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NATHANAEL JOHNSON
The mortality rate of California women who die from causes directly related to pregnancy has nearly tripled in the past decade, prompting doctors to worry about the dangers of obesity in expectant mothers and about medical complications of cesarean sections.
For the past seven months, the state Department of Public Health has declined to release a report outlining the trend.
California Watch spoke with investigators who wrote the report, and they confirmed the most significant spike in pregnancy-related deaths since the 1930s. Although the number of deaths is relatively small, the rate in California is higher than in Kuwait or Bosnia.
"The issue is how rapidly this rate has worsened," said Debra Bingham, executive director of the California Maternal Quality Care Collaborative, the public-private task force investigating the problem for the state.
The problem may be occurring nationwide. The Joint Commission, the leading health care accreditation and standards group in the United States, issued an alert to hospitals on Jan. 26, stating: "Unfortunately, current trends and evidence suggest that maternal mortality rates may be increasing."
To help improve care, the advisory asked doctors to consider morbid obesity, high blood pressure and diabetes, along with hemorrhaging from C-sections, as contributing factors to deaths.
In 2007, the U.S. Centers for Disease Control and Prevention reported that the national maternal mortality rate had risen. But experts such as Dr. Jeffrey C. King, who leads a special inquiry into maternal mortality for the American College of Obstetricians and Gynecologists, chalked up the change to better counting of deaths. His opinion hasn't changed.
"I would be surprised if there was a significant increase of maternal deaths," said King, who has not seen the California report.
But Shabbir Ahmad, a scientist in California's Department of Public Health, decided to look closer. In 2006, he organized academics, state researchers and hospitals to conduct a systematic review of every maternal death in California from 2002 to 2006. It's the largest state review ever conducted. The group's initial findings provide the first strong evidence that there is a true increase in deaths - not just the number of reported deaths.
Changes in the population - obese mothers, older mothers and fertility treatments - cannot completely account for the rise in deaths in California, said Dr. Elliott Main, the principal investigator for the task force.
"What I call the usual suspects are certainly there," he said. "However, when we looked at those factors and the data analyzed so far, those only account for a modest amount of the increase."
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