.S. government’s Healthy People 2010 target of no more than 3.3 maternal deaths per 100,000 live births.”
He also warns that:
“Maternal deaths are the tip of the iceberg for they are a signal that there are likely bigger problems beneath — some of which are preventable. It is important to consider the women who get very, very sick and do not die, because for every woman who dies, there are 50 who are very ill, suffering significant complications of pregnancy, labor and delivery.”
The Joint Commission, the group that accredits hospitals in the United States, has recently issued an alert in relation to the issue. It suggests the following actions to help hospitals and doctors prevent maternal deaths:
- Educate physicians and other clinicians who care for women with underlying medical conditions about the additional risks that could be imposed if pregnancy were added; how to discuss these risks with patients; the use of appropriate and acceptable contraception; and pre-conceptual care and counseling. Communicate identified pregnancy risks to all members of the health care delivery team.
- Identify specific triggers for responding to changes in the mother’s vital signs and clinical condition and develop and use protocols and drills for responding to changes, such as hemorrhage and pre-eclampsia. Use the drills to train staff in the protocols, to refine local protocols, and to identify and fix systems problems that would prevent optimal care.
- Educate emergency room personnel about the possibility that a woman, whatever her presenting symptoms, may be pregnant or may have recently been pregnant. Many maternal deaths occur before the woman is hospitalized or after she delivers and is discharged. These deaths may occur in another hospital, away from the woman’s usual prenatal or obstetric care givers. Knowledge of pregnancy may affect the diagnosis or appropriate treatment.