Maternal Mortality In Calif. Up Nearly Threefold Over Last Decade, State Data Show

Main Category: Pregnancy / Obstetrics
Also Included In: Women's Health / Gynecology;  Public Health
Article Date: 05 Feb 2010 - 3:00 PDT

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California's maternal mortality rate has nearly tripled during the past decade, according to an unreleased report from the state Department of Public Health, the Sacramento Bee reports. California Watch, a project of the Center for Investigative Reporting, conducted the investigation into the state's pregnancy-related deaths. The report "shows the most significant spike in pregnancy-related deaths since the 1930s," according to the Bee. The Bee notes that pregnancy remains safe for the vast majority of women in California, with 95 deaths in the state out of more than 500,000 live births in 2006. However, if California had met goals set by HHS, the number of deaths would have been around 28.

In 1996, California's pregnancy-related mortality rate was 5.6 maternal deaths per 100,000 live births, slightly more than the national goal of 4.3 per 100,000 live births After the World Health Organization revised its coding system, California's rate increased to 6.7 in 1998 and 7.7 in 1999. According to the Bee, WHO's coding-system change might have contributed to the rise in deaths in the late 1990s.

Reasons for Increase Disputed

California changed its coding system once more in 2003, and the maternal mortality rate rose to 14.6 maternal deaths per 100,000 live births. In 2006, California's rate reached 16.9, compared with the national average of 13.3. Investigators estimate that reporting system changes account for less than 30% of the increase in maternal mortality rates.

California might be mirroring the rest of the country with its rise in pregnancy-related deaths, according to a recent "Sentinel Event Alert" from the Joint Commission, a hospital accreditation organization. On Jan. 26, the commission sent the alert to hospitals to inform them that maternal mortality rates appear to be increasing nationwide. The Joint Commission suggested that diabetes, high blood pressure, hemorrhaging from caesarean sections and obesity could account for some of the increase in maternal mortality rates.

The Centers for Disease Control and Prevention reported a national rise in maternal mortality in 2007. Jeffrey King, head of an inquiry into maternal mortality for the American Congress of Obstetricians and Gynecologists, and some other experts attribute the change to more accurate recordkeeping.

Elliott Main, principal investigator for California's report, said the rise cannot be fully explained by population changes, such as fertility treatments, obesity and older mothers. "What I call the usual suspects are certainly there," Main said, adding, "However, when we looked at those factors and the data analyzed so far, those only account for a modest amount of the increase." Main noted that c-sections also increased by 50% during the same decade that pregnancy-related deaths went up. Currently, c-sections are the most common surgical procedure in the U.S.

In response to the rise in maternal mortality, California officials are starting work on pilot programs designed to improve hospital responses to hemorrhages, reduce the incidence of induced births and strengthen tracking systems for women's medical conditions (Johnson, Sacramento Bee, 2/3).

Broadcast Coverage

On Wednesday, KQED's "The California Report" included a segment on the rise in maternal mortality (Montgomery, "The California Report," KQED, 2/3).

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