Saving Mothers' Lives: - Public Health Agency for Northern Ireland

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1 Which mothers died, and why
age. These are also discussed in Annex 1 to this Chapter – The changing face of motherhood in the UK.
The fact that the rate is not falling means that there are no grounds for complacency and highlights the
necessity for further vigilance and the need for these Reports to continue.
Improved case ascertainment
A cross check between death certifi cates and the Offi ce for National Statistics (ONS) record linkage study,
described in the introduction of this Report, shows that virtually all Direct and Indirect maternal deaths were
identifi ed and assessed. Improved case ascertainment, therefore, is unlikely to account for the lack of decline.
Older mothers with health problems
As discussed in more detail in Annex 1 to this Chapter, factors such as an increase in the mean age of
childbirth and a rise in risk factors such as obesity means more mothers are likely to have complicated
pregnancies than in the past. Anecdotally obstetricians and midwives are regularly reporting they are
seeing larger numbers of, older and less healthy mothers.
Increases in numbers of births to migrant women
Since the previous triennium the percentage of births which were to mothers born outside the UK has
increased. There has been a corresponding increase in deaths amongst women arriving in the UK in poor
health. Compared to the last Report an additional 19 Direct maternal deaths occurred in recently arrived
women who were either new migrants, refugees, asylum seekers or ‘health tourists’ who had travelled to
the UK specifi cally to seek maternity care. For the fi rst time several maternal deaths occurred amongst
recently arrived women from the new member states of the European Union; these women too tended to
be in poorer general health.
Excluding refugees and asylum seekers from the numbers of maternal deaths, as shown in Table A1.3 in
the Annex to this Chapter, the mortality rate for 2003-05 was 12.25 per 100,000 maternities, compared with
12.47 per 100,000 maternities in 2000-02. This difference is not statistically signifi cant.
Changes in standards of clinical care
Since the last Report there has been no appreciable increase, or decrease, in the proportion of maternal
deaths assessed as having avoidable factors. However, the assessors were struck by the lack of
some health professionals’ skills in identifying and managing common medical conditions or potential
emergencies outside their immediate area of expertise. Resuscitation skills were also considered poor in
quite a few cases. Although these messages were identifi ed in the last Report, this lack of knowledge and
skills seemed more prevalent in this Report.
Deaths in pregnant women or new mothers up to one year after delivery which were not due to,
or affected by, pregnancy
In order to ascertain which deaths that occurred in pregnant or recently delivered women were directly or
indirectly related to their pregnancy, and thus are of importance to this Enquiry, it was necessary to fi rst
assess the cases of all mothers who died whilst pregnant or within a year of their delivery, from whatever
cause. The majority of deaths, once assessed, were found to be unrelated to pregnancy e.g. road traffi c
accidents or deaths from cancers. These fall into two broad categories; Coincidental and Lateii . By
international convention these do not contribute to the statistics used to calculate the UK maternal mortality
rate determined by this Enquiry.