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NYC's high maternal deaths defy usual explanations

RITA HENLEY JENSEN | 5/25/2011, 9:24 a.m.

The World Health Organization's recommendation is that no more than 15 percent of all births should be C-sections.

LACK OF PRENATAL CARE

The lack of prenatal care, even in a city with public hospitals and clinics, played a definitive role in the maternal mortality rate. The 2010 report indicates that 51 percent of those who died had "adequate or adequate plus" medical care while they were pregnant. This data was not broken down by race or ethnicity.

Of the mothers who died as a result of a pregnancy, the city's report found that 58 percent were African-American. That's an outsized statistic on its own, but even more glaring against the minority status of Black women, who represent only 24 percent of all births.

Ten percent of the pregnancy-related deaths were white women, who represent 30 percent of all births.

Hispanic and Asian-Pacific Islander women, who represent 45 percent of all those who gave birth, died at twice the rate of white pregnant women but at significantly lower rates than Black women.

Physicians, researchers, academicians, midwives and public health experts agree: Most of these deaths are preventable.

Obesity among those who died was emphasized in the city's official statements about the implications of the health department study. Pre-existing conditions have been the subject of significant research, and poverty and lack of maternal health care are often linked by maternal health activists to high maternal mortality rates.

However, the data in the city's report indicate that the medical community might have to look further than these usual suspects and ask themselves what more can be done by medical providers to save women's lives, particularly African-American women.

OBESITY FACTOR

Obesity was the maternal mortality factor that the city's press release on the report focused on, keeping in line with Mayor Michael Bloomberg's health agenda. In the study, 44 percent of the white pregnant women who died were obese. The obesity rate was 60 percent in the case of African-American women--an imbalance, but not one sufficient to explain the vast difference between the percentage of white women and African-American women who die of pregnancy-related causes.

At the same time, this data suggest obesity could be a bigger risk factor for Black women. However, the lack of information on the percentage of C-sections among Black women who died prevents a real finding.

The report also indicates that obese pregnant women with two or more previous births were at the highest risk, responsible for 60 percent of deaths. This data was also not broken down by race and ethnicity.

In fact, the report does not make clear the connection, if any, between C-sections and the mortality rates of obese women.

Carol Sakala, director of programs for Childbirth Connections, a national nonprofit organization based in New York City dedicated to improving the quality of maternity care, said during an interview that she was concerned that obese women were "tricked" into having C-sections despite the risks.

She acknowledges that it might be more difficult for medical personnel to assist an obese woman giving birth, but, given the alternative, she argues that more effort should be made.