Serious birth complications rising in the U.S

Severe complications from childbirth are rare in the U.S., but they are becoming more common, a new government study finds.

Between 1998 and 2009, the rate of serious complications like heart attack, stroke, severe bleeding and kidney failure during or after childbirth roughly doubled among U.S. women, according to researchers at the Centers for Disease Control and Prevention (CDC).

In 2008-2009, there were 129 cases of severe complications for every 10,000 women who delivered in a hospital. That was up 75 percent from a decade earlier.

At the same time, complications during women's post-delivery hospital stay also rose: There were 29 cases for every 10,000 women - up 114 percent from 10 years before.

Serious complications and deaths from childbirth are still uncommon in the U.S. Over four million women give birth each year, and this study found about 590,000 cases of severe complications over 11 years.

"We don't want to send the message that pregnant women should be afraid," said Dr. William M. Callaghan of the CDC, who led the study.

With this type of study, which used discharge records from U.S. hospitals, it's not possible to tell why childbirth complications rose, Callaghan said.

But it's "well-documented" from other research that more women are giving birth at older ages, are obese, or have certain health conditions like high blood pressure and diabetes, he added.

There are also more young women with serious conditions, like congenital heart defects, who are surviving and having children.

During the same study period, increases in the U.S. cesarean delivery rate and in the proportion of pregnant women with chronic conditions, postpartum hemorrhage, obesity, multiple births, and advanced maternal age have been documented. Against the backdrop of increases in numbers of women with high-risk conditions, a call for returning the "M" to maternal-fetal medicine has been made.2 Given this context, a more nuanced review of cases is needed to identify modifiable risks and develop best practices to deal with risks that might not be modifiable. Approximately 5,600 women died during a delivery or postpartum hospitalization during the period covered in this report. Although deaths are the most tragic events in obstetrics, our estimates suggest that severe maternal morbidity is on the order of 100 times more common. On an annual basis, with approximately 4,000,000 births in the United States, 129 episodes of severe maternal morbidity will affect approximately 52,000 women. Expanding the focus to what lies below the tip of the iceberg is needed, and we offer a comprehensive construct as a starting point for investigation. The information provided in this report has the potential to be used for clinical reviews, development of quality-of-care indicators, and identifying future research priorities in obstetrics.