Dying from childbirth

U.S. women are dying from childbirth at the highest rate in decades, new government figures show. Though the risk of death is very small, experts believe increasing maternal obesity and a jump in Caesarean sections are partly to blame.

Some numbers crunchers note that a change in how such deaths are reported also might be a factor.

"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.

The U.S. maternal mortality rate rose to 13 deaths per 100,000 live births in 2004, according to statistics recently released by 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.

Death from childbirth remains fairly rare in the United States. The death of infants is much more common -- the nation's infant mortality rate was 679 per 100,000 live births in 2004.

Maternal deaths were a much more common tragedy long ago. Nearly one 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.

The total number of maternal deaths -- still fewer than 600 each year -- is so small that 50 to 100 extra deaths could raise the rate, said Donna Hoyert, a health scientist with the National Center for Health Statistics.

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 might have resulted in more deaths being linked to childbirth, Hoyert said.

Some researchers point to the rising C-section rate, now 29 percent of all births -- far higher than what health experts say is appropriate. Like other surgeries, Caesareans come with risks related to anesthesia, infections and blood clots.

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 also are leading causes.

Experts also say obesity might be a factor. Heavier women are more prone to diabetes and other complications, and they might 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 risks are greater.

Other characteristics of the maternal mortality rate include:

• Race: Studies have found that the maternal death rate in black women is at least three times greater than is it is for whites. Black women are more susceptible to complications like high blood pressure and are less likely to get adequate prenatal care.

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

Sometimes, there is no clear explanation for a woman's death.

Davis' 37-year-old wife, Elizabeth, died a day after a vaginal delivery at a Danville, Va., hospital in September 2000. She had a heart attack after massive blood loss, Davis said. It's not clearly known what caused the heavy bleeding. There was no autopsy, he said, a decision he now regrets.

Two previous births had gone well.

"Nothing led us to believe anything was wrong with this pregnancy. She was like a picture of health," he said.

A lawsuit against the hospital ended in a settlement. Davis also sued the obstetrician, but a jury ruled in the doctor's favor.

The child born that day, Ethan, started second grade this fall. "He's a happy kid," Davis said. "He's just never had a mom."