HEALTH-AUSTRALIA: Many Maternal Deaths Preventable, Say Experts

By Neena Bhandari Reprint | | Print |

Neena Bhandari

SYDNEY, Australia, Jan 14 2002 (IPS) - Australia is a First World nation in more ways than one, but women giving birth here may well be justified if they feel they are getting less than the treatment they deserve.

To be sure, Australian maternal mortality rates — excluding data on the indigenous population — are still within the international standards of acceptability and are comparable with those of Canada, Japan, New Zealand and the United States.

A recently released study, however, indicates that a significant number of maternal deaths reported in this country could have been avoided, prompting specialists to call for an urgent scrutiny of maternity services.

As one specialist says, “For the majority of women, childbirth is a safe event.But there are sometimes rare, incredibly serious complications and one can’t afford to be complacent.”

The joint report was done the Australian Institute of Health and Welfare and the National Health and Medical Research Council.

The report’s researchers point to worrisome health trends, although the recorded maternal deaths reached only about 100 during 1994 to 1996, the period covered by the study.

Forty-six of the 100 deaths were directly related to pregnancy – a number that represents a steep increase from the 27 deaths of this type that took place between 1991 and 1993.

This, the researchers said, showed a reversal of the trend in the previous 15 years.

This is the first time that the triennial report, the eleventh in a series since 1964, includes data that can be verified, such as information from death certificates, the Australian Bureau of Statistics and various national hospitals.

Previous reports were based only on case studies volunteered by individual doctors.

The latest report, which acts as a sentinel for obstetric care and safe motherhood experience, indicates that there has been an increase in preventable factors in maternal deaths in Australia.

Says Professor Lesley Barclay of the University of Technology in Sydney: ” It demonstrates the importance of vigilance. This must occur in clinical care and also in the timely reporting of reliable statistics and careful case review of the few women who tragically die around childbirth.”

As it is, the Advisory Committee on Maternal Mortality and Morbidity, reviewing the cases in the report, found that many could have been managed better or saved with different treatment.

The study’s researchers said that the most common causes of “direct maternal deaths” were blood clots in the lungs and leakage of amniotic fluid into the blood vessels, both of which can be associated with Caesarean sections.

Direct deaths are those resulting from obstetric complications of the pregnancy, labour and puerperium (the immedaite period after childbirth) from interventions, omissions, incorrect treatment or from a chain of events resulting from any of these.

Other causes of the maternal deaths in 1994 to 1996 included pre-eclampsia, in which blood pressure rises dangerously, pregnancy outside the uterus, infections like septicaemia or blood poisoning, abortion and ruptured uterus.

Some observers say would-be mothers are being put through unnecessary risks because they are not giving birth the natural way.

Worldwide, there has been the problem of increasing Caesarean sections, where high medical intervention occurs, due to a variety of reasons ranging from the mother’s low threshold of pain to a physician’s preference for a quick procedure.

But Barclay observes, “Natural birth is safer for the mother and the baby, Caesarean section increases the risk and should only be performed if the mother or the foetus is more at risk from a vaginal birth.”

“If you increase the Caesarean section rate,” he continues, “you will have a small number of people who will die from surgical complications. They would not have died if a Caesarean section had not occurred. Countries like the United Kingdom are actively taking action to reduce Caesarean section rates.”

The situation in Australia is compounded by the fact that rising medical insurance premiums is accelerating the exodus of specialist obstetricians and gynaecologists from rural areas.

The Australian Medical Association also says the surge in multi- million dollar claims against specialists has resulted in a 50 percent drop in the number of obstetrician and gynaecologist trainees choosing obstetrics.

That can only mean even more expensive — and dangerous — childbirths in a country where pregnant women and new mothers seem to be already getting shortchanged in health care.

It is telling, for instance, that in the 1994-96 report, 10 of the deaths had infection as a principal contributory cause.

Among these fatalities was a 32-year-old mother of two who had symptoms of flu, brought on early labour. After her baby was stillborn, the woman was given paracetamol and allowed to return home. She died the next day of septicaemia.

Experts note that deaths from septicaemia have now become the most frequent cause of death from infection, overtaking pneumonia.

Other maternal fatalities were also cases of either simple misdiagnosis or inadequate examination. A 19-year-old woman, for example, had an inexplicable swollen calf after giving birth. She was subjected to an ultrasound test, which found nothing.

Three weeks later, she was dead, apparently from a stroke brought on by deep vein thrombosis, which in turn had been triggered by her pregnancy.

A 22-year-old breastfeeding mother, meanwhile, did not know she was pregnant again. A hospital diagnosed her severe abdominal pain as a stomach virus and sent her home, where she died during the night from internal bleeding caused by a pregnancy implanted outside the uterus.