Black Maternal Health of New York City

Part: 4

Study Details Causes of High Maternal Death Rates

Tuesday, April 26, 2011

A small study of maternal deaths in New York City rings loud warning bells for pregnant African American women. Experts offer ideas on lowering some of the deadliest risks for all women: hypertension, C-section, embolism and pre-eclampsia.

(WOMENSENEWS)--Research on why women die in childbirth is very scarce.

One of the few looks at maternal mortality in the United States was New York City's recent analysis of 161 women who died from 2001 to 2005.

It's a small study with loud warning bells for African American women, who make up 24 percent of the city's maternity population.

Fifty-eight percent of those who died of pregnancy-induced conditions in the study were black and 10 percent were white. Hispanic and Asian/Pacific Islander pregnant women died at twice the rate of white pregnant women, but at significantly lower rates than blacks.

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Women over 40 were found to be about 2.6 times more likely to die from childbirth-related conditions than younger women. Forty-nine percent were obese. Pregnant women who had private insurance and those insured by Medicaid –government insurance for those with low incomes--had similar rates of pre-natal care.

The New York City report drew no conclusions about how to lower the city's high rate of maternal deaths among African Americans.

Debra Bingham has some ideas.

She is vice president of research, education and publications of the Washington-based Association of Women's Health, Obstetric and Neonatal Nurses, an association of 24,000 nurse clinicians, educators and executives who promote the health of women and newborns.

Bingham suggests examining the level of care that different women receive.

"Some women may have received too few interventions while others received too many," she said. "Some women may have had difficulty getting access to primary care and contraception, so they were more likely to have an unintended pregnancy and develop complications because their bodies hadn't recovered from the previous birth."

More Follow-Up Care

In the United States 1 out of every 7 maternal deaths occurs six weeks after delivery, so some deaths might have been prevented if the woman received more follow-up care.

"On the other hand, some women may have received too many interventions," Bingham said. "Surgical interventions may have reached a level of overuse in the United States. Although there has been a 50 percent increase in the number of Cesarean sections since the 1990s, we have not seen any data to show that this leads to improvements in outcomes for the mother or baby. C-sections carry all the risks of abdominal surgery, such as infection and hemorrhage and life-long complications, such as adhesions."

The city's report found that 79 percent of all mothers who died from pregnancy-related causes gave birth via C-section. Although the report did not break the C-section data down by race or ethnicity, it did note that C-sections were the most common method of delivery among women who died from hemorrhage, infections and embolism.

A national review of several obstetrical studies from 1998 to 2005 found significant increases in the rate of pulmonary embolism (blood clots that form in the legs and travel to the lung) among women who had C-sections. Other risk factors for embolisms were advanced maternal age, obesity and prolonged bed rest.

In the New York study, of the 28 women who died of embolism, 82 percent were African American, 24 percent were Hispanic and 4 percent were Asian. No white women died of embolism. Seventy-two percent of embolism deaths occurred either shortly before the birth or within one day of the end of pregnancy.

"Prompt diagnosis and therapy are extremely important in preventing deaths from embolism," said Bingham. "Many patients have non-specific signs. Anti-coagulant drugs and compression devices can make a big difference. Most patients who die do so within the first few hours. But in those who survive, a second incident often occurs."

The Atlanta-based Centers for Disease Control and Prevention (CDC) estimates that 17 percent of maternal deaths due to pulmonary embolism are preventable. Studies in other medical specialties indicate that embolism following surgery has been reduced by about 70 percent by using either compression devices or anti-coagulant drugs.

However, a 2008 study in the American Journal of Obstetrics and Gynecology, which examined maternal deaths in a group of hospitals, found that none of the nine women who died of pulmonary embolism had received compression devices or medications.

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