General Information on Maternal Mortality
Other Reports of Post- Cesarean Maternal Deaths ~ Email Comment list for discussion of obstetrics and gynecology & media sources
Report on maternal deaths from necrotizing infection of her episiotomy incision:
CDC: Maternal Deaths Remain Steady
~ "Not budged in 15 years" "It said half of all such deaths are preventable."
"such deaths are underreported and the real rates could be three times higher"
"maternal deaths of black women ranged from 18 to 22 per 100,000 births,
compared with five to six deaths per 100,000 births for white women"
The Associated PressBy RUSS BYNUM
ATLANTA (AP) -- The rate at which American women die from pregnancy and childbirth complications hasn't budged in 15 years. Every year from 1982 to 1996, maternal deaths occurred at a rate of seven or eight per 100,000 live births, the Centers for Disease Control and Prevention reported Thursday. It said half of all such deaths are preventable.
Like infant mortality, maternal deaths are used as a measure of a country's overall health. In some developing nations, maternal death rates are as high as 1,700 per 100,000 births. In other countries, such as Norway and Switzerland, maternal deaths occur at about half the U.S. rate. The CDC said the United States will probably fall short of its goal of 3.3 maternal deaths per 100,000 births by 2000.
Researchers said such deaths are rare enough that many doctors may not notice the problem. Also, many women now see pregnancy as risk-free and fail to seek prenatal care, said Dr. Isabella Danel, a CDC epidemiologist. The CDC identified maternal deaths by looking at death certificates. However,researchers said such deaths are underreported and the real rates could be three times higher.
More than half of maternal deaths are caused by bleeding, infection, pregnancy-induced high blood pressure and tubal pregnancies -- complications that can be prevented or treated with early diagnosis, the CDC said.
Many doctors have little experience handling life-threatening births, said Dr.James Gell, an obstetrician and gynecologist who teaches at Wayne State University Medical School in Detroit. ``The average obstetrician may never encounter a maternal death during a lifetime of practice,'' Gell said. ``So, as a result, he may not be as well prepared for the sudden, calamitous situation when it does arrive.''
Still, Gell said he is not alarmed that the U.S. maternal death rate hasn't declined since 1982.``We're getting down to an almost irreducible minimum,'' he said. ``I'm not sure we can get much lower.''
The CDC said differences in maternal deaths between black and white women indicate room for improvement. It found that maternal deaths of black women ranged from 18 to 22 per 100,000 births, compared with five to six deaths per 100,000 births for white women.
``That makes us think the problem is access to health care and treatment,'' Danel said. Women with unintended pregnancies are also considered a high-risk group. ``Women who want a pregnancy are usually very careful -- they eat right, they read all the books,'' Danel said. ``Women who don't want the pregnancy don't do that.''
Date: Sun, 6 Sep 1998
Subject: Re: MW: CDC: Maternal Deaths Remain Steady (double)In a message dated 9/6/98 2:34:09 PM, Keg504 wrote:<< What is an anesthesia death? Is that from malignant hyperthermia? Allergic reaction? Respiratory distress?>>
epidural anesthesia deaths* cardiac arrest (if not immediate death, brain damage and respiratory failure can lead to life support-which if maintained 2 weeks then the death is likely to be reported as a death from anesthetic complications)* anaphalactic shock from reaction to the medication which also result in delayed death-cause of death alergic reaction to anesthesia
* profound hypotension causes brain damage-delayed death could also fail to be reported as maternal death...*rare complication when the brain comes down through the foramen magnum into the spinal column and causes death....
a rare complication caused by accidental dural puncture which occurs in .3 to 4.2% of epidurals. This could also result in life support/delayed death and failure to report as maternal death.
other anesthesia deaths. i e general anesthesia.....cardiac arrest, profound hypertension, failure to intubate, anaphylactic shock, IV analgesia same risks....all of which can result in delay of death...
Lewis Mehl, MD adds...
"I've worked in hospitals and have seen this done. No hospital wants a maternal mortality. Life support is used until necessary to avoid reporting. It's not just an issue of looking good, but also of malpractice prevention in some people's minds. The fact that maternal mortality has not changed in 15 years in the US, suggests to me it is probably on the rise, and probably related to the increasing use of cesareans and regional anesthetics. In 1987, for example, 25-100 avoidable maternal deaths occurred related to unnecessary cesareans."
Faith Gibson wrote:> I have some historical journal articles that acknowledge the common practice of under-reporting of maternal deaths and gives a report on studies done in NYC and elsewhere to determine just how great the discrepancy. They quoted 12% in one and 21% in another. I personally know of a post-cesarean section complication with maternal death 9 months later (Nancy Lim, Oakland) that surely would not have been recorded as such. Also there are delayed deaths such as Elizabeth Glaser and her two children who died from AIDS after CS with AIDS-contaminated blood transfusion
Date: Mon, 7 Sep 1998 15:38:12 EDT
To: Birthmuse@aol.com, Keg504@aol.com
Subject: Re: Re: MW: CDC: Maternal Deaths Remain Steady
PS: we had a maternal death anesthesia related here in Vermont that was not reported as maternal death.
Mother 2nd babe, was having planned repeat cesarean, they attempted to do an epidural, could not get it in, not uncommon. The doctor cursing that she seemed to have some anomally in her spinal development (hint). So they put her out...and began to intubate....low and behold she had some anomaly of her trachea so that they could not intubate....so they frantically attempted a tracheotomy and cut through her carotid artery while doing the tracheotomy as she had another "anomaly" causing her carotid artery to cross her throat at the exact spot where they cut for the tracheotomy, she was brain dead within minutes as blood shot up to the ceiling. They kept her on life support for more than 2 weeks..... she was not listed as a maternal death. (Does it come to any ones mind that this mother might be here today if she had planned a vbac-first baby was a breech, this one vertex)