Uncomfortably high rates of maternal deaths during childbirth raise concerns: Study

By Dr. Ananya Mandal, MDApr 30 2012

According to latest figures more than a 100 mothers have died in childbirth in London in the last five years. This is twice the rate in the rest of the country. There were 11 deaths in 2005-6, compared with 29 in 2010-11. Births in London have soared by 27 per cent in the last decade from 106,000 in 2001 to 134,000 in 2011, but numbers of midwives and doctors have not kept pace.

Cathy Warwick, president of the Royal College of Midwives, said yesterday, “London still has some of the worst shortages of midwives across the country. There are more women facing more complex pregnancies creating a difficult situation. We need to target resources at women who need more support.”

Professor Cathy Warwick said, “Two factors are combining: maternity services are under pressure from a steadily rising birth rate while dealing with far more women with complex pregnancies.” Since 2001 the UK birth rate has jumped by 21 per cent, up from 594,634 to 723,165 last year alone. By contrast, the number of midwives has only increased by 15 per cent over the same period, from 18,048 to 20,790. The college estimates an extra 5,000 midwives are needed.

Two inquiries have been held into the high maternal death rate in London in the last four years and both have found maternity services wanting compared with the rest of the UK. Younger midwives cannot afford to live in the capital and older, more senior ones move out.

The new figures came from research by Susan Bewley, professor of complex obstetrics at Kings College London and Angela Helleur of NHS London and published in The Lancet. Professor Bewley said that the number of deaths was small relative to the number of births, but maternal mortality was a sensitive measure of healthcare quality. Risks were higher in older mothers, and linked with obesity, poverty, ethnic minorities, immigration and twin pregnancies (following IVF), all of which were more common in London. “What we don't know is if the rise in maternal mortality is a measure of illness in the population or the response of the medical services to it. It is possible that more women are falling through the net because they are [more ill],” she said.

In 2008, the Healthcare Commission found maternity provision in the capital was poor by comparison with the rest of the country. In 2010, a review by the Centre for Maternal and Child Enquiries into the deaths of 42 mothers in London over 18 months found 76 per cent might have been avoided with better care. Staff on the frontline in maternity services were working harder and harder to stand still, Professor Bewley added. “There are improvements in some parts of the health service – we have made incredible strides in heart disease and stroke – but worrying trends in others. Maternal mortality is a public health issue: we have to take a twin approach which means educating women about the risks associated with obesity and delaying childbirth as well as improving the health service. “

Pregnancy was a lot safer than in the past but Professor Bewley said there were still risks. “Pregnancy is more dangerous than jumping out of a plane or riding a bicycle without a helmet.”

Trish Morris-Thompson, Chief Nurse at NHS London, said, “The majority of births in London are healthy and happy occasions, but having a baby can be a difficult process.” One in five babies born in England is born in the capital, she said. “London also treats more women with complex health needs and more women from black and minority ethnic backgrounds that are traditionally harder to reach and often access services later in their pregnancy…This is a challenge and we are working hard to engage with women in our communities and make sure women get the care and support they expect during pregnancy.”

Tony Falconer, president of the Royal College of Obstetricians, said improving safety meant concentrating maternity services in fewer, larger hospitals. “There is a need for significant change to the way NHS women's health services are structured. Hospitals will need to be configured to provide more midwifery-led care and 24/7 medical obstetric services for women on fewer sites.”