Rate of U.S. women dy­ing in child­birth on the rise

C-sec­tions, obe­sity may play role

The Covington News - - HEALTH & WELLNESS -

AT­LANTA — 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 trag-

By Mike Stobbe The As­so­ci­ated Press

edy 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 Csec­tions. “ 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 clear ex­pla­na­tion is no for a wo­man’s death.

Va­lerie Scythes, a 35year- 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’ 37year- 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.”

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