Rise in U.S. maternal death rate

ATLANTA - Women are dying from childbirth at the highest rate in decades, new federal figures show. Though the risk of death is very small, experts believe that growing rates of maternal obesity and cesarean sections are partly to blame.

Some numbers crunchers note that a change in how such deaths are reported also may be a factor.

"Those of us who look at this a lot say it's probably a little bit of both," said Jeffrey King, an obstetrician who led a recent New York state review of maternal deaths.

The U.S. maternal mortality rate rose to 13 deaths per 100,000 live births in 2004, according to statistics released last week by the National Center for Health Statistics.

The rate was 12 per 100,000 live births in 2003 - the first time the maternal death rate rose above 10 since 1977.

To be sure, death from childbirth remains fairly rare in the United States. The death of infants is much more common - the nation's infant-mortality rate was 679 per 100,000 live births in 2004.

Maternal deaths used to be much more common. As recently as 90 years ago, nearly one in every 100 live births resulted in a mother's death.

That maternal deaths are rising at all these days is still shocking, said Tim Davis, a Virginia man whose wife died after childbirth in 2000.

"The hardest thing to understand is how in this day and age, in a modern hospital with doctors and nurses, that somebody can just die like that," he said.

Whether the death of Elizabeth Davis, 37, had anything to do with the factors that may be pushing the nationwide trend is unknown.

A clear explanation is not always possible.

Last spring, two South Jersey women who taught together at Avon Elementary School in Barrington delivered healthy babies and then died, two weeks apart.

Both gave birth at Underwood-Memorial Hospital in Woodbury. Both had cesareans; indeed, New Jersey has the highest C-section rate in the nation.

So far, however, these all appear to be coincidences.

Valerie Scythes, 35, of Woodbury, died of a blocked blood vessel, and Melissa Farah, 28, of Oaklyn, died from bleeding, said John Baldante, a Philadelphia lawyer investigating the death for Scythes' family.

"I'm not sure there was any connection between the two deaths," Baldante said.

Nationally, the total number of maternal deaths - fewer than 600 a year - remains so small that just 50 to 100 more can raise the rate, said Donna Hoyert, a health scientist with the National Center for Health Statistics.

In 2003, a change took effect in death-certificate questions in the nation's most populous state, California, as well as Montana and Idaho. That may have linked more deaths to childbirth - perhaps enough to push up the 2003 rate, Hoyert said.

Some researchers point to the rising C-section rate, now 29 percent of all births nationally - far higher than what public health experts say is appropriate. Like other surgeries, cesareans come with risks related to anesthesia, infections and blood clots.

"There's an inherent risk to C-sections," said Elliott Main, who cochairs a panel reviewing obstetrics care in California. "As you do thousands and thousands of them, there's going to be a price."

Excessive bleeding is one of the top causes of pregnancy-related death, and women with several previous C-sections are at especially high risk, according to a review of maternal deaths in New York. Blood-vessel blockages and infections are other top causes.

Obesity may be a factor, too. Heavier women are more prone to diabetes and other complications, and they may have excess tissue and larger babies that make a vaginal delivery more problematic. That can lead to more C-sections.

The age of mothers could be another factor. More women are giving birth in their late 30s and 40s, when complications are more likely.