A very pregnant Akira Eady, 21, lived in New York City in 2007 with her two young children. With a regular job, private health insurance and a partner who was the father of her other two children, she had every right to expect the birth of her third child to go smoothly.

Instead, Eady died shortly after giving birth at Mount Sinai Medical Center, one of New York City’s most prestigious hospitals. Her infant lived. The official cause of death of the this African-American mother of three, as recorded by the New York City medical examiner, was heart failure after post-partum seizures.

Eady’s aunt, Carole Eady, recounted recently that her niece bled heavily after receiving an epidural to ease the pain of labor. After giving birth, she complained of headaches. Nevertheless, the hospital released her. Two days after giving birth, she had a seizure and then a heart attack. She was brain dead four days after giving birth.

Carole Eady, now raising Akira’s oldest daughter in her Harlem home, acknowledges that her niece’s partner might have played a role in her death by hitting her on the morning of her seizure, but she feels strongly that the hospital staff did not properly administer the epidural or respond to her complaint of headaches.

Mount Sinai’s press officer was unable to comment on Eady’s death because of the state’s privacy laws.

20 DEATHS IN 2007

Eady was one of the city’s 20 African-American new mothers who died in 2007 as a result of a pregnancy gone wrong. With the absolute numbers of African-American births in New York city dropping, the city’s vital statistics reports state that African-American women had a maternal mortality ratio of 68.7 (the number of deaths if 100,000 women had given birth) in 2007.

The following year, 22 African-American women died in New York City from “pregnancy-related causes,” for a maternal mortality ratio of 78.8.

Dr. Jo Ivey Bufford, president of the New York Academy of Medicine and a researcher in maternal mortality, estimates that 45 percent of these deaths are preventable.

In New York City in 2008, two white women died during pregnancy and childbirth, for a maternal mortality ratio of 5.1. The following year, four white women died for a maternal mortality rate of 10.4, according to the New York City vital statistics reports.

Going beyond the data that is routinely gathered, New York’s health department issued a report on maternal mortality for the city in the years 2001 to 2005 that provides an unprecedented level of detail about which women die and how.

The findings drew no conclusions about how to lower the high rate of maternal deaths in New York–among the highest in the nation–and among African-Americans.

But the city’s report does detail the high risk of Cesarean sections. The New York study found that a whopping 79 percent of all mothers who died of pregnancy-related causes gave birth via C-section. In addition, other reports from New York City’s health department indicate a consistent rise in C-sections in the city, from 25.8 percent of all births in 1997 to 34.4 percent–more than a third–of all births in 2008.

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.

POVERTY

While obesity proved an inconclusive factor in the maternal mortality disparities, poverty, which is often raised as a possible explanation, was apparently not a primary factor in the city’s mortality rate or the high rate among African-American women.

Pregnant women who had private insurance and those insured by Medicaid–government insurance for those with low incomes–had similar maternal mortality rates, the report found.

THE AGE FACTOR

A chart in the city report indicates that maternal mortality hit a low between the ages of 20 and 24, rose by 10 percentage points after age 30 and doubled after age 40.

Older age is a long-established medical risk factor in pregnancy but Sakala pointed out a less-noted suspicion. She said she was concerned that the high number of deaths among older mothers might reflect that the women underwent multiple Cesarean sections

“Each C-section a mother has is more dangerous,” she said.

PRE-EXISTING CONDITIONS

As for the final usual suspect, pre-existing conditions; according to the New York City report, of the mothers with pre-existing conditions who died, 56 percent were white and 58 percent were African-American. (Of the Hispanic women who died, 60 percent had pre-existing conditions; of the Asian women, 28.6 percent did.)

In other words, pre-existing conditions played a similar role in Black and white pregnancies and didn’t account for demographic differences in the rate of maternal deaths.

Why exactly is pregnancy and childbirth so much more dangerous for African-American women than white women in New York and nationally?

Dr. William M. Callaghan is acting chief of the maternal and infant health branch of the Atlanta-based Centers for Disease Control and Prevention’s division of reproductive health.

He has published research that demonstrates that throughout the United States white and Black women have similar levels of pre-existing conditions during their pregnancies.

Despite this, Callahan’s research has found that for the past five decades Black women have consistently suffered an almost four-times greater risk of death from pregnancy complications than have white women.

The higher risks, he wrote in a 2007 paper published in the American Journal of Public Health, are also independent of age, number of births or education.

“Why this is true,” Callahan said in a recent telephone interview, “is what I ask myself when I wake up at 3 a.m. and am staring at the ceiling fan.”