Getting to grips with maternal death rates

Ireland, we have been told over recent weeks, is one of the the safest countries in the world to be pregnant and have a baby. According to figures from the Central Statistics Office (CSO) for 2009, there were four maternal deaths per 100,000 live and still births.

However, experts here now say that figure is an underestimate and the rate is double that.

The World Health Organisation (WHO)defines a maternal death as: “The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.”

According to figures in the Confidential Maternal Death Enquiry (MDE) in Ireland, Report for the Triennium 2009–2011, the maternal death rate here is eight per 100,000. Dr Michael O’Hare, consultant obstetrician at Daisy Hill hospital in Newry, Co Tyrone and chairman of the Maternal Death Enquiry group, says the higher rate comes from far more thorough data gathering than that gleaned solely from the civil register of deaths.

The MDE, a joint collaboration of the Institute of Obstetricians and Gynaecologists and the HSE, was established in 2007 to gather more accurate data on maternal deaths, for reasons of accuracy as well as to learn how better to save mothers’ lives.

“We are confident that the figures we have covering 2009 to 2011 are certainly the most accurate available and that the rate up to now has been hugely underestimated,” says Dr O’Hare.

Dr O’Hare explains that up to 2009, data was based only on figures as recorded by the CSO. Though the CSO has a robust system for collating data, there are internationally recognised problems with relying on civil registration to record maternal death rates.

Death certificates

Not all maternal deaths are recorded as such on death certificates, he says, partly due to inconsistent notification from coroners. There are also instances where maternal deaths in the community are not recorded as maternity-related.

According to a 2005 report on maternal mortality by the WHO, Unicef, UNFPA (United Nations Population Fund) and the World Bank, in 2005 Ireland had one reported maternal death per 100,000.

As that report says: “Even in developed countries where routine registration of deaths is in place, maternal deaths may be underreported and identification of the true number of maternal deaths may require additional special investigations into the cause of deaths.

“A specific example of such an investigation is the Confidential Enquiry into Maternal Deaths [CEMD] which was established in the United Kingdom in 1928.”

The same report continues: “The most recent report of the CEMD (2000-2002) identified 44 per cent more maternal deaths than was reported in the routine civil registration system.”

And it is this more thorough, empirically robust system, as pioneered by the British CEMD, that is now being implemented here. Not only does it use a far wider network of reporting systems than heretofore, but as in Britain, the death of a mother up to one year after end of pregnancy – not just six weeks – is now recorded as a maternal death.