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; instead, she discovered 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 childbirth 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 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,getting the care you need can be challenging. 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, many preventative strategies can be implemented against these causes, and we'll discuss them in the next section.

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

Improving Access to Quality Maternal Healthcare

So, how can we ensure that women get the care they need (and deserve)? One way is to invest in healthcare infrastructure, especially in underserved areas. This means building more clinics and hospitals, training more healthcare workers, and ensuring 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 must also tackle the social factors affecting 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.

Healthcare providers play a pivotal role in reducing maternal mortality by ensuring early detection, timely intervention, and comprehensive care for expectant mothers. Their expertise, vigilance, and patient education efforts are crucial in preventing complications and improving maternal health outcomes.

Early and Regular Prenatal Care

Doctors, gynaecologists, and midwives must prioritise early and consistent prenatal check-ups to monitor the health of both mother and baby. Identifying and managing pre-existing conditions like hypertension, diabetes, anaemia, and thyroid disorders can significantly reduce pregnancy-related risks.

• Obstetricians should conduct routine screenings for high-risk pregnancies, including gestational hypertension, pre-eclampsia, and foetal growth restrictions.
• Physicians must ensure immunisations, nutritional counselling, and supplementation (iron, calcium, folic acid) are provided as per ICMR and FOGSI guidelines.
• Ultrasonologists and radiologists are critical in monitoring foetal development and detecting congenital abnormalities early.

Recognising and Managing Pregnancy-Related Complications

Many maternal deaths occur due to delays in recognising and treating complications like pre-eclampsia, postpartum haemorrhage (PPH), infections, and sepsis. Healthcare providers must:

• Closely monitor blood pressure, proteinuria, and swelling for early signs of pre-eclampsia.
• Be vigilant about excessive bleeding post-delivery and immediately initiate PPH protocols (uterotonics, fluid resuscitation, and surgical intervention if required).
• Administer prophylactic antibiotics and maintain strict hygiene to prevent postpartum infections.

The Federation of Obstetric and Gynaecological Societies of India (FOGSI) and the Indian Council of Medical Research (ICMR) highlight symptoms that could indicate life-threatening situations, such as:

• Severe vaginal bleeding during or after pregnancy
• Persistent high fever
• Severe headaches, blurred vision, or dizziness
• Swelling of the hands, feet, or face
• Severe abdominal or chest pain

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.