What are the main causes of death in childbirth in America or other countries with similar health care procedures? I’d guess hemorrhaging, if so why can’t transfusions replace the blood quickly enough and why can’t the bleeding be stopped? If it’s something else, how can it be avoided? What about elective caesarean, have the studies on caesareans in non-emergencies been completed yet?
After haemorrhaging, preeclampsia is a pretty big one. It’s when some sort of problem with the placenta causes various problems as the pregnancy progresses, most importantly high blood pressure followed by seizures and death. It ends when the mother either gives birth to or aborts the baby, depending on how far along the pregnancy it occurs. There are ways to keep it under control with drugs for a short time but the only real solution is to get the placenta out of there. It can also progress very quickly, which makes it dangerous. It also sometimes kills the baby 
Here is a link to a Wikipedia article about meternal death :
http://en.wikipedia.org/wiki/20th_century/Maternal_death_rates
It seems to agree with most studies I have seen and is a lot easier to read.
maternal
The main cause of death during pregnancy, childbirth and the puerperium in developed world are thromboembolic disease (i.e. DVT and pulmonary embolus), hypertensive disease (i.e. eclampsia and pre-eclampsia) and Haemorrhage. Sepsis, death from ruptured ectopic pregnancy and amniotic fluid embolism are rarer causes.
In the developed world, Eclampsia, haemorrhage and sepsis are much more common.
http://news.bbc.co.uk/2/hi/health/220376.stm
http://www.who.int/reproductive-health/publications/MSM_94_11/MSM_94_11_chapter1.en.html
Death from haemorrhage in childbirth in developed countries is most likely to occur in women with placenta praevia or placental abruption, often during a complicated c-section. These women may lose blood at about 1Litre per minute- often too fast for even the most sophisticated modern transfusions to be effective, they simply can get the blood in quickly enough and can’t stop the source of the bleeding (there is massive bleeding from the entire placental bed). Women may suffer from DIC due to a consumptive coagulopathy. Basically their body has used up all the clotting factors in their blood and it can’t make more quickly enough. This leads to both clotting (where you don’t want it, like the skin, kidneys and lungs) and continued bleeding.
Thrombo-embolic disease is a coomon cause of maternal martality because pregnancy is a pro-thrombotic (pro clotting) state, this is a physiological change sdesigned to prevent the body losing too much blood during labour. Unfortunately it often works too well, and women can develop blood clots in the legs (DVTs) which can break off and travel to the lungs (a pulmonary Embolus or PE) which is often fatal. DVTs and PE s are treated with anticoagulation (heparin in pregnancy), they can be prevented with lower dose heparin in at-risk women, as well as exercise, pressure stockings and adjusting risk factors.
Risk factor for thromboembolic disease are:
Obesity
Immobility (e.g. prolonged bed rest)
Antiphospholipid antibodies (e.g. in women with SLE)
Inherited thrombophilias (Protein S and C deficiencies, Factor V Leiden)
Eclampsia can cause death due to liver failure, renal failure, DIC and prolonged seizures (which can lead to brain hypoxia and death). Screening for pre-eclampsia and prompt treatment to reduce hypertension before end-organ damage occurs reduce the progression from pre-eclampsia to eclampsia and prevent serious complications.
Hemorrhage is a pretty general term – one can break it up into uterine atony, placental abruption (althought his is solved by delivery), uterine rupture (especially after a trial of labor after a C-section), placenta previa, placenta accreta/percreta, retained products of conception, and rarely velamentous cord insertion (mostly causes fetal demise, though). Of these, uterine atony and rupture are probably the most likely to lead to emergent post-delivery hysterectomy.
The gravid uterus at delivery has expanded to be a 40 lb organ that expands nearly up to the diaphragm. It is a huge organ and has the blood supply to go along with it. The average blood loss in a normal delivery is half a liter, in a C-section it is 1 L. It is pretty easy for even small mistakes to cause huge amounts o f blood loss.
Generally one can replace the blood, and that’s one of the reasons we don’t lose that many people during childbirth. But there are always cases where we can’t – for instance if the patient has refused blood products (we have quite a few Jehovah’s Witnesses around here that do this), or attempted a home delivery that has gone awry.
Preeclampsia is a bad one, but much worse is when it turns into eclampsia. Flash pulmonary edema, intractable seizures, incredibly bad, hard to control hypertension. These are very, very bad things.
Other causes include disseminated intravascular coagulation caused by retained products of conception or a retained fetus after demise. Another is “obstetric catastrophe” is an amniotic fluid embolus, where amniotic fluid enters the blood. This is extraordinarily bad.
Other causes can include the usual causes of death – sepsis, etc. – which of course all can still happen around childbirth.
This study covers Utah form 95-2000. It is probably fairly representative of the rest of the US.
In order of cause were:
Injury (13, with 5 suicides!)
Pulmonary or amniotic fluid embolism 12
Cardiac 11
Respiratory distress 7
Eclampsia/preeclampsia 5
Malignancy 5
Hemorrhage 4
Infection 3
Undetermined 1
How many American women die in childbirth each year? How about Canadian women? British women? Australian women?
Here you go HeyHomie.
This is a link to the WHO site, where you can download the whole pdf of the 2000 study into Maternal Mortality.
Sample stats.
Adjusted Maternal mortality per 100,000 live births (in no particular order)
Australia: 4
Iceland: 0
Ireland: 5
Canada: 6
Australia: 8
Japan: 10
UK: 13
USA: 17
Israel:17
New Zealand: 7
Netherlands:16
Puerto Rico: 25
Sweden: 2
Mexico: 83
I know it’s none of my business, but are you , or soon to be, pregnant? Is so, I would strongly suggest that you discuss your concerns with your doctor. He/She will be best able to explain the risks that are most likely for your situation and explain his/her plan for each possibility. Pregnancy can be a nerve-wracking thing. It’s okay to be nervous. Talk to your doctor.
For the record, eclampsia can be survived. My wife had eclampsia with our third child. It scared the h*** out of both of us, but she survived. The eclampsia came four days after delivery. The child, however, was stillborn. His loss, however, was probably unrelated to eclampsia/pre-eclampsia.
A good website: The Preeclampsia Foundation .
Eclamptic seizures can also occur up to 3 months post-partum.
I’m not pregnant, and don’t plan to be for a few years, but the thought of dying from childbirth really scares me. I like the idea of an elective c-section, partly to avoid an episitomy, and partly because it seems safer (women in my family have had awful labors, so I’d rather a planned section than 24 hours of labor followed by a section, as my mother had).
I’m sorry for your loss, Drum God, and glad your wife made it through.
Just for clarity: Are we talking about the mother dying or the child?
My sife still has chronic blood pressure issues and has panic attacks that all stem from this experience. However, the blood pressure is easily managed with medication and the panic is something we’re learning to cope with. Both may be solved with weight-loss, which my wife is actively working on. Honestly, I could drop about twenty pounds myself.
Just a few suggestions and things to think about:
[ul]
[li]It’s okay to be nervous. Understand this and embrace it.[/li][li]Share your concerns with your doctor.[/li][li]When it is time to start a family, get pre-natal care. Get the vitamins, etc. Use this time to share your worries with your doctor.[/li][li]Seek the companionship of other new moms. Share your hopes, dreams, and concerns and learn that you’re not alone.[/li][li]Also find moms older than you who have made it through. Your own mom may be a good resource. Your mother-in-law, too.[/li][li]Nature tends to give you the tools you need when you need them. You’re nervous now, while childbearing is an abstract concept. When it’s real, you’ll likely handle it better.[/li][/ul]
That’s about all I can think of right now. Good luck as you plan your future family.
Drum, I’m sorry for your loss.
Lioness:
Awful labor doesn’t mean death. Having been railroaded into an unecessary induction and then C-section, I’d rather take vaginal birth next time around than major abdominal surgery.
A friend of mine had to have a C-section. No doubt about it, had to have it. She survived, but she’s missing the first couple of months post-partum. Gone. In the ICU and hanging around Pedro’s bookstand, and it was friggin luck that saved her - a nurse figured out what just about no one else could about the infection she had that post-surguery caused her to swell up to larger than she had been with child. And lots of my friends were just find affter their c-sections and the VBACers whose ranks I hope to join were, too.
The risks with major abodominal surgery versus vaginal delivery to me (even post-c-section) are much much too high. The general stat I have heard quoted was 5% major complication rate with a c-section versus 1% major complication rate for VBAC. And that overall for most women, vaginal delivery is much safer than a c-section. Yes, there are some women who do need a section; undiscoverd heart shaped or bi-cordinate uterus. Undetected pelvic deformation. 14 pound babies.
General site for birth info:
all my handy info is c-section versus VBAC, sorry.
Some of the myths you might have heard, such as you won’t do as much damage to your pelvic floor or have incontinence problems if you have a c-section aren’t really true - aside from a casual observation among my circle of friends (150 ish) I’ve also read it - no cite yet it’s late. It’s from being pregnant at all.
As was stated before, your practicioner should be able to assess your physical situation and advise you. You can attend classes, listen to hypnobirthing tapes, and look into hiring a doula to help coach you through a very hard process that you seem already a little concerned about. I kick myself every day I didn’t hire one, and am seriously considering one next time through.
Find someone you’re comfortable with. I changed OBs mid-pregnancy (NOT BY CHOICE) and I regret not interviewing much more thourouglhy by then. I was just happy to have an office that would see me within two hours of my scheduled appointment time. Now I’ve been interviewing offices for over a year, and have just found someone I think I can trust my last pregnancy to instead of just cleaning the bathtub and having a home birth (nothing wrong with HB, just a bit riskier for VBAC and out of my comfort zone).
I don’t know your age, but the ‘theory of birth’ such as it has been practiced has evloved a lot in the last couple of decades. If my experience was any indication, you’d be offered a c-section within thirty seconds of dilation to 10 or if you got stuck at any level for 20 min or more. (Possibly a slight) exaggeration. My mom would have probably had at least two c-sections with her kids, based on the practices of today (of course she would have had less worries with her last kid but that’s another story), I betcha.
Your mom, or aunt, or whomever going through the same pregnancy today might have other options. Walking around instead of being “tied” to a bed. Birthing balls. Squat bars, birthing tubs. There are many ways to make birth easier for an average woman. Really.
Good luck.
And even if you do have to have a cesarean, you can have a rewarding birth experience that needn’t be frightening and awful - as Mynn said it all comes down to having a practitioner you can trust. That is to assume you will have a vaginal delivery, and if you really, truly need a cesarean (I did, both times) and then if you do to allow you to maintain as much control over your own situation as you possibly can under those circumstances.
This happened with my first birth when my son suddenly grew too big, turned diagonally and had his head kinked under my hip bone. Labour just did not happen and all the time he was growing and growing. In the end it was a case of “If you haven’t begun labour by Friday, out he comes, and due to the position of his neck, it’s not going to be an induction.”
I got ALL the other wishes on my list - that he was born and held by my husband (they offered him to me but I was in an odd state of nerves/panic and was shaking too much to hold him, so I asked them to hand him to Dad), rooming in from the very moment of the birth - he was never separated from us apart from an hour or so in the morning when the pediatrician came, on demand feeding, no sugar water or nipples of any kind, and the best of all, my husband stayed in our room for five days so he spent the entire time with his baby in the bed with him or stuffed down Dad’s shirt. A very happy, calm baby ensued.
Make a list of what you want for a birth (when the time comes!) and then separate them into non-negotiable, really would prefer, and would like this categories. Go hospital shopping and find the one that most closely matches your wishlist. (Within the restraints of your available facilities, insurance and budget of course.)
Don’t worry - every single person you see had a mother, and pretty much all of them survived the birth experience.
Drum God- I’m sorry for your loss and hope your wife makes a full recovery soon.
Little Lioness if you look into the USA maternal mortality stats in detail, you will see that they are much higher in non-white women, women from lower socio-economic groups and women who have not had good preconceptual health or prenatal care.
The best thing you can do for yourself is to get yourself healthy, talk to your doctor before you get pregnant, plan your pregnancy, and see a doctor frequently during your pregnancy.
Every obstetrician’s worst nightmare is an obese/malnourished, unwell women who arrives at a hospital in labour or bleeding heavily, with no idea of her dates, no idea of the health or position of her baby and no antenatal care whatsoever. Do your utmost not to be that woman and you’ll be OK.
Some Ob’s have lower thresholds for intervening than others- in the Dublin hospital where I did my Ob/Gyn rotation (I’m a med student) they practised managed labour. That means no-one (and I mean no-one) labours for more than 14 hours unless delivery is imminent at 13 hours. No-one at that hospital delivers a breech vaginally if it is their first baby, and no-one delivers a baby over 10lbs vaginally. However, everyone suitable for VBAC, attempts VBAC and they don’t do purely elective sections (i.e. there has to be a reason for the section other than maternal preference).
Find someone simpatico- someone who has the same ideas about what are acceptable risks and what are not acceptable risks as you do. Chances are you and your baby will be perfectly healthy anyway, but you’re more likely to be happy with your birth experience if you and your doctor are on the same page.
Thanks, all, for the kind words. I feel kind of like I partially hijacked this thread with my sad story and that wasn’t at all what I wanted to do. Our experience was nearly three years ago. It is something that does not really leave you, but there it is. My wife’s recovery is fine. It is possible that the blood pressure issues would have happened without the pregnancy. It may also be weight-related.
I like Irishgirl’s answer. Find a doctor who has similar values as yours. Understand his/her plans for a wide variety of problems/issues. As the pregancy continues, pay attention to your body. If you feel something is wrong, talk to your doctor.
Best wishes on a grand adventure. Eventually, your child will be sixteen and you’ll be back here with a whole bunch of new issues. I swear, sometimes I worry my daughter won’t make it to seventeen! 