Maternal death rate in the UK

[ArabellaScott]

https://www.npeu.ox.ac.uk/news/2486-maternal-death-rates-in-the-uk-have-increased-to-levels-not-seen-for-almost-20-years

Alarming news about maternal death rates, the highest they've been for 20 years.

Death rates for Black women are three times as high as for white women. Asian women are twice as likely to die in childbirth or shortly afterwards as white women.

Thrombosis was the most common reason for death.

That's shocking.

Thrombosis is linked to being over 35 and being overweight, I wonder if that is a factor?

Maternity care in the UK is dire as shown by reports on 1/3 maternity units failing quality standards.
But I wouldn't take maternal death rates during the Covid years as an indication of anything.
So many resources diverted towards Covid, staff ill and off, etc etc. Similar is seen in other countries.

I'd say so, yes. Women are older and fatter having babies than they were even 30 years ago.
There are also a lot more IVF babies now too - often with multiple births.

Thanks Arabella. I will read this in the morning.

It's outrageous - but there's not the political will to change things. The NHS has presided over inadequate maternity services for decades now with no sign of sustained change and politicians just don't insist they prioritise this. Bet if the NHS was told that funding for Diversity staff / initiatives was dependent on all their maternity services being rated good - they'd manage it.
But tackling so many of the inbuilt issues that would save the lives of women and babies just doesn't get the plaudits that lanyards and flags receive.

https://www.dailymail.co.uk/health/article-12853775/Senior-midwife-tasked-probing-horrifying-NHS-maternity-scandals-criticises-extremely-disappointing-progress-making-safe-women-birth-Britain.html

Thank you Arabella.

Covid was second or third cause of death iirc. But even after Covid related cases had been removed the stats had worsened.

The NHS is an absolute disaster that too many people defend it as though it’s sacrosanct. It just stumbles from one scandal via persistent suboptimal care to another scandal year after year.

MNHQ has been tweeting about the APPG into birth trauma, which may be of interest here:

x.com/mumsnettowers/status/1745378987340087487?s=46&t=WHoOZ_3Kv5G6-FyQuvE0LQ

x.com/mumsnettowers/status/1734521880550252639?s=46&t=WHoOZ_3Kv5G6-FyQuvE0LQ

x.com/theodoraclarke/status/1744460213535617035?s=46&t=WHoOZ_3Kv5G6-FyQuvE0LQ

That's awful to read

Thanks Rex. Maybe could use its own thread?

Covid increases your thrombosis risk, not just when you have it but for some time afterwards. - at least 3 months. It also increases the risk of pulmonary embolism for 6 months. I dont think the impact of repeated infection has been properly investigated yet.

The reasons for this need to be properly studied because otherwise these figures will not improve.

'October 2023

• Main points
• There was a statistically non-significant increase in the overall maternal death rate in the UK between 2018-20 and 2019-21. A statistically non-significant decrease occurred when deaths due to COVID-19 were excluded.
• COVID-19 was the leading cause of maternal death in the UK in 2019-2021 during or up to six weeks after the end of pregnancy. Cardiac disease was the second most frequent cause of maternal death followed by thrombosis and thromboembolism and mental health-related causes.
• There remains an almost four-fold difference in maternal mortality rates amongst women from Black ethnic backgrounds and an almost two-fold difference amongst women from Asian ethnic backgrounds compared to white women. These disparities are statistically unchanged from 2018-2020.
• Women living in the most deprived areas have a maternal mortality rate more than twice as high as women living in the least deprived areas. This disparity is statistically unchanged from 2018-2020.

1. Maternal mortality rates UK 2019-2021
2. Overall, 261 women died in 2019-21 during or within 42 days of the end of pregnancy in the UK. The deaths of 20 women were classified as coincidental. Thus in this triennium 241 women died from direct and indirect causes, classified using ICD-MM (World Health Organisation 2012), among 2,066,997 maternities, a maternal death rate of 11.66 per 100,000 maternities (95% CI 10.23 – 13.23). This compares to the rate of 10.90 per 100,000 maternities (95% CI 9.53 – 12.40) in 2018-20 (rate ratio (RR) 1.07, 95% CI 0.89-1.29, p=0.4631 (Figure 1).
3. Thirty-three of the women who died between March 2020 and December 2021 during or within 42 days of the end of pregnancy died from complications of COVID-19 infection. If these women's deaths attributable to COVID-19 are excluded, the maternal mortality rate for 2019-21 would be 10.06 (95% CI 8.74 – 11.53) lower than the corresponding rate for 2018-20 (10.47 (95% CI 9.13-11.95) but not statistically significantly so (RR 0.96 (95%CI 0.79 – 1.17), p=0.684) (Figure 1).'

https://www.npeu.ox.ac.uk/mbrrace-uk/data-brief/maternal-mortality-2019-2021

The stats/report I've posted above show the stats had not worsened when Covid related deaths were removed - apologies, I got the wrong end of the stick.

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

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.

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?

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.

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.

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.

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

this is horrendous - thanks for the thread

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.

@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.

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.