The number of maternal deaths in Ireland has risen sharply, and the pregnancy-related death rate is now higher than in the UK, according to a new report.
There was a 22 per cent rise in the number of maternal deaths in 2010-2012, according to the second report of the Confidential Maternal Death Enquiry, based in UCC. The period coincided with a number of controversial deaths of pregnant women, most notably Savita Halappanavar in 2012.
The rate of maternal death picked up by the report from hospitals and other sources is four times higher than official figures gathered by the Central Statistics Office from death certificates. The report, which says this issue is not unique to Ireland, recommends that a question on pregnancy status at time of death be added to the coroner's death certificate.
There were 38 maternal deaths between 2009 and 2012. Ten were classified as direct maternal deaths, ie due to obstetric causes. Twenty-one were indirect maternal deaths due to pre-existing conditions exacerbated by pregnancy. The rest were attributed to “coincidental causes”; these are not included when calculating the maternal mortality rate.
Increased risk
The rate increased from 8.6 per 100,000 maternities in the period 2009-2011 to 10.5 in 2010-2012. However, the report says this increase is not statistically significant and the Irish rate is similar to the UK rate of 10.1. There was no evidence of clustering in any one maternity hospital.
Women born outside Ireland were over-represented in reported deaths, pointing to an increased risk for migrant ethnic minorities. Almost 39 per cent of deaths were among women born outside Ireland, while this group represented 24 per cent of all women giving birth.
“This raises issues as to how these women engage with Irish maternity services and the importance of the availability of interpretative services. A particular concern was the issue of engagement with the services by non-national patients in receipt of alternative medical advice from outside the country.”
Two of the deaths were due to flu, and the report says all pregnant women should be immunised.
Mental illness
In relation to women with mental illness, the report says the absence of a mother-and-baby unit is a “continuing and regrettable deficiency” in the health services.
“Standalone psychiatric units are poorly equipped to look after women with medical and obstetrical complications,” the report says.
In cases where deaths occurred in general hospitals, the report is critical of a lack of communication with the maternity unit and/or GP in some cases.
The risk of maternal mortality also appeared to be higher among older women. Heart disease was the single most common cause of indirect maternal death.
With indirect causes accounting for 70 per cent of deaths, women with pre-existing medical or mental health disorders should be given counselling before conception, the report says. A comprehensive medical history should be documented at a patient’s first visit to a maternity unit.
The aim of the inquiry, which covers Ireland and the UK, is to investigate why some women die during or shortly after pregnancy and to learn from these tragedies.
The UK inquiry has been ongoing since 1952 but data from the Republic has only been included since 2009.
