In a wealthy country like Canada, women shouldn’t be dying bringing a child into the world.
Yet somewhere between 50 and 85 moms-to-be die each year in childbirth or in the postpartum period. At least half of their babies die, too.
Canada ranks only 39th in the world in maternal mortality, according to the World Health Organization. With roughly 10 maternal deaths per 100,000 births occurring within 42 days of the end of the pregnancy, we are outperformed by such health powerhouses as Belarus and Turkmenistan.
There are many causes of complications during and after birthing, including hemorrhaging, embolisms, superbug infections, and rare cancers that can be triggered by pregnancy, as well as postpartum depression and suicide. Substance misuse can also occur, as studies suggest that drug users often abstain during pregnancy and can overdose when they resume using afterward.
Women are also giving birth at an older age, and with chronic health conditions like diabetes and cancer, that can lead to complications too. A recent coroner’s inquest in Ontario estimated that the maternal death rate had doubled since the late 1990s – to 11.9 per 100,000 births from 5.1 per 100,000 – largely because of more high-risk pregnancies.
The very least we can do is learn from these tragedies. We need to count the cases properly, study them thoroughly and, after critical reviews, work on prevention. After all, for every case of maternal mortality, there are dozens more near-misses, where women and their babies suffer severe complications, but survive, often with long-term consequences.
Yet only five Canadian provinces – B.C., Alberta, Ontario, Nova Scotia, and Newfoundland and Labrador – have some form of review within their health systems after a maternal death. And there is no standardization of data or approaches, even among the five that do reviews; each province follows different criteria to identify and audit cases. For example, B.C. reviews cases up to six weeks postpartum, while in Newfoundland and Labrador, it’s up to a year.
Some of these tragedies do make headlines, such as when the well-known curler Aly Jenkins died during the birth of her daughter Sydney in 2019. Ms. Jenkins, 30, suffered an amniotic fluid embolism, a rare complication that sees the fluid that surrounds the fetus leak into the bloodstream, triggering a cascade of problems that can cause the heart to stop.
But while there was an outpouring of grief and a lot of money donated to a GoFundMe campaign after her death, there was no formal inquiry.
Thoughts and prayers and financial support aren’t enough. That’s why the Canadian Foundation for Women’s Health (CFWH) and the Society of Obstetricians and Gynaecologists of Canada have been pushing for a standardized review of every maternal death that occurs.
“Cases are rare, but they keep happening,” said Dr. Catherine Popadiuk, a gynecological oncologist and chair of the CFWH. “The least we can do is learn from what happened and share the findings in an appropriate manner.”
Countries such as the U.K., the U.S., Australia and New Zealand all have a form of surveillance and review that ensures that every death related to childbirth is investigated.
The U.K.’s confidential inquiry system allows clinicians to report thoroughly on the details of a case while keeping the patient’s identifying details secret, something that is done routinely with child deaths, as well. And when the system was introduced, the U.K. quickly learned that there were twice as many maternal deaths occurring as it previously knew.
The U.S.’s review system, meanwhile, has demonstrated that about 60 per cent of deaths are preventable.
Of Canada’s piecemeal approaches, Newfoundland and Labrador’s year-after-pregnancy reviews are the most appropriate, because not all maternal deaths occur during childbirth or shortly thereafter. Recall the case of Dr. Suzanne Killinger Johnson, who suffered from postpartum depression and died by suicide six months after the birth of her son. Or Sarah Turpin, who died of choriocarcinoma (cancer of the uterus) nine months after a miscarriage.
But what Dr. Popadiuk says is really needed is a national system to standardize data collection and synthesize findings so they can be shared.
There is a lot of precedent for provinces and territories sharing data to a national body like the Canadian Institute for Health Information. Doing so with rare conditions like maternal death is a bit more tricky because of privacy concerns, but other jurisdictions have demonstrated it’s doable and useful.
Besides, collecting and studying maternal deaths would cost little. All it would require is a bit of co-operation and data-sharing between jurisdictions.
As Dr. Popadiuk said: “It seems fundamentally wrong that provinces seem to think this is too much trouble, especially when it can save women’s lives.”
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André Picard