More women are dying related to their pregnancies than in years past. While the maternal mortality rate in the U.S. - and in Ohio - is on the rise, most European counties tout much lower numbers. WOSU got some answers on what's behind the increase.
The numbers are startling. Ohio's maternal death rate has more than doubled over the past 2 decades - up 138 percent. Nationally, the maternal mortality rate increased 33 percent since 1990.
Ohio's and the United States' rates are double and even triple the rates of some European countries.
In Ohio, for every 100,000 births, 15 mothers die. Only Albania, Estonia, Moldova, Russia, Romania, Turkey and Ukraine have higher rates. The national maternal death rate is 13 deaths per 100,000 births. Ohio and the U.S. are on par with Serbia.
While the maternal death rate can fluctuate significantly from year to year, Ohio's rate has been steadily rising. And for every death, experts say they are 50 life-threatening near misses.
Maternal Mortality does not necessarily mean a woman died during labor; it includes deaths related to pregnancy or other obstetric causes.
Some suggest the changes in record keeping have account for the increases. Take 2007, for example. The state added new questions about pregnancy to its death certificate - asking if the woman had been pregnant within a certain time period. That year, Ohio saw its maternal death rate quadruple.
Doctor Cynthia Shellhass directs the Ohio Department of Health's Bureau of Child and Family Services. She's also associate professor of Maternal Fetal Medicine at the Ohio State University Medical Center.
"Some of it certainly may be due to the identification of cases," Shellhass said.
But Shellhass suggested better record keeping is not the sole reason behind the increases. She says, overall, women are higher risk these days. And who's getting pregnant also is changing.
"Number one, we see more older women getting pregnant. And as women age they're more likely to have chronic diseases like hypertension and in particular in diabetes and other things that would place them at risk in a pregnancy, as well as higher risk of obesity which could potentially be risk factors," she said.
The CDC's Chief of Maternal and Infant Health, Doctor William Callaghan, said it's difficult to pinpoint the exact cause for the higher numbers because maternal mortality is still relatively rare. In his words "they're doing some intelligent speculation."
"To what extent that is an actual real increase, and to what extent it is that we are getting better at finding maternal deaths is a little bit difficult to say," Callaghan said.
California's maternal mortality rate has nearly tripled in the last decade. And the state can say for sure that its increase is not related to changes in reporting. A team of academics, state researchers and hospitals reviewed every maternal death in California and found changes in population - and paperwork - could not completely account for the increase. The study's principal investigator, Dr. Elliott Main said, "it's hard to ignore the fact that C-sections have increased 50 percent in the same decade that maternal mortality increased."
In Ohio, and around the country, nearly one in three babies is delivered via Cesarean section. Since 2001, in Ohio, there has been a 50 percent increase in the number of first-time mothers receiving C-sections.
The ODH's Cynthia Shellhass says the rising obesity rate and voluntary inductions are increasing the C-section rate. And she said the more C-sections a woman has, the greater the risks of hemorrhaging. A 1997 report from the CDC looked at the deaths of more than 1,400 women over a four year period. The study found that hemorrhaging was the immediate cause of death for 29 percent of the women. The CDC's William Callaghan said it's difficult to say if there is a link between C-sections and the rising maternal mortality rate.
"If you can get rid of all the predisposing factors in those women and you could find this group of totally healthy women who died because of a complication of their Cesarean section that would answer the question. Those data are very, very difficult to get at," he said.
Right now, Ohio does not have a Maternal Mortality Review Team to closely look at every maternal death. Health officials hope a grant will fund one. Shellhass said, until Ohio gets a review team, no one will know for sure what is at the root of the increase.
"But looking at California's experience, when they examined their data, they found that their increase over the last ten years in (maternal) mortality was not related strictly to the change in ascertainment. And so I'm suspicious that we would find the same thing, but I don't know that," Shellhass said.