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Death rate from childbirth rises in California

Older mothers, obesity, poverty and C-sections were blamed on the spike in maternal deaths.

The rate of women dying from pregnancy-related complications has increased at a "statistically significant" pace, according to a long-awaited report on maternal deaths released today by the California Department of Public Health.

African American, low-income and less-educated women had higher deaths rates from complications related to childbirth, according to the report, which also noted "excessive gestational weight gain" and medical problems from C-sections as contributing to maternal deaths.

"More than a third of pregnancy-related deaths were determined to have had a good to strong chance of being prevented and some causes of death appeared to be more preventable than others," the report said.

Researchers had described the findings to California Watch in February 2010, but today's report is the first public release of the numbers. Experts in women's health had called the trend shocking; the statistics had showed giving birth in California was more dangerous than in Bosnia.

Today's report contains some new numbers – California’s maternal mortality rates for 2007 and 2008. The last released rate (from 2006) was 16.9 deaths per 100,000 live births. In 2007, the rate fell to 11, then bounced back to 14 the next year. That’s up from 6 in 1996.

Because these are small numbers, the rate appears to fluctuate dramatically. But the numbers show a “statistically significant increase in maternal mortality from 1999 to 2008,” according to the report.

The report suggests that a combination of factors were responsible.

Better counting of deaths played a part; improved methods of record keeping was responsible for 33 percent of the rise, the report's authors estimated. In addition, older, heavier and sicker mothers were among those who died from pregnancy-related complications; 60 percent of the victims studied were overweight, and heart-disease was the largest cause of death.

Social factors such as poverty and the stress of racism also have played a part. African American women were more than four times as likely as white women to die from childbirth, and women who did not finish high school were four times as likely to die as women who made it to college.

The report also cited the overuse and under-use of medical treatments. Some women, for example, are getting C-sections they don’t need, while others do not have access to the C-sections they do need.

The maternal mortality rate is defined as the number of women who die from a pregnancy-related cause within 42 days of giving birth. A copy of the report can be found here.

For a deeper look at the problem, the report looked at maternal death cases from 2002 and 2003, providing a snapshot of those two years. Here’s what they found:

  • Number of pregnancy related deaths not reported as such (under counting): 24
  • Number of deaths reported as pregnancy related, which reviewers determined were not related (over counting): 14
  • Corrected number of deaths directly related to pregnancy: 98
  • Of those 98, number in which delays of inadequacy of treatment contributed to death: 41
  • Number in which use of ineffective treatments contributed to death: 35
  • Number in which Cesarean surgeries contributed to the death: 15
  • Number of deaths where obesity or weight-gain was a contributing factor: 18
  • Number with multiple preexisting contributing medical conditions: 24
  • Number of women who were 30 and older at their death: 57
  • Number younger than 30 years old: 41

Clearly obesity, diabetes, better counting techniques, and the pressures forcing women to put off childbirth until later in life are all contributing to this increase. But those usual suspects do not explain the entire rise.

The rest are probably explained by changes in society and in hospitals.

But more important than assigning blame is asking what can be fixed, and how. The report notes 36 out of 98 deaths in which there was a good chance the fatality could have been averted. Out of those 36, the report said that health care professionals had contributed to 35  of those deaths. Hospitals or birthing centers were blamed for 27 deaths, while "patient factors" contributed to another 27.

In other words, there’s a lot of room for improvement here all around.
 

California Department of Public Health

 

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