Maternal deaths on the rise, but off the radar
The latest research in the UK (Knight et al. on behalf of MBRRACE, 2023) and Sweden (Hagatulah et al., 2024) reveals that the death rate during, and in the weeks following, pregnancy has increased significantly. Although similar data can be found among other ‘First World’ nations, the rate in the UK alone has reached a 20-year high.
The leading causes of death during 2019-2021 were: at 14% each, Covid, cardiac disease and blood clots, followed (at 10% each) by mental health conditions and sepsis. The women most likely to die while creating ‘new life’ are non-white. Asian women were twice as likely to die, while the rate for Black women was four times higher than for White women.
Socioeconomic status and inequality also were major risk categories for maternal mortality. Those living in the most deprived areas of the UK experienced twice the risk of death as women living in the least deprived areas. The MBRRACE authors offer 10 recommendations to improve maternity care. They emphasise the need for all health professionals working with women during the perinatal period (and pre-pregnancy) or those likely to become pregnant, to work together cooperatively, as ‘silo working repeatedly leads to compromised care’.
Commenting on the MBRRACE report, Gill Walton from the Royal College of Midwives, said:
‘The numbers in the report don’t lie - we are moving backward not forward….. Midwife shortages are undermining the ability of maternity staff to deliver the safest possible care…..Action is needed nationally, with a multi-agency approach, to address the wider inequalities faced by Black and Asian women. There needs to be more joint working between clinicians so that issues are spotted earlier, better training – and the time to undertake such training - and specialist midwives to meet the increasingly complex needs of women and families.’
Approaching the topic of maternal mortality from a different perspective and data set, new research from Sweden focuses on deaths among women experiencing perinatal (especially post-partum) depression. It is already known that up to 20% of women become depressed during or following pregnancy. This research reveals that women experiencing perinatal depression die roughly twice as often as those not experiencing depression, irrespective of family factors or a pre-existing psychiatric diagnosis. The deaths occur most often in the first year after pregnancy and particularly through suicide.
In the developed world, infant deaths are more frequently addressed by the media than maternal mortality, making these two studies of particular importance.
Knight, M., Bunch, K., Felker, A., Patel, R., Kotnis, R. et al. (Eds.) on behalf of MBRRACE-UK. (2023) Saving Lives, Improving Mothers’ Care Core Report - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019-21. Oxford: National Perinatal Epidemiology Unit.
Hagatulah, N., Brann, E., Oberg, A.S., Valdimarsdottir, U.A., Shen, Q. et al. (2024) Perinatal depression and risk of mortality: Nationwide register-based study in Sweden. British Medical Journal, 384:e075462.