Too many young mothers are dying

By Dr. Jo Ivey Boufford

The Daily News, July 19, 2010

Since the start of the decade, New York has emerged as the public face for good urban health: It is aggressively fighting everything from smoking to reducing the amount of salt we eat to waging war on adult and childhood obesity.

Yet in the 21st century, we continue to grapple with the early 20th century plague of maternal mortality.

More than 75 years ago, The New York Academy of Medicine, in partnership with the New York City Department of Health, published its groundbreaking study "Maternal Mortality in New York City," which analyzed in detail all reported childbed deaths in the city from 1930-1932. The report, which revealed that simple preventive measures could dramatically contribute to the reduction of maternal death, became a major rallying point in a decades-long movement by doctors and health activists to address the many factors that put America's maternal mortality rates higher than those of most industrialized western nations.

We've made good progress, but much more needs to be done - especially here in the city. Today, New York State has one of the highest rates of pregnancy-related deaths - with 15 deaths per 100,000 live births, a dismal 47th in the nation. Worse yet, New York City has the highest rate in the state, with an average of 23 deaths per 100,000 live births between 2001 and 2005. While the actual numbers of maternal deaths may seem small, the problem is significant for a variety of reasons. A maternal death is most always the death of a young woman, leaving behind a motherless child and distraught family.

There is also an alarming disparity in rates for different races and ethnic groups; death rates for African-American (non-Hispanic black) women are consistently three to four times higher than for other women and seven times higher than non-Hispanic white women. This disparity is unacceptable and must be addressed.

State and city health officials who know all too well that this is a broad-based problem are beginning to work collaboratively on a process to reduce maternal mortality. Their recent reviews of pregnancy-related deaths provide clear and useful insight into the risk factors, characteristics, and challenges related to pregnancy-associated mortality.

A good first step is assuring that all maternal deaths are reported and appropriately reviewed - so that the causes can be systematically understood. Then, armed with data, we can set about to make the changes in policy, procedures and practice needed to assure the highest likelihood for a healthy delivery for mother and baby.

Nationwide, other factors include obesity, diabetes and older women who seek to become pregnant. We can do much more to tackle these factors now. Women who suffer from these conditions must be counseled about the risks they may face before becoming pregnant and carefully followed throughout the pregnancy as their risks may increase.

Cesarean sections are another serious cause of complications that can lead to death during pregnancy. While C-sections can speed up the birth of a child or, in some cases, save the life of the mother or the newborn, they can also increase the risk of hemorrhage during and after labor and delivery.

The national C-section rate has been rising steadily; between 1996 to 2007, it went up 53%. In New York State, the rate of cesarean sections is 33.7% compared to the national average of 32%, and New York City hospitals have C-section rates that vary between 16% and 48% - well above the 15% recommended by the World Health Organization and the U.S. Department of Health and Human Services.

Clinical leaders in New York's hospitals who are working to assure good birth outcomes for mother and babies should examine the rates and appropriateness of C-sections in their facilities and take action to reduce unnecessary risks.

Finally, the problem of obesity in pregnant women demands special attention. Obesity has grown to epidemic proportions; statewide, a quarter of all women are obese. Obesity is not only correlated with maternal deaths but may also be a driver of some of the racial disparities in maternal death rates. Among New York City women giving birth, African- American and Hispanic women have higher pre-pregnancy weights and higher rates of weight gain during pregnancy compared to white women.

Leading experts including city and state health officials have recently called for the kind of integrated approach that is needed to coordinate pre-pregnancy prevention, prenatal and primary care, labor and delivery and postpartum follow-up.

Saving a mother's life is a cause the entire city should rally behind.

Boufford is president of the New York Academy of Medicine

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Contact:
Andrew J. Martin
Director of Communications
The New York Academy of Medicine
1216 Fifth Avenue
New York, New York 10029
212-822-7285
amartin@nyam.org

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