Deaths from childbirth rising in U.S., but still low
By Mike Stobbe
AP Medical Writer
By Mike Stobbe
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 number 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 had risen above 10 since 1977.
Death of mothers from childbirth remains fairly rare in the U.S. Infant deaths are much more common — at 679 per 100,000 U.S. live births in 2004.
Maternal deaths were a more common tragedy long ago. Nearly one in every 100 live births resulted in a mother's death as recently as 90 years ago.
Some health statisticians note that 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 scientist with the National Center for Health Statistics.
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 to push up the 2003 rate, Hoyert said.
Some researchers point to the rising C-section rate, now 29 percent of all births. 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 California obstetrics-care review panel. "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 higher 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 may have excess tissue and larger babies that add to vaginal delivery problems. That can lead to more C-sections. "It becomes this sort of snowball effect," King said.
As well, more women are giving birth in their late 30s and 40s, when complication risks are greater.