More U.S. women dying in childbirth

U.S. women are dying from childbirth at the
highest rate in decades, new government figures show. Though the risk
of death is very small, experts believe increasing maternal obesity and
a jump in Caesarean sections are partly to blame.
Some numbers crunchers note that a change in how such deaths are reported also may be a factor.
“Those
of us who look at this a lot say it’s probably a little bit of both,”
said Dr. Jeffrey King, an obstetrician who led a recent New York state
review of maternal deaths.The U.S. maternal mortality rate rose to 13
deaths per 100,000 live births in 2004, according to statistics
released this week by the National Center for Health Statistics.
The rate was 12 per 100,000 live births in 2003 — the first time the maternal death rate rose above 10 since 1977.

To be sure, death from childbirth remains fairly rare in the United
States. The death of infants is much more common — the nation’s infant
mortality rate was 679 per 100,000 live births in 2004.Maternal
deaths were a much more common tragedy long ago. Nearly one in every
100 live births resulted in a mother’s death as recently as 90 years
ago.
But the fact that maternal deaths are rising
at all these days is shocking, said Tim Davis, a Virginia man whose
wife Elizabeth died after childbirth in 2000.
“The
hardest thing to understand is how in this day and age, in a modern
hospital with doctors and nurses, that somebody can just die like
that,” he said.
Some
health statisticians note the total number of maternal deaths — still
fewer than 600 each year — is small. It’s so small that 50 to 100 extra
deaths could raise the rate, said Donna Hoyert, a health scientist with
the National Center for Health Statistics. The rate is the number of
deaths per 100,000 live births.
In
2003, there was a change in death certificate questions in the nation’s
most populous state, California, as well as Montana and Idaho. That may
have resulted in more deaths being linked to childbirth — enough push
up the 2003 rate, Hoyert said.
Some
researchers point to the rising C-section rate, now 29 percent of all
births — far higher than what public health experts say is appropriate.
Like other surgeries, Caesareans come with risks related to anesthesia,
infections and blood clots.

“There’s an inherent risk to C-sections,” said Dr. Elliott Main, who co-chairs a panel reviewing obstetrics care in California. “As you do thousands and
thousands of them, there’s going to be a price.”
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 and infections 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 King, 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 complications risks are greater.
Other characteristics of the maternal mortality rate include:

• Race:
  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.
  
• Quality of care: Three different studies indicate at least 40 percent of maternal deaths could have been prevented.
  

Sometimes, there is no clear explanation for a woman’s death.
Valerie Scythes, a 35-year-old elementary schoolteacher, died in March at a
hospital in New Jersey — the state with the highest Caesarean section
rate. She had had a C-section, as did another teacher at the same
school who died after giving birth at the same hospital two weeks later.
However,
Scythes died of a blocked blood vessel and the other woman died from
bleeding, said John Baldante, a Philadelphia attorney investigating the
death for Scythes’ family.
“I’m not sure there was any connection between the two deaths,” Baldante said.
Also
mysterious was the death of Tim Davis’ 37-year-old wife, Elizabeth, who
died a day after a vaginal delivery at a Danville, Va., hospital in
September 2000.
She
had a heart attack after a massive blood loss, Davis said. It’s not
clearly known what caused the heavy bleeding. There was no autopsy, he
said, a decision he now regrets. Two previous births had gone well.
“Nothing
led us to believe anything was wrong with this pregnancy. She was like
a picture of health,” he continued, noting she had been a YMCA fitness
instructor.
A lawsuit against the hospital ended in a settlement. Davis also sued the obstetrician, but a jury ruled in the doctor’s favor.
The child born that day, Ethan, starts second grade next week. “He’s a happy kid,” Davis said. “He’s just never had a mom.”