Deaths from pregnancy-related causes, which usually occur around the time of childbirth, have risen dramatically in the United States in the last decade. In a report released Tuesday, a committee investigating such deaths in California cited an increase in caesarean-section births as a major contributor to the disturbing trend.
The report was issued by the California Pregnancy-Related and Pregnancy-Associated Mortality Review, a committee of experts who investigated the increase in maternal mortality. Deaths related to pregnancy in California have risen from 8.0 deaths per 100,000 live births in 1999 to 14.0 deaths per 100,000 births in 2008. The report reflects only data from 2002 to 2003 but shows a marked change in the safety of giving birth in California, especially for black women and poor women.
Some of the explanation for the increase in deaths -- a total of 90 for 2002-03 -- was not surprising. The committee found a high rate of obesity among many of the women and estimated that excessive weight was a factor in one in four deaths. The upswing in the number of women who enter pregnancy overweight is now considered a major public health problem across the country.
But the report also identified underlying cardiovascular disease as a leading factor in many of the deaths. Until this report, cardiovascular disease has not been linked to maternal mortality.
The increase in caesarean sections -- which now account for almost one-third of all U.S. births -- was identified as another trend corresponding to the rise in maternal mortality. Caesarean section or the anesthesia administered during a caesarean section was one of the contributing factors in 15 of the 65 maternal deaths with caesarean section. Most were unplanned or emergency surgeries to try to save the lives of the mother and infant. But previous caesarean sections were cited as complications in some of the cases.
The committee found under-served women were especially at risk. More than half of the women who died were Medi-Cal recipients.
African American women are four times more likely to die from pregnancy-related causes compared with women in other racial groups.
Women need to enter pregnancy in better health, the committee concluded. On the professional side, obstetricians should increase their efforts to help women maintain a healthy weight during pregnancy and should counsel women on the risks associated with caesarean section. Doctors should be alerted to the possibility of underlying cardiovascular disease in some pregnant women and should make better use of cardiac screening tests and monitoring, the authors wrote.
The report also recommended improvements in preventing blood clots in women undergoing a caesarean as well as better screening for clots.
About the photo: Matt Logelin lost his wife due to a blood clot one day after she gave birth to their daughter in March 2008. After a difficult pregnancy, weeks of bed rest and an emergency caesarean section, Liz Logelin only got a quick peek at her daughter before the newborn, healthy but premature, was whisked away to the neonatal unit. The next day, a nurse arrived with a wheelchair to take the first-time mother to see her baby. With husband Matt by her side, Logelin rose, took a few steps, uttered the words "I feel lightheaded," and died. She was 30. Matt Logelin (pictured) lives in Los Angeles with the couple's daughter, Madeline. He's written a book, published this month, entitled, "Two Kisses for Maddy: A Memoir of Loss and Love."