Today, the MBRRACE-UK collaboration, led from Oxford Population Health's National Perinatal Epidemiology Unit (NPEU), has published the results of their latest UK Confidential Enquiry into Maternal Deaths and Morbidity. These annual rigorous reports are recognised as a gold standard in identifying key improvements needed for maternity services; this year marks the 70th anniversary of confidential enquiries into maternal deaths in the UK, and the 10th anniversary of the MBRRACE-UK-led enquiries. The latest Saving Lives, Improving Mothers' Care analysis examines in detail the care of all women who died during, or up to one year after, pregnancy between 2018 and 2020 in the UK. This is the first report to include data that demonstrates the impact of the COVID-19 pandemic on maternal deaths.
The report's key findings show that:
229 women died during or up to six weeks after the end of their pregnancies in 2018 – 2020 from pregnancy-specific causes or conditions made worse by pregnancy, an increase of 24% compared to 2017-2019.
Taking into account their surviving babies and previous children, 366 motherless children remain.
Of the 229 women who died during or up six weeks after the end of their pregnancies, nine women died from COVID-19. Of those nine women, five were Asian women and three were Black women. Changes to maternity services and pressures because of the pandemic also contributed to some other maternal deaths.
Black women were 3.7 times more likely to die compared to White women and Asian women were 1.8 times more likely to die compared to White women.
A further 289 women died between six weeks and one year after the end of pregnancy.
Including the deaths of 18 women who died during pregnancy or up to six weeks after pregnancy which were classified as coincidental, in total, there were 536 maternal deaths among 2,101,829 maternities.
One in nine of the women who died had experienced severe and multiple disadvantage. The main elements of a multiple disadvantage were: a mental health diagnosis; substance misuse; and domestic abuse. The report notes that the figures reported are likely to be a minimum estimate due to inconsistencies in reporting these types of disadvantage.
Women were three times more likely to die by suicide during or up to six weeks after the end of pregnancy in 2020 compared to the 2017 – 2019 report. Maternal suicide was also a leading cause of death in women between six weeks and a year of their pregnancies ending, accounting for 18% of the women who died between 2018 and 2020.
At least half of the women who died by suicide and the majority from substance misuse had multiple adversity with a history of childhood and/or adult trauma frequently reported.
Cardiovascular disorders and psychiatric disorders are now equally responsible for maternal deaths in the UK, accounting for 30% of the women who died up to six weeks after the end of pregnancy; in previous reports, cardiovascular disorders have been reported as the leading direct cause of maternal death.
86% of the women died in the postnatal period.
The report demonstrates that even when the women who died as a result from COVID-19 are excluded, the number of women who died has still increased by 19% compared to 2017 – 2019, suggesting that an even greater focus on the report's recommendations for improvements to maternal healthcare are needed.
Marian Knight Professor of Maternal and Child Population Health at Oxford Population Health, who led the study, said
There is a widening gap in outcomes for women who live in the most deprived areas compared to those who live elsewhere. In addition, there is a concerning rise in maternal suicide deaths. Many women who died had multiple disadvantages, health and social problems. It is critical that health professionals and service providers recognise and respond to the individual needs of all women during and after their pregnancies, and that sufficient resources are available to enable appropriate care across all services. This latest report shows that urgent action needs to be taken across the maternity system in its widest sense to ensure that this worrying increase in maternal deaths is reversed.
The more than three-fold difference in maternal mortality rates amongst women from Black ethnic backgrounds and almost two-fold difference amongst women from Asian ethnic backgrounds compared to white women and the continued increase in maternal deaths in women who live in deprived areas further emphasises the need for a continued focus on action to address disparities in maternal care.
In addition, the report highlights that it is vitally important that all maternal health services recognise the importance of recording trauma histories and involving specialist perinatal mental health teams if women have a history of involvement with secondary mental health services or risk, especially when they are experiencing their first pregnancy. The report further recommends that maternal healthcare staff must be alert to factors such as stigma, fear of child removal, or barriers that may influence a lack of willingness to disclose symptoms of mental illness, thoughts of self-harm, or substance misuse.
To find out more, download the full report, lay summary and infographic from the NPEU website.