Maternal deaths may be higher Two reports indicate many deaths during delivery go unreported

July 31, 1996|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

One out of four women delivering babies in the United States suffers a serious complication such as obstructed labor, hemorrhaging or diabetes, according to a report released yesterday on pregnancy-related illnesses and deaths.

The Safe Motherhood status report also indicates a lack of reporting and research in this area. The report was compiled by the U.S. Department of Health and Human Services at the request of Rep. Patricia Schroeder.

Referring to figures that show 10 women died for every 100,000 live births in 1990, the Colorado Democrat said the report shows "strong evidence that we have been underestimating the rate of maternal mortality in the United States."

A study prepared for the August issue of Obstetrics and Gynecology affirms her assertion. In it, the U.S. Centers for Disease Control and Prevention concluded that more than half of pregnancy-related deaths in the United States are "probably still unreported."

Schroeder, who almost bled to death after giving birth 26 years ago, plans to introduce a package of legislation as one of her last actions. She is not seeking re-election. Among other goals, the bills would require standardized reporting, more research, education campaigns aimed at women who plan to get pregnant, and accreditation standards for fetal ultrasound procedures.

"The time has come," said Schroeder, who also miscarried twins 28 years ago. She said her physician kept dismissing her complaints that something was wrong. One twin had died in the womb, and she lost the other one when she went into premature labor.

"The doctor said, 'You're just so high strung,' " she recalled. "They really had me convinced that I was some kind of a nut case."

The report shows that women are unnecessarily dying in childbirth or experiencing miscarriages. Schroeder blamed a culture in which women feel guilty complaining, physicians and others make light of women's worries, and obstetricians and gynecologists are concerned about potential liability.

The overview of studies by the CDC, the Institute of Medicine and data from the National Hospital Discharge Survey, found:

The actual number of pregnancy-related deaths in the United States is unknown. Six different sources are used to count them, and because of discrepancies and the voluntary nature of reporting, the number is likely much higher than recorded.

The leading causes of pregnancy-related death are hemorrhaging, embolism and hypertensive disorders of pregnancy such as pre-eclampsia. Combined, they account for over 70 percent of pregnancy-related deaths.

Older women and women without prenatal care have a higher risk of pregnancy-related death. African-American women have a mortality-pregnancy three to four times higher than white women.

More than one-half of all pregnancies in the United States are unintended. Among women over 40, the proportion of unintended pregnancies is 77 percent, almost as high as the 82 percent rate for adolescents age 15 to 19.

The new CDC study found 1,453 pregnancy-related deaths in the United States from 1987 through 1990. In Maryland, the latest figures show at least 30 women died lost their lives because of pregnancy in 1993 through 1995, including 11 last year.

Karen Lynn Moats was among them. The Hagerstown woman, 25, died just over a year ago, a few days after giving birth to her first child. Joshua Thomas Moats now has six teeth and is beginning to try to walk. He can say a few words, including "Mom."

At a family birthday party for him July 8, he was spoiled with presents, said his father, Todd Moats, who has not remarried. But everyone struggled to deal with the other anniversary -- of Karen's death.

"It's like it's still just happened yesterday," Moats said. His wife hemorrhaged and later went into cardiac arrest.

Moats said he is gratified that someone is trying to address the issue. "I hope it helps people, so they don't have to go through what I did," he said.

More than 1 million children worldwide are orphaned every year because their mothers die giving birth, and pregnancy is still among the leading causes of death for women.

A report released last month by UNICEF, the World Health Organization and the Johns Hopkins University said nearly 585,000 women in developing countries die every year because of pregnancy-related complications. The top causes were chronic hemorrhaging, blood poisoning, botched abortions and brain or kidney damage stemming from pre-eclampsia.

Dr. Beatrice Desper, an obstetrician-gynecologist in Plainville, Conn., and a vice president of the American Medical Women's Association, said that overall, the United States does a good job of maternal care. She serves on a medical committee that reviews Connecticut's maternal deaths every year, and contends not many could have been prevented.

Some of the preventable deaths included homeless women who had no prenatal care. Other women, unaware they had congenital heart disease, died suddenly because of the strain on their hearts. They should never have become pregnant, Desper said.

Dr. Jeffrey King, chairman of an American College of Obstetricians and Gynecologists group on maternal mortality, has been pushing for years for a standard definition of death related to pregnancy and childbirth and for uniform reporting. One drawback is the expense and who would pay for it.

Many changes would be required, including standardized entries for maternal death on medical charts, he said. King said that maternal death affects a small number of women, but it is an "important indicator of quality of care for obstetrical services."

Pub Date: 7/31/96

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