5 Common Avoidable Reasons for Maternal Death During Birth May 4, 2023.
Childbirth should be a happy moment for families. Unfortunately, it can be a stressful and even tragic time for some. Maternal mortality during birth is on the rise thanks, in part, to the COVID pandemic. Doctors and researchers have found that there are a variety of risk factors, including the mother’s health, genetics, and access to health care. The leading cause of maternal death in the first trimester is hemorrhage, followed by cardiovascular illness such as high blood pressure. Even where death is not a result, the mother may be at a lifetime risk for other diseases, such as diabetes, blood clots, or heart disease.
Death during pregnancy is another matter and is not included in the statistics regarding maternal deaths during childbirth. Deaths during pregnancy can occur due to complications during pregnancy, accidents, and even homicide. These female death statistics are not included in maternal deaths during childbirth.
1. Hemorrhage During Childbirth
Excessive bleeding during and after childbirth is called postpartum hemorrhage. This occurs when the blood vessels in the uterus fail to contract after the placenta is delivered, and can result in massive, rapid blood loss. The most common cause of postpartum hemorrhage is uterine atony, a condition where the post-delivery contractions are not strong enough to close the blood vessels. Bits of retained placenta can also cause hemorrhage during the postpartum period.
Doctors can prevent postpartum hemorrhaging by recognizing the condition immediately and utilizing techniques to stop it, including:
- Administering drugs, such as oxytocin, to induce contractions
- Performing uterine massage to encourage the uterus to contract
- Removing any retained placenta
- Packing the uterus with sterile gauze to put pressure on the blood vessels
Some women are at higher risk for postpartum hemorrhage, including those with high blood pressure, multiple pregnancies, or a history of postpartum hemorrhage. Doctors whose patients have these histories should be alert for a recurrence of the issue.
2. Infections in Pregnancy and Post-Delivery
Most infections and illnesses during pregnancy are not harmful to the mother or baby. The mother’s immune system provides the fetus with protection against nearly all viruses and bacteria. However, some infections can put the fetus and the mother at risk, especially if untreated. They include:
- Listeriosis. A type of food poisoning, this bacteria is found in dairy products and cheese.
- Toxoplasmosis. A common bacteria found in cat feces, it becomes dangerous when encountered by those with suppressed or compromised immune systems.
- Chorioamnionitis. This is a condition where multiple types of bacteria enter the amniotic fluid where the fetus is protected. It can lead to premature birth or miscarriage.
These conditions and others may lead to maternal and fetal death because they may initially seem like mild infections. Once established, they rapidly become serious and, unlike other infections, they can cross the placental barrier to attack the fetus. They require rapid, aggressive treatment.
3. Pre-eclampsia and Eclampsia Complications
Pre-eclampsia is a blood pressure condition that develops after the first trimester of pregnancy. Pre-eclampsia causes high blood pressure and high levels of protein in the urine, which places stress on the heart and other organs. Doctors are unsure what causes pre-eclampsia. It may be more common in first-time mothers, and also in those with pre-existing high blood pressure, those who are overweight, and those with a family history of pre-eclampsia.
Eclampsia is a rare complication of pre-eclampsia. Fewer than 3% of those with pre-eclampsia develop eclampsia. It occurs during delivery and leads to seizures and loss of consciousness. As with pre-eclampsia, doctors do not know why some individuals go on to develop eclampsia. The only treatment for both conditions is the delivery of the baby.
Once a patient has been diagnosed with pre-eclampsia, their doctor will monitor them closely throughout the remainder of the pregnancy. Danger signs are increased blood pressure, waste products, called creatine, in the urine indicating increased protein breakdown, and fluid in the lungs. Infants are at risk for low birth weight and premature birth.
4. Obstructed Labor and Its Risks
Obstructed labor is a failure of the baby to progress through the vaginal canal due to “mechanical mismatch” and is diagnosed when the labor has lasted more than 24 hours without any progression. Obstructed labor is a significant issue in developing nations and anywhere where access to emergency medical care is limited or restricted.
Even in the United States, obstructed labor is a serious medical issue, because once the baby has entered the vaginal canal, medical options become limited. A c-section may no longer be an option, but if the baby has progressed into the vaginal canal and cannot proceed due to malpresentation, there are few other alternatives.
The best prevention for obstructed labor is to recognize the possibility of malpresentation or mismatch before labor begins and schedule a c-section early enough to avoid this difficulty. Healthcare providers should be alert to malpresentation during ultrasounds for the time period before delivery.
5. Access to Quality Health Care
The common factor in all these avoidable deaths is ready access to affordable maternal health services. According to the Centers for Disease Control, the United States suffers more than 700 pregnancy-related deaths annually—spiking to over 1200 in 2021—yet has some of the worst maternal healthcare in the developed world. The maternal death rate by state is tied to the availability of health care. There are social factors involved as well, and states which provide undocumented immigrants with services have lower overall rates than those that do not.
The Affordable Care Act (ACA) is mandated to cover midwife care, which would alleviate many of the issues facing women before and after pregnancy, but there are too few providers for the number of expectant mothers who need assistance. And since the decision in Dobbs v. Jackson Women’s Health Organization, the number of applicants for OB/GYN residencies is falling while the number of hospitals closing their doors in affected states is rising.
Legal Support for Families Impacted by Maternal Complications
If you or your family has been affected by a maternal death or the consequences of medical malpractice in Ohio, Mellino Law can help. We have been handling maternal and pediatric cases with the compassion and diligent advocacy our clients need for many years, and we understand what our clients are feeling. We know you want someone who will listen to you and help you get the compensation and justice you deserve.