Maternal death rate in the UK

African Americans tend to be disadvantaged and in occupations where they are more exposed to covid, I doubt vitamin D deficiency would explain all, or even most, of the issues. Sixty percent of people with South Asian ancestry carry a gene (LZTFL1 ) that increases the risk of dying from covid compared to 15 percent of those with European ancestry but african americans dont have high levels of that gene. There is another gene APOL1 carried by many African Americans that does increase covid severity (and the risk of sepsis) and drugs are now being developed to target it.

Sometimes people are unable to take care of themselves because they dont have access to things that would help - there are places in this country where it's a very long trek to buy any fresh fruit and veg and if you are relying on food banks you'll be eating a lot from cans. We need ways to make healthy choices available to everyone.

aplogies for badly worded post. I need to go to bed!

Another thought on the generally increased maternal mortality rates -

I was always shocked by how incredibly unhealthy most of the women in the maternity ward waiting room were, whenever I was there. It seemed that most women would struggle to.move around, let alone birth a baby.

If you take the midwives out of the equation : a healthy mum is more likely to have a healthy birth. So all of these women literally require assistance to survive birth. If everyone is getting more unhealthy, it is likely that deaths are going to increase.

It does make me think that rather than everyone finger pointing to the authorities and saying how 'shocking' and 'disgusting' it is, it my might be worthwhile pointing out that birth is a physiological process that is dangerous if you are unhealthy. How long do we expect to trash our health and our bodies willy nilly, and expect other people to take care of us?

I know there was higher COVID mortality for African Americans, and woke crew were blaming racism, but apparently it was linked to vitamin D deficiency.

Apparently many black skinned people in USA are vitamin D deficiency (with some having not low levels, but no level detected in their body). Vitamin D plays a big part in immunity and this was thought to be the reason.

I wonder if Vitamin D might play any part in birth? we would need to know the cause of death for these women.

@MissLucyEyelesbarrow I have seen it all being blamed on institutional racism and in particular staff not listening.

International comparisons are interesting - I understood we were similar to the US and Brazil - which are the countries with lower ratios, then perhaps we can find what they do better.

The dietary advice is something is interesting, that wouldnt be difficult or expensive to change. However some health authorities do seem to be trying - see https://www.mkuh.nhs.uk/patient-information-leaflet/gestational-diabetes-diet-sheet

Sometimes the diagnostic routes rely on observations that are less effective for women with darker skin compared to caucasian women, which means early warning signs are missed.

You see it on NHS online a lot - eg recommending seeking help if someone pale or has blue lips. This is harder to spot on someone with darker skin than a caucasian person.

So research should be done to establish more universal warning signs, or if known already then training and publications (leaflets, NHS online) needs to be updated.

It's also little things like a lot of GD dietary advice mentions White British foods and diet and is often silent on other cuisines, particularly those of the ethnic groups more likely to develop GD.

I haven't seen anyone suggest that racism from staff is the main problem (which is not to deny that it exists). Most PPs have highlighted differential access to services, for complex socioeconomic reasons.

If genetics were the main risk factor, you would expect consistent excess mortality amongst people of a particular ethnicity, wherever they lived. They would have the baseline mortality risk of the country they live in (obviously variable by country) plus a consistent additional risk caused by genetics. But that is not what we see. Women from ethnic minorities do have a higher mortality rate than white women in most (not all) majority white countries, but the level of excess risk is quite variable.

So genetics may well play a part, but it is probably not the main factor.

You'll be accused of racism for daring to suggest there may be some genetic factors. That is the sort of woke racism described by John McWhorter- woke virtue signalling rather than addressing all the issues. Black women may meet some racism from staff but that isnt going to be the only cause of higher mortality.

Some of the genetic risk factors for black women could perhaps be compensated for by ensuring better access to ante natal care. That might mean holding clinics where people live or work.

Technology - google translate - might help when there are no interpreters available. It may not be perfect, it's better than no communication.

Sorry to be that person, but I think you mean mortality rather than morbidity - morbidity means "illness".

The differential between black mortality and white mortality has dropped from five times to about 2.8 times, but this is largely down to an increase in the number of white women dying, rather than a drop in the number of black women dying.

@MissLucyEyelesbarrow I know, my post was aimed at @ZeldaFighter re the increased morbidity rates for black and Asian women.

In around 2018 it was 5x and it's now 3.7x I believe (I don't have the report infront of me this is from memory so excuse any errors).

Google fivexmore they're a fab organisation, successfully battling for change in mat services

Anecdotally the area I work is an area where lots of refugees are living at the moment, they aren't from here, they don't understand how services work, how to access care, what they need to do, who they go to, or how services work together.

Yes, I work in an urgent care centre and we regularly get migrant/refugee women attend who are in the 3rd trimester or even in labour, yet have had no antenatal care. However, that isn't a new thing, so it can't account for the recent rise in deaths.

It's not necessarily genetic (though it probably is in part) - BAME women in this country are economically deprived, compared to the average population, and deprivation is a maternal mortality risk factor.

The reasons for the death rate are complex. It's not as simple as the NHS being shit at everything, as some PPs are suggesting, but, equally, the NHS has serious failings in maternity care. Postnatal care, in particular, is egregiously under-resourced. We spend billions less on healthcare than France and Germany, for example (our spend did increase for Covid but the baseline spend is low).

On top of that, we are bad at preventative and primary healthcare - we invest a far smaller percentage of our healthcare spend on those areas than most comparable countries. Women who are in poor health before they become pregnant are far more at risk.

Yes, higher death rates for black and Asian women. There are likely to be genetic factors as well as health factors, which I presume have been taken note of.

My opinion is that it's the impact of Covid, both direct and indirect.

MBRRACE should break down the data so we can see what specifically BAME women are dying of. My professional knowledge tells me that it's multifaceted and the answer isn't simple.

There is a higher prevalence of pre existing health conditions in women from BAME communities like hypertension, diabetes, obesity and cardiovascular disease. It's easy to dismiss this but obesity aside, these are conditions that can be really difficult to manage during pregnancy and birth and massively increase the risks to mum and babe.

Research tells us that Black and Asian women aren't listened to my professionals and sometimes their worries are dismissed. There are systematic inequalities and racism at play here.

Also language barriers, finding an interpreter is a bloody nightmare, there aren't enough of them and sometimes there aren't any available. Try doing a thorough assessment when you don't speak the same language. How can the woman give informed consent?

Other things to consider:
Socio-economic factors
Lack of understanding of how NHS services work... for example BAME women in a specific area of London were found to be more likely to book their pregnancies much later which can worsen outcomes.

Anecdotally the area I work is an area where lots of refugees are living at the moment, they aren't from here, they don't understand how services work, how to access care, what they need to do, who they go to, or how services work together.

Sorry, just to emphasise my point, from the link I posted above, from 2018-2020, the MMR for Aboriginal and Torres Strait Islander women in Australia was 9.4. That is better than the overall rate for UK women with Covid deaths removed.

A woman has a slightly lower chance of dying having a baby in some of the remotest locations on earth compared to the entirety of the UK.

That is seriously fucked up.

@ZeldaFighter this is related to something I used to work on and as far as I recall, there was a combination of factors. For example, black women have higher risks of preeclampsia and gestational diabetes etc, this is thought to have a genetic increased risk. There are also social and cultural barriers to seeking health care in some black and Asian populations. Thirdly there is evidence that black women are listened to less and taken less seriously when expressing pain etc. How these factors break down in the huge risk disparity I’m not sure, but there must be room to bridge the gap.

The other thing that I think plays into it is that our medicine and healthcare are all based on research and data from white women. This is slowly changing as we appreciate that personalised risk scores improve outcomes.

I think it’s wrong to say “even corrected for Covid” or “even if Covid is taken out”. If a country like Australia, with a similar demographic of people, with an indigenous population that is routinely specifically worse with health outcomes in pregnancy similar to other disadvantaged ethnicities, can manage to have zero maternal deaths from Covid, then maternal deaths from Covid in the UK are not just part of life with Covid, they’re another example of how pregnant woman have been let down.

Pregnant women died of Covid unnecessarily in the UK. This was due to failure of care. This component of the spike in maternal mortality alone is something to discuss, not be removed.

this is horrendous - thanks for the thread

SARS-COV-2 (COVID-19) infection was not reported as the cause of death for any maternal deaths during 2018-2020.

https://www.aihw.gov.au/reports/mothers-babies/maternal-deaths-in-australia-2018-2020/summary

I've studied the MBRRACE stats and the problem is they don't break cause of death down by ethnicity. So we know more black mothers die, but we don't know whether they're dying of thrombosis, sepsis, suicide or something else. There may be demographic factors (eg maybe black mothers are older giving birth, and therefore more at risk) or it may be that black mothers are more susceptible to heart problems. On the other hand, it may be that health professionals miss the signs of sepsis in black women, or they are more reluctant to refer black women for mental health support, making them more susceptible to suicide. We just don't know.

As far as I can tell from the data I can find, no pregnant woman died of Covid in Australia. The disaster that was the Covid management and the disaster that is the NHS is the reason for this. If it was just Covid itself, Australia would have had about half of the number per population. Women shouldn’t have died of Covid either.

So to my untrained eye, it looks like much if not all of the increase is likely related to Covid?

Some of the increase is due to Covid. The proportion of maternal deaths rose from roughly 8 in 100,000 to 13 in 100,000. If you remove Covid deaths from the equation, it's 11 in 100,000.

So it's still quite a big rise, but the overall numbers are small. And some are almost certainly down to changing demographics - the biggest single cause of death was thrombosis and thromboembolism.

I don't want to be glib because there is a lot of room for improvement in maternity, but I don't think we should leap to the conclusion that this rise in deaths is entirely down to failing maternity care.

Black mothers are more likely to die during or after childbirth. Is this just blatant racism - ie a lower standard of care is offered to black women? Is there a health or cultural reason? How should this be fixed?

It's not just Covid related deaths. We're also talking about the indirect effects.
Having had Covid linked to a higher risk of thrombosis although patients recovered by the time they gave birth. Staff being diverted from maternity wards to help with more 'urgent' things/Covid due to Covid-related short staffing. Etc etc.

Not making excuses here. maternity care in the UK is embarrassingly inadequate. But when discussing these particular figures a very deep dive on a case by case basis is required. Anybody going to do that? Probably not.