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Associated Press, August 25, 2007

Death from childbirth hits highest rate in decades


ATLANTA -- Death from childbirth remains fairly rare in the United States. Nonetheless, women are dying from childbirth at the highest rate in decades, according to statistics released this week by the National Center for Health Statistics.

Maternal deaths were much more common long ago. Nearly 1 in every 100 live births resulted in a mother's death as recently as 90 years ago.

But the fact that maternal deaths are rising at all these days is shocking, said Tim Davis, a Virginia man whose wife, Elizabeth, died after childbirth in 2000.

"The hardest thing to understand is how in this day and age, in a modern hospital with doctors and nurses, that somebody can just die like that," he said.

Experts believe that increasing maternal obesity and a jump in Caesarean sections are partly to blame.

"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.

13 per 100,000 births

The U.S. maternal mortality rate rose to 13 deaths per 100,000 live births in 2004, according to the National Center for Health Statistics.

The rate was 12 per 100,000 live births in 2003 -- the first time the maternal death rate rose above 10 since 1977.

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, said Donna Hoyert, a health scientist with the national agency.

In Texas, there were 47 maternal deaths in 2004, for a rate of 12.3 per 100,000 live births. The mortality rate for blacks was 38.0, more than double the state rate. Anglos and Hispanics had maternal mortality rates of 11.7 and 8.0 respectively, according to the Texas Department of State Health Services.

A mix of factors

Some researchers point to the rising C-section rate, now 29 percent of all births -- far higher than what public health experts say is appropriate. 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, co-chairman of a panel reviewing obstetrics care in California.

Excessive bleeding is one of the leading causes of pregnancy-related death, and women with several previous C-sections are at especially high 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 they may have excess tissue and larger babies that make a vaginal delivery more problematic.

That can lead to more C-sections.

The age of mothers could be a factor, too. More women are giving birth in their late 30s and 40s, when the risk of complications is greater.

Other characteristics of the maternal mortality rate include:

Race: Studies have found that the maternal death rate for blacks is at least three times greater than for whites. Blacks are more susceptible to complications like high blood pressure and are more likely to get inadequate prenatal care.

Quality of care: Three studies indicate that at least 40 percent of maternal deaths could have been prevented.

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