It's Now More Dangerous to Give Birth in California Than It Is in Kuwait or Bosnia

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 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, it’s more dangerous to give birth in California than it is 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. “That’s what’s shocking.”

The problem may be occurring nationwide. The Joint Commission, the leading health care accreditation and standards group in the United States, issued a “Sentinel Event Alert” to hospitals on Jan. 26, stating: “Unfortunately, current trends and evidence suggest that maternal mortality rates may be increasing in the U.S.” 

The alert asked doctors to consider morbid obesity, high blood pressure and diabetes, along with hemorrhaging from C-sections, as contributing factors.

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. He organized academics, state researchers and hospitals to conduct a systematic review of every maternal death in California. 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.”

Main said scientists have started to ask what doctors are doing differently. And, he added, it’s hard to ignore the fact that C-sections have increased 50 percent in the same decade that maternal mortality increased. 

The task force has found that changing clinical practice could prevent a significant number of these deaths.

“This could be a sentinel finding, and I could see other states taking a closer look and finding the same thing,” said Dr. Thomas R. Moore, chair of the Department of Reproductive Medicine at UC San Diego. Moore was not involved in the report.

Low numbers, high consequences

Despite the increase in deaths, pregnancy is still safe for the vast majority of women.

In 2006, 95 California women died from causes directly related to their pregnancies – out of more than 500,000 live births. That’s a small number by public health standards. If California had met the goal set by the U.S. Department of Health and Human Services to bring the state’s maternal mortality rate down to a level achieved by other countries, the number of dead would be closer to 28. (See California maternal mortality rate chart here.)