Understanding Maternal Mortality: Causes and Prevention

When Mira first learned about maternal mortality, the thought unsettled her. She’d always heard childbirth was a beautiful experience, but the risks lingered in her mind, casting a shadow over her excitement. But she didn't stop there but instead dove into finding out more. Talking to her gynaecologist and understanding the factors, preventive care, and signs to watch for helped her regain confidence and realise that informed choices could make all the difference. Armed with knowledge, she felt prepared to take on motherhood with a renewed sense of strength and calm.

Maternal mortality is a devastating reality that affects many women and families around the world. It is one of the most severe complications of childbirth and labour-related concerns. It refers to the death of a woman during pregnancy or within 42 days after the termination of pregnancy, resulting from complications related to the pregnancy or its management.

Maternal death remains a frequent occurrence for countless families, particularly in low and lower-middle-income communities. In India, the maternal mortality rate serves as a sobering wake-up call, highlighting the urgent need for action and change. Let's  understand the causes of these preventable deaths so we can strive for a future where no woman has to die while bringing new life into the world.

Among the leading causes of maternal death are heart disease and stroke, with cardiomyopathy being a particularly insidious threat during the postpartum period. The silent struggle of a weakened heart muscle can quickly turn a time of joy into one of grief.

Additionally, hypertensive disorders, such as pre-eclampsia and eclampsia, and the sudden onset of high blood pressure during pregnancy can put both mother and child at grave risk. Infections, severe bleeding, or unsafe abortion further contribute to the heartbreaking toll of maternal mortality.

These conditions serve as a poignant reminder of the critical importance of early detection, timely intervention, and access to quality healthcare—for every woman, everywhere. Let's look at the most common causes of maternal mortality in detail:

Haemorrhage and Hypertensive Disorders

Haemorrhage, or excessive bleeding, is one of the most terrifying and life-threatening complications of labour. Postpartum haemorrhage, in particular, can result from a variety of factors, such as:

• uterine atony,
• retained placenta, or
• damage to the genital tract.

Severe bleeding can quickly endanger a healthy woman’s life, highlighting the need for fast recognition and treatment. Quick action and expert care can make all the difference.

Infections and Other Complications of Childbirth

Infections during pregnancy, labour, and the postpartum period pose a significant threat to maternal health and survival. From urinary tract infections to more severe conditions like sepsis, these insidious invaders can quickly escalate, putting both mother and child at risk. Puerperal sepsis, a potentially life-threatening infection of the reproductive tract, is a particularly devastating complication that demands swift intervention and expert care.

Other complications of childbirth, include:

• obstructed labour,
• uterine rupture, and
• unsafe abortion.

These further contribute to the unacceptable toll of maternal mortality.

Most of these conditions often arise in settings where access to skilled birth attendants, emergency obstetric care, and comprehensive reproductive health services is limited or nonexistent.

Let's talk about some non-medical factors that can sadly lead to maternal mortality. For example, if a woman doesn't have easy access to good healthcare, especially if she lives in a poor or remote area, that can be a big problem. And sometimes, laws or social attitudes can make it hard for women to get safe abortions. This can also be very dangerous for non-medical reasons (emotional and mental toll on the woman).

Socio-economic Disparities and Access to Care

Imagine you're a woman from a low-income family. You might not have the money to afford the best healthcare, right? And if you live far away from a good hospital, it can be really tough to get the care you need. These socio-economic differences can mean that some women don't get the help they need during pregnancy and childbirth, which can lead to more complications and a higher risk of maternal death.

Maternal Age and Underlying Health Conditions

Another thing to consider is the mother's age and her overall health. If a woman gets pregnant when she's over 35, she might be more likely to have health issues like diabetes or high blood pressure during pregnancy. These underlying health conditions can make complications of childbirth more likely and increase the risk of maternal mortality.

However, there are many preventative strategies that can be implemented against these causes, and in the next section, we'll go over them.

It's not all doom and gloom. One of the most important strategies is making sure that all women have access to quality maternal healthcare. This means having enough skilled healthcare workers, well-equipped facilities, and affordable services. It's also crucial to educate women and their families about the importance of prenatal care and safe delivery practices.

Improving Access to Quality Maternal Healthcare

So, how can we make sure that women get the care they need (and deserve)? Well, one way is to invest in healthcare infrastructure, especially in underserved areas. This means building more clinics and hospitals, training more healthcare workers, and making sure that facilities have the right equipment and supplies. It's also important to remove financial barriers to care, like high costs for basic services or a lack of insurance coverage.

Addressing Social Determinants of Health

Improving healthcare access is just one piece of the puzzle. We also need to tackle the social factors that can affect maternal health, like poverty, malnutrition, and lack of education. By working to improve women's overall living conditions and empowering them with knowledge and resources, we can help reduce the maternal mortality rate and give every mother a better chance at a healthy pregnancy and safe delivery.

One thing we can't ignore is the crucial role healthcare providers play in reducing maternal mortality rates. Early and regular prenatal care is absolutely essential. It allows providers to identify and manage any pre-existing health conditions that could lead to complications of pregnancy.

Yale Medicine points out that early prenatal visits help update immunisations, review medical and genetic histories, and control pre-existing health conditions. All of this can significantly reduce the risk of complications. Healthcare providers need to be super vigilant in recognising early warning signs of pregnancy-related illnesses. Conditions like pre-eclampsia, eclampsia, and post-partum haemorrhage require prompt diagnosis and treatment.

The American College of Obstetricians and Gynecologists (ACOG) emphasises the importance of clinical guidance and resources to improve maternal safety. This includes screening for severe maternal morbidity and reviewing cases of maternal death to identify areas for improvement.

Another key aspect is empowering patients to recognise urgent maternal warning signs. The Alliance for Innovation on Maternal Health (AIM) has outlined some important symptoms that could indicate life-threatening situations. These include:

• vaginal bleeding or fluid leaking during or after pregnancy
• chest pain
• swelling of the limbs
• fever
• dizziness

Empowering women through education and awareness is a vital step in reducing maternal mortality. By providing comprehensive information about the risks and complications of childbirth and labour, we can help women make informed decisions about their health and well-being.

Education is key to reducing the maternal mortality rate, especially in India, where the maternal mortality rate remains high. Through targeted education programmes, we can raise awareness about the leading causes of maternal mortality, such as severe bleeding, infections, and pre-eclampsia. It's also crucial to educate women about the importance of regular prenatal care, safe abortion practices, and good hygiene.

By providing comprehensive education on sexual and reproductive health, we can empower young women to make informed decisions about their bodies and their futures. Investing in women's education can create a ripple effect that benefits generations to come and prevent worst-case scenarios like maternal death.