Maternal Mortality: Everything You Need to Know
By: Jordan Atkins
Edited by: Francine nori Oblero
Introduction
Childbirth is a miracle of life. When you’re expecting a child, thinking about your future with your baby can be really exciting. Despite all the wonderful things that can come with pregnancy and delivery, there are many things that can go wrong, some even leading in death. Despite the quality health care we see in delivery rooms in developed countries, knowing the risks that come along with childbirth and life postpartum is still extremely important. Not only knowing the risks for friends and family members, but to know the complications that carriers alike in third world countries battle for their lives with everyday. Here is everything you need to know about maternal mortality.
What is Maternal Mortality?
Maternal mortality is the death of a carrier due to anything related to childbirth or pregnancy. Death in carriers and expecting carriers can occur at any time during the pregnancy, labour or childbirth, or even up to 42 days after giving birth, as well as up to 42 days after an abortion. Hundreds of thousands of maternal deaths occur annually worldwide due to some of these (very) preventable causes. These causes can range from inadequate healthcare, poor health of the carrier, to even insufficient education.
The Main Causes of Maternal Mortality
Postpartum Hemorrhage
Postpartum hemorrhage is the abnormal and excessive bleeding that can occur after delivering a baby. Blood after childbirth is absolutely normal, but postpartum hemorrhage occurs when there is extreme blood loss from the carrier.
Postpartum hemorrhage typically occurs after a cesarean section, and after the placenta (otherwise known as the afterbirth) has been delivered. After delivery of the baby, the uterus usually continues to expand and contract so that the placenta may be delivered. According to The Children’s Hospital of Philadelphia, when the uterus contracts strongly enough, it helps to compress the bleeding vessels in the area the placenta was attached. When these contractions of the uterus are not strong enough, these blood vessels are able to bleed freely. This failure to contract is known as uterine atony. Other causes of postpartum hemorrhage can include:
A hematoma (mass of blood) that can occur in a hidden tissue space in the pelvis
Blood clotting disorders
A tear in the cervical or vaginal tissues, blood vessels, or uterus
Who is at risk for postpartum hemorrhage?
The following risk factors can increase your chances of postpartum hemorrhage:
An over-distended uterus (larger than normal uterus)
Hypertensive disorders during pregnancy
Abnormalities in the positioning of the placenta.
What is the treatment for postpartum hemorrhage?
Doctors will diagnose postpartum hemorrhage by checking blood pressure of the carrier, and estimating blood loss (1000mL+). Stimulating contractions of the uterus (manually by hand or through medications) is a common way to try to treat postpartum hemorrhage.
Eclampsia and Hypertension
Eclampsia is a complication of severe preeclampsia. Preeclampsia causes changes to blood vessels and arteries (making them “leaky” arteries or narrower), which can result in decreased blood supply to the baby, and several organs in the carrier’s body. Preeclampsia usually occurs in the 20th week of pregnancy, but the exact cause of it is unknown. When preeclampsia is severe, it can result in eclampsia, which is when newly onset seizures occur in the carrier unrelated to a brain disorder. It is hypothesized that preeclampsia is a result of abnormal placenta development.
Who is at risk for preeclampsia?
The following factors can increase your chances of developing preeclampsia:
Obesity
High blood pressure
Autoimmune disorders
Family history of preeclampsia
What are the symptoms of eclampsia?
The following can be a result of eclampsia, some cases being deadly:
Blood clotting problems
Premature delivery of the baby
Infant death
Placenta separation
Kidney and liver failure
Stroke
What is the treatment for eclampsia?
The best way to treat preeclampsia is to deliver the baby, premature delivery may be required if conditions worsen. Anti-seizure medications and medications to lower blood pressure can also be given to carriers with eclampsia.
Infection and Sepsis
Infections are common after surgeries, and are more likely to occur in carriers with cesarean sections than vaginal deliveries, though infections can occur in both procedures.
What are some postpartum infections?
Postpartum infections pertaining to the uterus include:
Endometritis
Myometritis
Parametritis
Breast infections can also occur postpartum.
What can postpartum infections cause to the carrier?
Not only can infections happen postpartum, but they can also occur after an abortion, especially an unsafe or non-sterile abortion. Infections postpartum, and infections in general can become deadly. When your body has an infection, your immune system tries to fight it off. But what happens if your immune system stops fighting the infection and instead turns on itself? This is when sepsis occurs.
What is sepsis?
Sepsis is the body’s life threatening, toxic, inflammatory response to an infection. Sepsis can progress to cause tissue damage, organ failure, and death. This condition can advance from sepsis, to severe sepsis, to septic shock which causes life threatening conditions in your body.
What are the symptoms of sepsis?
Despite the many possible maternal infections that can occur, sepsis can be difficult to diagnose after delivery as many postpartum changes in your body are also common symptoms of sepsis, such as:
Changes in blood pressure and breathing
Chills
Heavy sweat
Dizziness
Lightheadedness
What is the treatment for sepsis?
Sepsis is a deadly and medical emergency that needs to be treated immediately, hence why postpartum infections can become deadly.
Unsafe Abortions
Every carrier should have the right to choose whether they want to have an abortion or not, and the access to a safe abortion if that should be the case. Unfortunately, the legality of abortions in some countries, or the lack thereof for better terms, results in many, many unsafe abortions that can result in death.
What are the side effects of unsafe abortions?
The following are issues that unsafe abortions can lead to:
Infections and sepsis
Organ damage
Hemorrhage
Genital trauma
Necrotic bowel (deadly)
Infertility
Many of the side effects of these abortions have and will continue to kill many carriers.
How are unsafe abortions performed?
The illegality of abortions, especially in developing countries, lead carriers to turn to other options such as attempting abortions themselves. The following are methods that have been used for unsafe abortions:
Drinking bleach and mixtures that have livestock manure in them
Doing dangerous physical activities to cause severe trauma to the abdomen (many of which can put their life on the line)
Injury to the vagina and cervix directly such as placing foreign objects like twigs and coat hangers into them, and even forcing a chicken bone into the uterus.
These are just some of the examples that can result in fatality, and the physical impacts alone can be deadly.
Ectopic Pregnancies
Ectopic pregnancies occur when implantation occurs outside of the uterus, usually occurring in the fallopian tubes but sometimes even in the abdomen. Ectopic pregnancies can not result in a baby being born, because a baby can not survive in the fallopian tubes like it does a uterus. Ectopic pregnancies can be dangerous if not treated and is the leading cause of first trimester death.
What is the treatment for ectopic pregnancies?
If gone untreated by medically stopping the baby’s growth, or surgically removing the baby, then these pregnancies can stretch the fallopian tubes to the point of breaking. Otherwise known as a ruptured ectopic pregnancy, this can lead to internal bleeding, infection and sepsis, and death. These pregnancies account for a total of approximately 10% of maternal mortalities.
Statistics on Maternal Mortality
According to the World Health Organization:
In 2017 the maternal mortality rate was 810 deaths per day
Females aged 10-14 are at a higher risk for maternal mortality than other women
The causes of maternal mortality listed above (postpartum hemorrhage, eclampsia and high blood pressure disorders, unsafe abortions, infections and sepsis, ectopic pregnancies) account for 75% of all maternal mortalities
94% of all maternal deaths come from low income and medium to low income countries
Maternal mortality rates in low income countries is 462 per 100,000 live births compared to the 11 per 100,000 live births that we see in developed countries
Why are Carriers from Developing Countries at such a High Risk of Maternal Mortality?
It is undoubtedly clear that there is a huge difference between maternal mortality rates in developed and developing countries. This is because women in developing countries are more likely to receive inadequate health and prenatal care.
This could be due to:
Poverty
Distance to an adequate health care facility
no adequate health care facilities at all
lack of doctors, midwives, nurses, emergency services, or antibiotics at said facilities.
Cultural beliefs, religion, and laws also largely impact maternal mortality, specifically abortion laws, resulting in unsafe, illegal abortions being done and harming carriers greatly.
It stems deeper than inadequate healthcare facilities though. Less or no education due to gender inequality and insufficient funds also play a huge role in maternal mortality in developing countries. It is a common trend in demographics that the more education a group of women receive, the less children they will have, and the later in life they will have them.
This is significant because having more than five childbirths can lead to complications while giving birth, increasing the chance of mortality. It is important to note as well that young carriers from 10 to 14 years old having children are not only more likely to end in fatality than older carriers, but in having a long lasting psychological impact on them and their baby.
A lack of access to contraceptives and adequate sexual education is also a huge factor in maternal mortalities, due to unsafe abortions from unexpected pregnancies, as well as fatalities from complications in young pregnancies. This is why access to proper education can quite literally save thousands of lives yearly, in terms of maternal mortalities alone. All these factors result in the huge difference in developed countries’ mortality rates, and underdeveloped countries’ mortality rates.
In Summary
In summary, maternal mortality is not as common in developed countries, but is still extremely important to learn about, as well as how and why these fatalities can occur. It is even more so important to learn about the socioeconomic and social injustice factors that do lead to so many maternal fatalities in developing countries, and how impactful these social injustices are on women’s health.
Works Cited
Danielsson, Krissi. “Get the Stats on Ectopic Pregnancies.” Verywell Family, Dotdash, 2
Donna Murray, RN. “Chances of Dying in Pregnancy and Childbirth Around the World.”
Verywell Family, 5 June 2019, www.verywellfamily.com/maternal-mortality-rate-causes-
“Eclampsia: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of
Medicine, 27 Jan. 2020, medlineplus.gov/ency/article/000899.htm.
Haddad, Lisa B, and Nawal M Nour. “Unsafe Abortion: Unnecessary Maternal Mortality.”
Reviews in Obstetrics & Gynecology, MedReviews, LLC, 2009,
“Maternal Mortality.” World Health Organization, World Health Organization,
“Preeclampsia.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 19 Mar.
Publishing, Harvard Health. “Preeclampsia And Eclampsia.” Harvard Health,
Sepsis Alliance, 26 Dec. 2020, www.sepsis.org/.
The Children's Hospital of Philadelphia. “Postpartum Hemorrhage.” Children's Hospital of
Philadelphia, The Children's Hospital of Philadelphia, 24 Aug. 2014,
