Steep rise of complications in childbirth spurs action

Giving birth has gotten riskier.

Hospitals and public health officials are working to improve safety for mothers in the delivery room following sharp increases in the rate of severe complications from childbirth. Emergencies during delivery, such as cardiac arrest, respiratory distress and kidney failure, increased by 75 percent in the decade ended 2009, according to a new study by the federal Centers for Disease Control and Prevention. In the days immediately following delivery, severe complications for women more than doubled over the same time period.

Some type of pregnancy or delivery complication occurs during many of the more than four million births annually in the U.S., but most aren't life-threatening. Severe complications affect a total of about 52,000 women a year.

A big reason for the increase is the number of pregnant women who are older, obese, or have chronic conditions such as diabetes and kidney disease that put them at higher risk. But healthy women, too, can experience major complications such as severe bleeding, or hemorrhage, which is the most common cause of death after childbirth.

A nearly 60 percent increase in the rate of Caesarean-section delivery since 1996 is associated with a sharp increase in a condition known as placenta accreta, in which the placenta grows into the uterine wall through a surgical scar, and can cause severe hemorrhage after delivery.

"There is a clarion call now to address the problem of maternal complications," says William Callaghan, chief of the CDC's maternal and child health bureau and lead author of the recent study. "Regardless of age or health, when things go wrong they can go south very fast, and you need a well-oiled team trained to respond in times of crisis.

"Many safety-improvement programs in the past have focused on preventing harm to infants. Now, experts are calling for an equal emphasis on the mother. The CDC is funding programs in a number of states to establish guidelines and protocols for improving safety and preventing injury.

And obstetrics teams are holding drills to train doctors and nurses to rapidly respond to maternal complications. They are using simulated emergencies that include fake blood, robots that mimic physiologic states, and actresses standing in as patients.

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