Maternal Mortality Rate, Causes, and Prevention

When you’re having your first child, it’s exciting to think about holding your baby for the first time and all the beautiful moments you’ll spend together. But, it can also be scary when you don’t know what to expect. Many soon-to-be moms worry about childbirth, anesthesia, and complications. It is even normal to wonder about the chances of dying.

But, if you live in a country like the United States, you can breathe a sigh of relief. In developed countries, dying during childbirth or because of pregnancy is very rare, even if your pregnancy is high-risk. Here is what you need to know about the rate, causes, and prevention of maternal mortality.

When a woman dies from anything having to do with pregnancy, it is called maternal mortality or maternal death. Maternal death can happen while a woman is pregnant, during labor and delivery, or in the 42 days after childbirth or the termination of pregnancy. If a woman passes away from an accident or a health issue that doesn't have anything to do with the pregnancy, then it is not considered a pregnancy-related death.

In countries with a good economy, modern technology, and access to healthcare, the chances of dying during pregnancy, in childbirth, or in the days and weeks after delivery are very low. In places such as the United States, the United Kingdom, and Canada, most women have healthy pregnancies and births. Of course, there is still a small risk of maternal death, even in developed countries.

According to the Centers for Disease Control (CDC), approximately 700 women a year lose their life from complications having to do with pregnancy in the United States. Health officials report the rate of maternal mortality as how many women die for every 100,000 live births. There are around 4 million births in the United States each year, and in 2015 there were approximately 17 maternal deaths for every 100,000 live births.

Other developed countries have similar and even lower maternal mortality rates when compared to the United States. However, that is not the case everywhere. Throughout the world, over 300,000 women die each year from problems that arise during pregnancy and childbirth. Where about 700 women die each year in the US, the World Health Organization (WHO) reports that approximately 830 women die each day worldwide.

Most of these women (99 percent) live in poor, developing countries. In some places, the odds of dying because of pregnancy are as high as 1 in 15. And, the sad fact is that many of these deaths are preventable.

As you can see, where you live has a significant impact on your health and well-being as a pregnant woman. Other things that influence the risks involved with being pregnant are:

1. Age: Women in their twenties tend to have fewer complications during pregnancy than younger or older women. Young girls under the age of 15 have a much greater chance of complications that can lead to death. The risks also go up with advanced maternal age and increases as women become pregnant in their late 30s, or in their 40s and 50s.
2. Socioeconomic status: Poor women in a lower socioeconomic group may have less education, a poor diet, and barriers to healthcare. Less education contributes to earlier or unplanned pregnancy. Lack of nutrition can lead to health deficiencies and a poor pregnancy outcome. And, not getting quality care can put women at risk for infection or other complications that could otherwise be managed and treated in a health care facility or by a skilled healthcare provider.
3. Gender inequality: In some countries, girls and women have less opportunity to get an education. They are often denied financial resources and do not have a say in their own lives and family choices.
4. Available resources: For many women, medical care is far away and difficult to reach. The lack of prenatal care, delivering a baby without someone skilled in attendance such as a doctor, midwife, or nurse, and not having access to treatments such as antibiotics and emergency services can have life-threatening consequences.
5. Parity: Parity is the number of times a woman has been pregnant. The chances of having an issue with pregnancy or problems during childbirth are a little higher in a first pregnancy. The odds are less in a second pregnancy. But, after five or more pregnancies the risk grows once again.

In the United States, severe complications of pregnancy and maternal death are rare. With proper medical care, most of the problems that come about during pregnancy, childbirth, and the postpartum period can be treated or even prevented. However, in other parts of the world, these conditions are more dangerous. Here are the leading causes of maternal mortality.

Postpartum hemorrhage (PPH) is excessive bleeding and loss of blood after childbirth. A skilled health care provider can stop the bleeding. But, if a healthcare provider with the proper knowledge and skills is not available, a mother can die from losing too much blood.

Prenatal care and testing usually pick up issues such as high blood pressure and protein in the urine. With good medical care, doctors can treat and monitor pre-eclampsia. But, without care, it can become dangerous and lead to death. Hypertensive disorders are responsible for 14 percent of pregnancy-related deaths.

Women can get an infection from unsafe abortion, an unsanitary delivery, or a very long labor. A lack of understanding and information on personal hygiene and how to care for the body after childbirth can also put a mom at risk for infection. About 11 percent of maternal deaths are the result of an infection.

According to a report on abortion surveillance by the Centers for Disease Control and Prevention, "Deaths of women associated with complications from abortion for 2015 are being assessed as part of CDC’s Pregnancy Mortality Surveillance System. In 2014, the most recent year for which data were available, six women were identified to have died as a result of complications from legal induced abortion." However, in other areas of the world, unsafe abortion is a leading cause of death among women who have an unintended pregnancy. According to a paper published in 2009, unsafe abortions are why approximately 68,000 women die each year.

A pulmonary embolism (PE) is a blood clot in the lungs. PE can develop after delivery, and the risk is higher with a cesarean section. About 3 percent of maternal deaths are due to pulmonary embolism.

Approximately 10 percent of women die from other direct pregnancy-related issues. Conditions such as placenta previa, uterine rupture, and ectopic pregnancy can lead to complications and death without proper care and treatment.

An indirect cause of death in pregnant women is from a condition that is not directly related to the pregnancy but develops or gets worse during pregnancy. Pregnancy can affect health problems such as HIV and heart disease. Conditions such as diabetes and anemia can develop or get worse. These issues account for approximately 28 percent of maternal deaths.

Between 1990 and 2015, the number of women dying because of pregnancy and childbirth has gone down by 44 percent. The decrease is due to:

• The education of women
• An increase in the use of contraception
• More prenatal care
• More births in hospitals or with skilled health care providers present
• Greater availability of antibiotics, blood transfusions, and treatments for complications
• Advances in specialized care for high-risk pregnancies and deliveries

But, in many parts of the world, more work needs to be done. To lower maternal mortality rates where they are the highest women need:

Young women (and men) who know more about reproduction, fertility, birth control, and the consequences of unprotected sex can make better choices for themselves. Family planning information can prevent unplanned pregnancy and unsafe abortions.

Healthcare, management of pre-existing conditions, and the availability of safe procedures can prevent death during pregnancy. Nutrition services and reproductive health services are especially important for girls and young women.

The knowledge of good personal hygiene practices and how to care for the body can keep germs away. Regular handwashing, a clean perineal area during prenatal check-ups, and a hygienic delivery area during childbirth can also help to prevent infection.

Skilled care before and during childbirth can prevent complications and lead to a safe birth. If possible, women should have their babies a healthcare facility. If delivery in a hospital, clinic, or office is not possible, then someone skilled at delivering children should be at the home delivery.

After childbirth, women continue to need care. Postpartum checkups for abnormal bleeding or infection can make all the difference. Living far from services or not being able to afford them can prevent a woman from gaining the knowledge she needs to care for herself after the birth or to get the life-saving antibiotics and the postpartum attention she may need.

In developed countries, the chance of dying from a cesarean section is still rare, but it’s a little higher than a vaginal delivery. A study published in 2008 in the American Journal of Obstetrics and Gynecology found that maternal mortality is 2.2 per 100,000 for c-sections and 0.2 per 100,000 for vaginal births. The reason a cesarean section has a higher rate is that it's a surgery, and surgery has some risks.

Complications from a C-section that could lead to maternal death include:

• Infection
• Blood clots
• Anesthesia reactions
• Blood loss
• Injury to other organs during surgery

But, keep in mind that C-sections save lives, too. There are times when a C-section is the best option. When it's necessary, a cesarean can lower the chances of maternal death as well as neonatal death and make delivery a lot safer.

In the past, pregnancy and childbirth were more dangerous. But, today, it’s so much safer to have a baby. If you get regular prenatal care, eat well, make good lifestyle choices, and have a skilled health practitioner at your delivery, the chances of having a healthy pregnancy and birth are excellent.

However, in some parts of the world women continue to face difficult circumstances surrounding pregnancy and childbirth. Just like many other women, they have the same hopes and fears about having a child. Unfortunately, their fears are well-founded. But, so is their hope.

Maternal and child health organizations such as WHO, USAID, UNICEF, UNFPA, and many others are bringing awareness to this issue. They are developing programs to help fight maternal mortality and make the future better for all women. If you would like to get involved, you can look for opportunities to help those less fortunate in your community or make a difference by lending support to organizations such as these that are trying to bring life-saving education, medication, and care to women around the world.