Miscommunication! Yes, I know it seems crazy and no it doesn’t mean that the U.S. has the safest rates but it can shed a little light on the situation.
Looking at definitions:
The World Health Organization [WHO] defines maternal death as
Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. To facilitate the identification of maternal deaths in circumstances in which cause of death attribution is inadequate, a new category has been introduced: Pregnancy-related death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death. -1
The CDC defines maternal death as:
For reporting purposes, a pregnancy-related death is defined as the death of a woman while pregnant or within 1 year of pregnancy termination—regardless of the duration or site of the pregnancy—from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. -2
These sound very similar with one HUGE difference – the World Health Organization reports a death as maternal death 42 days after the delivery/termination and the CDC reports it as a maternal death if it is reported with in 1 year. That’s 8.5 times longer! If a woman dies from a complication on day 43 around the world it won’t be considered a ‘maternal death’ but it would be here in the United States.
Another reason is better reporting. In 1986, the CDC created the Pregnancy Mortality Surveillance System, this system was put into place to better record mortality rates after pregnancy. Since the beginning of this system, mortality rates have more than doubled. Other factors have changed, like the upgrading from the ICD-9 to the ICD-10, adding a check-box to death certificates if a woman of childbearing age had a baby in the last year and making the change of monitoring to a full year from 42 days.
The causes of maternal mortality in the United States are states below. As you can see there are several factors
- Cardiovascular diseases, 15.1%.
- Non-cardiovascular diseases, 14.1%.
- Infection or sepsis, 14.0%.
- Hemorrhage, 11.3%.
- Cardiomyopathy, 10.1%.
- Thrombotic pulmonary embolism, 9.8%.
- Hypertensive disorders of pregnancy, 8.4%.
- Amniotic fluid embolism, 5.6%.
- Cerebrovascular accidents, 5.4%.
- Anesthesia complications, 0.3%. -2
As you can see several of those can be associated with a higher obesity and poor diet. The other alarming thing I found was the difference in race when it comes to maternal mortality. African American’s are almost 3.5 times more likely to die as a result of a pregnancy than white women. This is believed to be a result of poor obstetric care.
- 12.5 deaths per 100,000 live births for white women.
- 42.8 deaths per 100,000 live births for black women.
- 17.3 deaths per 100,000 live births for women of other races.
- The cause of death is unknown for 5.9% of all 2011 pregnancy-related deaths -2
Around the world causes include
- Pre-exsisting conditions 28%
- Severe bleeding 27%
- Pregnancy-inducing high blood pressure 14%
- Infections 11%
- Obstructed labor and other 9%
- Abortion complication 8%
- Blood clots and embolism 3% -1
Clearly the US is not the safest place to have a baby, and that is a problem that needs to be addressed, especially with the disparity in the African American race. Learning about the way the deaths are reported can help you understand why the numbers are so high.
1-“Maternal Mortality Ratio (per 100 000 Live Births).” WHO. N.p., n.d. Web. 23 Sept. 2015.
2 – Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 23 Dec. 2014. Web. 23 Sept. 2015.