Why mothers die

Abstract

The UK maternal mortality rate is now 13·4 per 100,000 maternities, which is much lower than in the developing world but still too high. For 50 years in England and Wales the CEMD has published triennial reports, and since 1985 the Enquiry has covered the whole of the UK. Its latest report, Why Mothers Die 2000–2002, published in November 2004, includes 106 Direct (due to complications of pregnancy) and 155 Indirect deaths (due to pre-existing conditions made worse by pregnancy).

Since 1997, Indirect deaths (which are rising) have outnumbered Direct deaths, which fell in the 1990s. The leading Direct cause is thromboembolism, which accounted for 30 deaths in 2000–2002, mainly in women with predisposing risk factors such as obesity or thrombophilia. The leading Indirect cause is cardiac disease, which led to 44 deaths, including eight from myocardial infarction and eight from cardiomyopathy. Obese women accounted for 35% of all maternal deaths. The increasing tendency to delay pregnancy means that 18% of births are now to women aged 35 or over. Maternal mortality in the UK is related to social class, with the rate among socially excluded women being 20 times higher than that in social class 1. Women from ethnic minorities have three times the rate of the overall population, and the risk among black African women is increased sevenfold.

When late deaths (up to one year after delivery) are included, the overall leading cause of pregnancy-related death is psychiatric disease, which accounted for 60 deaths in 2000–2002. Suicide due to puerperal psychosis is usually by violent means and shows no social class gradient. The Enquiry also records Coincidental deaths, among which the leading cause is murder. The 11 murders in 2000–2002, all perpetrated by the woman’s partner, highlight the continuing problem of domestic violence.