(continued from Part II)
By Ina May Gaskin, CPM, MA
Originally published by Journal of Perinatal Education, 2005-08-04
Every 3 years, the Confidential Enquiry into Maternal and Child Health (CEMACH) publishes a report titled Saving Mothers’ lives: Reviewing Maternal Deaths to Make Motherhood Safer (formerly titled Why Mothers Die). The publication, now in its seventh edition, is much like a report card on the results of the combined maternity services in Wales, Scotland, England, and Northern Ireland (CEMACH, 2007). As the public outreach component of the United Kingdom’s respected CEMACH, each edition of the book is based upon data drawn from every maternal death in the United Kingdom from causes stemming from pregnancy or birth during a given 3-year period. Each of the main causes of maternal deaths—hypertension, thromboembolism, hemorrhage, amniotic fluid embolism, infection, anesthesia deaths, and injuries to the cervix, perineum, or vagina—gets its own chapter and includes at least one narrative of a case of such a death. The comparable report from the CDC and the National Center for Health Statistics (NCHS) is limited to—at most—a page each year (Kung et al., 2008).
The United Kingdom claims a high degree (97%) of accuracy in determining how many maternal deaths occur each year. Sometimes cases involving substandard care are described in Saving Mothers’ Lives, but the names of hospitals or cities are never mentioned. Because the purpose of the CEMACH system (the United Kingdom’s equivalent of the CDC) is to seek truth, names and places are kept confidential so that results of the enquiries can’t be used in malpractice lawsuits. Saving Mothers’ Lives not only provides detailed, accurate numbers of deaths in each category of deaths but it also recommends what steps should be taken to ensure that the number will be reduced in the next 3-year period. As of 1999, in the fifth report, building upon the excellent feedback provided by the CEMACH system, the U.K. maternity system has been able to reduce the number of maternal deaths each triennium. There was a slight, but statistically insignificant, rise in the death rate described in the sixth and seventh reports.
If the amount of money spent on maternity care provided an accurate indication of how well we are doing, mothers in the United States would be the luckiest in the world. After all, our country has the distinction of spending more per birth than any nation in the world on maternity care for the 4.3 million births that take place each year. Apparently, we are not spending that money in the smartest way possible, and it’s about time that we did.
Can you imagine the passage of laws that would
effectively scrap our fragmented way of gathering health information and institute a system like that in the United Kingdom?
• Reporting of deaths would be mandatory
• Failure to report a death or error would have to be penalized.
• Death certificates for all the states would ask the same questions regarding the pregnancy status of women of childbearing age who have died.
• Death certificates would be completed only by individuals who have been instructed how to fulfill this task properly.
• An autopsy would be performed following the death of a woman of childbearing age. (Studies have shown that there is a 25%-40% rate of error in diagnosis if there is no autopsy).
• Maternity insurance of all types would cover the payment of such autopsies.
• There would be periodic audits of maternal death data.
The Safe Motherhood Quilt Project
About 8 years ago, I began to feel powerfully impelled to follow the example of the AIDS Quilt in drawing attention to a problem that wasn’t getting the attention it needed. Whenever I get documentation about a U.S. woman’s death from pregnancy-related causes between 1982 and the present, I arrange for a quilt block to be made in her honor. Sometimes a family member or friend creates the block, and sometimes it is made by one of the many who have contributed their efforts to the project.
The Quilt was first exhibited at the Summit for Safe Motherhood, sponsored by the CDC, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives, in Atlanta, September 4-5, 2001. Since then, it has been shown at the Oakland Museum, at Dartmouth-Hitchcock Medical Center, and many other sites in the United States, as well as in Brazil, Iceland, Germany, Austria, Hungary, France, England, Ireland, Scotland, Northern Ireland, Italy, Canada, England, Costa Rica, and Mexico.
I am sure that when enough people are informed about the maternal death problem in our country, we can exert enough political pressure to fix it. Only when we are able to equal the United Kingdom’s CEMACH system of ascertaining and analyzing maternal deaths will we be able to find out the causes of preventable maternal deaths and then set about preventing them.
Ina May Gaskin, Certified Professional Midwife, is director of the Farm Midwifery Center in Summertown, Tennessee. She is the author of Spiritual Midwifery, now in its fourth edition, and Ina May’s Guide to Childbirth, now in its fifth printing since its publication in 2003. She is originator and curator of the Safe Motherhood Quilt Project. www.rememberthemothers.net
States with Mandatory Reporting of Adverse Events
California
Colorado
Connecticut
Florida
Georgia
Illinois
Indiana
Kansas
Maine
Maryland
Massachusetts
Minnesota
New Jersey
Nevada
New York
Ohio
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Washington
REFERENCES
Charatan, F. (1999) Medical errors kill almost 100,000 Americans a year. British Medical Journal, 319 (7224), 1519.
Confidential Enquiry into Maternal and Child Health [CEMACH]. (2007). Saving mothers’ lives: Reviewing maternal deaths to make motherhood safer (2003-2005), 7th report. London: Author.
Deneux-Tharaux, C., et al. (2005) Underreporting of pregnancy-related mortality in the United States and Europe. Obstetrics & Gynecology, 106, 684-692.
Hill, K., Thomas, K., AbouZahr, C., Walker, N., Say, L., Inoue, M., and Suzuki, E. (2007) Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data. The Lancet, 370, 1311-1319.
Johnson, D., and Rutledge, T. (1998) Maternal mortality—United States, 1982-1996. The Morbidity and Mortality Weekly Report 47 (34), 705-707.
Kung, H. C., Hoyert, D. L., Xu, J. Q., & Murphy, S. L. (2008, January). Deaths: Final data for 2005. National Vital Statistics Reports, 56(10), 25. Retrieved March 16, 2008, from http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf
Tanne, J. (2002) US doctors and public disagree over mandatory reporting of errors. British Medical Journal, 325 (7372), 1055.
U. S. Department of Health and Human Services. (2000, November). Healthy People 2010: Objectives for improving health. Washington, DC: U.S. Government Printing Office. Retrieved March 16, 2007, from www.healthypeople.gov
