Maternal deaths: Why women still die in childbirth

It may seem surprising that women still die in childbirth. Out of every 100,000 women who give birth or are pregnant, just under 9 die. 41% of these deaths are preventable.

The figures come from a report by MBRRACE-UK (Mothers and Babies: Reducing the Risk through Audits and Confidential Enquiries across the UK). The study looked at figures for 2013-2015.

Maternal deaths: why did women die?

The report found that 8.8 women per 100,000 died during pregnancy or up to 6 weeks after giving birth. The most common causes of death include:

• Heart disease;
• Thrombosis and thromboembolism: these are blood clots which often start in the legs and move to the lungs;
• Haemorrhage (severe bleeding): this may be caused by an abnormal placenta or damage to the uterus (womb) during delivery;
• Stroke;
• Suicide; and

There were also some indirect causes of death. These included heart disease, which is the leading cause of death overall, influenza and sepsis.

Are the figures improving?

The number of women dying has not changed significantly since 2010-2012. In fact they have slightly increased from 8.76 to 8.8 women in every 100,000. This suggests that there has been a failure to take effective steps to improve care. The government had set a target of reducing deaths by 50%. It seems we are not making progress.

The report found that better care could have prevented the deaths of 41% of these women. That is not so far from the government’s target. It should therefore be possible to do better.

One area where there has been improvement is deaths from sepsis. This may be due to better awareness of sepsis and improved systems to detect it early.

The authors issued a call to action to improve care.

Avoiding mothers dying: what can be done?

The report makes a number of recommendations. These include:

• All maternity units having policies to cover busy periods. There should be more senior obstetricians and anaesthetists when needed.
• Women with epilepsy should have better advice as to how to manage their condition during pregnancy.
• There should be better investigation of women with symptoms suggesting they are at risk of stroke – including neck stiffness, sudden onset headaches and neurological problems (weakness or altered sensation)
• Doctors with different specialisms should be consulted where pregnant women have complex problems. It should not be assumed that they should not have surgery just because they are pregnant. They may also need care by more senior doctors.
• Midwives and others should be alert to sepsis.
• Where women have serious bleeding (haemorrhage), they must have the right care. This may include supporting their blood pressure and action to stop the bleeding.
• Doctors and midwives should be more alert to the possibility of haemorrhage.

Maternal deaths and claims for damages

In our experience women dying during and after childbirth is rare. But those rare cases are tragic.

Examples of past successful claims include:

• A woman who suffered a severe haemorrhage after giving birth. Mistakes were made in assessing how much blood she had lost. She was not transfused sufficiently. She had a heart attack and died.
• A woman developed an infection and sepsis when her baby died before birth. Clinicians failed to realise how ill she was. They responded too slowly to her developing infection. They failed to resuscitate her early enough and they delayed taking her to theatre to remove the source of her infection. By the time they did, it was too late.
• A woman developed an infection and sepsis after a caesarean section. Again, there were delays in diagnosing and managing her. Treatment was too little and too late.

If you would like advice about a possible claim please contact the Enable Law team on 0800 044 8488.