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California's maternal mortality on the rise

Women are still dying from complications of pregnancy, and not just in remote locales. A new State of California report (.pdf) presents detailed analysis of the state's rising death rate among pregnant women and new mothers. Among its findings: Maternal mortality more than doubled in California between 1998 and 2008, rising to 14.0 deaths per 100,000 live births, or about 50 maternal deaths per year statewide, and nearly 40 percent of these deaths could likely have been prevented.
As I reported in today's Inside Stanford Medicine, other troubling findings surfaced as well:

The report also shows a disturbing inequity: The maternal death rate in California is about four times higher among African-American women than among white or Latina women, and the gap in maternal death rates between African-American women and other groups has widened in recent years.

While the total number of fatalities may seem small, maternal mortality is considered an important public health marker, partly because these numbers represent the tip of the iceberg in terms of rising trends of injury and illness among a young and healthy population. Increasing maternal mortality is not limited to California; some other heavily populated states, such as New York, have also seen a rise in recent years. In addition, there has been a rise in serious birth-related injuries in the United States.

“This increase certainly is disturbing, especially since we estimate that for every maternal death there are a number of near misses,” said Sheila Cohen, MD, an emeritus professor of anesthesiology at Stanford and a member of the panel that reviewed medical records of women who died.

While some of the deaths could not have been avoided, there are several things that could be done to improve obstetric care in California and prevent maternal deaths:

Opportunities for improving care included earlier recognition and evidence-based management of obstetric emergencies, training for timely recognition and response to warning signs such as changes in pain, heart rate and blood pressure; better communication between care providers; and more opportunities for care staff to become certified in procedures such as pregnancy CPR.

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