Maternal Death Rates Up, New Study Says

(March 9) -- Death after childbirth remains a rarity among American mothers, but new research suggests that the tragic occurrence is on the rise -- and experts are at a loss to pinpoint the reason.

Despite being a leader in medical research and facilities, the United States places 41st on the World Health Organization's list of safest countries for childbirth. As for 2006, 13 women out of every 100,000 died during or shortly after giving birth, which is higher than rates in Canada, the United Kingdom and Poland, among others.

That's around 550 deaths out of 4 million annual births across the country.

The federal government had set a goal to reduce maternal deaths by 2010, but the new numbers are four times higher than what they'd hoped to attain.

Health experts aren't pointing the finger at a specific cause, but they do hypothesize that more obese mothers might be a critical factor. Many maternal fatalities are caused by undetected health issues, such as asthma or heart disease -- problems that are more common among obese people.

Pregnancy can exacerbate pre-existing health conditions, leaving obese women -- who now make up 20 percent of pregnancies -- more susceptible to potentially fatal consequences.

"Obesity can lead to hypertensive disorders, diabetes and other medical conditions, and thus can directly and indirectly present significant health risks for pregnant women," Janet Hardy, a perinatal epidemiologist at the University of Massachusetts, said in a statement issued by the Joint Commission, a nonprofit health care accrediting agency.

Cesarean sections might be another important factor. The number of women scheduling cesarean births has increased by 50 percent, to 31 percent of all births, since 1996. And while the risks of C-sections are small, the procedure is still considered major surgery.

Those over 30 are at increased risk. So are black women: They face four times the risk of maternal death compared with whites.

And for every woman who dies in childbirth, another 50 suffer from dangerous health complications during or after delivery, the Joint Commission report states.

But once a woman reaches the delivery room, potentially fatal conditions are harder to control. That's why most maternal fatalities aren't considered "preventable" by studies, including a 2008 review in the American Journal of Obstetrics & Gynecology, which concluded that "the majority" of maternal deaths in 124 hospitals couldn't have been prevented in the delivery room.

Instead, advocates hope to see more preventive efforts earlier in pregnancies. That means improved awareness of complications among pregnant women and better screening efforts by doctors, along with thorough postnatal care.

Debate also persists over the safety of out-of-hospital births. A report from the Centers for Disease Control and Prevention released last week concluded that they've increased for the first time in two decades. The births still make up less than 1 percent of all births in the country, but home births in particular were up by 5 percent.

The pros and cons of home births have yet to receive much study, and they don't have the backing of the American Congress of Obstetricians and Gynecologists. The agency cites concerns over health of baby and mother in advising against the nonhospital route.

"Despite the rosy picture painted by home birth advocates," the group's statement reads, "a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby."