Is Maternal Mortality Really Rising in the United States? If so, How Can We Prevent It?

Is Maternal Mortality Really Rising in the United States? If so, How Can We Prevent It?

A study released last year by the California Department of Public Health maintained that the state’s rate of death among women giving birth had risen from approximately 8 to 14 per 100,000 between 1999 and 2008. This corresponds to data released by the Centers for Disease Control showing a rise in U.S. maternal mortality rates after the year 2000.

However, the CDC’s numbers are only currently compiled through 2007, and more than a few in the field say that official statistics are not definite proof of an upward trend in the number of fatalities. One who acknowledges the likelihood of an increasing problem while questioning the reliability of the statistics is Portland-based ob/gyn, Nicole Marshall, MD.

Marshall says that the American Congress of Obstetrics and Gynecology (ACOG) has reported that there were 548 such deaths in 2007, but she pointedly comments that there is “no good way to track the numbers. Each state has different procedures for death certificates and some include cases from up to a year from the time of delivery.”

Marshall cites several factors as possible causes of the increase. First, she says more and more women with congenital heart disease are living to an age at which they become pregnant. Second, there are more women with complications from placenta accreta – the attachment of the placenta to the uterine wall following birth – after Caesarian sections. Third, there are increasing numbers of obese mothers and these women face a greater number of risks, most especially of pulmonary embolisms. (Pregnancy and high estrogen levels are additional risk factors for pulmonary embolisms as they may place a patient in a hypercoagular state.) Fourth, as the average age of maternity increases, more underlying hazards for older mothers come into play, including co-morbidities like diabetes.

Marshall’s colleague, Mary Anna Denman, MD, points to placenta accreta as a particularly troubling issue, anecdotally observing that during her time as a clinician in training in Philadelphia she saw a jump from one such case per year to one every few months. These cases become increasingly likely when a third C-section has been performed, Denman notes, and still more frequent with each additional procedure.


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