Maternal death rates are up 50 per cent - what's going on?

This compares to 191 between 2017 and 2019, before the pandemic.

The mortality rate has soared by 53% over those two periods - an unprecedented spike - from 8.79 maternal deaths per 100,000 pregnancies, to 13.41 per 100,000.

Tragically, Covid is major contributor - accounting for 38 deaths among new or expectant mothers in the period from 2020 to 2022 - but it is not the only explanation.

Even after Covid deaths are excluded, the mortality rate still stands at 11.54 per 100,000 - a 31% hike on pre-pandemic levels, and a large enough increase to be considered "statistically significant" by experts.

In other words, it is not down to chance; something has gone wrong.

The fact that this might come as a surprise - as opposed to something that has been filling the headlines all week - is perhaps a sad indictment of the way in which women's health, and maternity services in general, tend to be neglected compared to other areas of healthcare.

It also has to be said that the 272 maternal deaths are a rarity among the 2,028,543 "maternities" over that period (that is, pregnancies resulting in a birth, stillbirth, or recorded miscarriage).

Roughly one in 10,000 ended in a mother's death.

By global standards, then, giving birth in the UK is safe. The problem is, it is becoming less safe - and we need to know why.

Maternal mortality in the UK has increased sharply (Image: MBRRACE)

The latest statistics were published on Thursday as part of an interim update by MBRRACE-UK, a long-standing audit of mother and infant deaths which is carried out by the National Perinatal Epidemiology Unit based at Oxford University.

It is due to publish a more in-depth report, 'Saving Lives, Improving Mothers’ Care', later this year.

There is no Scotland-specific breakdown for the data, but the UK-wide figures highlight some worrying patterns that should be on the radar of clinicians and policymakers throughout the country.

When it comes to what lies behind this upsurge in maternal deaths, the biggest increases (besides Covid, which did not exist pre-2020) have been seen for blood clots and psychiatric causes including suicides or drug and alcohol misuse.

There were 18 deaths by suicide among new and expectant mothers in the UK between 2020 and 2022, compared to 10 in the three years prior to the pandemic. Overall, psychiatric-related maternal deaths are up by 66%.

*NB: graphic should read 'UK', not 'Scotland'

However, the most common cause of death between 2020 and 2022 was thrombosis and thromboembolism - where blot clots block the arteries or veins with life-threatening consequences.

A total of 44 women died as a result of this type of complication, compared to 20 between 2017 and 2019.

The maternal mortality rate for thrombosis/thromboembolism has soared from 0.92 to 2.17 deaths per 100,000 maternities - a 136% jump.

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Some of this is likely to be a knock-on effect from Covid as the infection is known to make the blood stickier and more prone to clotting, even in cases where symptoms are mild.

Beyond the virus itself, the pandemic "exposed gaps in the healthcare system" according to MBRRACE which created "overwhelming pressures for services, systems and providers, and re-ignited conversations about vaccination in pregnancy...confused messaging alongside misinformation resulted in vaccine hesitancy, particularly for disadvantaged and minority groups".

It would be misleading to present Covid as the sole culprit, however.

The experts behind the MBRACCE review also caution that the uptick in maternal deaths must be seen as a "warning signal concerning the state of maternity services and the consequences of increasing inequalities and social complexities".

Maternal mortality rates are three times higher among Black women and two-fold higher among Asian women, compared to white mothers, and twice as high among mothers living in the most deprived areas.

Worse could be yet to come, they note, given that the most recent period mostly pre-dates the cost of living crisis which began in 2022-23.

Professor Marian Knight, reporting lead for MBRRACE and the director of the National Perinatal Epidemiology Unit, said that its 2023 report - covering 2019-21 - had already "identified clear examples of maternity systems under pressure".

She added: "This increase in maternal mortality raises further concern. Ensuring pre-pregnancy health, including tackling conditions such as overweight and obesity, as well as critical actions to work towards more inclusive and personalised care, need to be prioritised as a matter of urgency now more than ever."

It comes as a Fatal Accident Inquiry finally got underway earlier this week to investigate the deaths of three infants in Lanarkshire who passed away in circumstances which the Crown Office said had given rise to "serious public concern".

Evidence led this week into the case of Mirabelle Bosch, who died in July 2021, heard that she might have been safely delivered by planned caesarean if midwives had acted on the "very unusual" characteristics of her mother's presentation to diagnose a breech baby.

In the end, she suffered fatal oxygen deprivation when her head became trapped after her mother went into labour at home.

Also unresolved is the question of what led to two highly unusual spikes in neonatal mortality in Scotland in September 2021 and March 2022, when a total of 39 newborns died - more than twice the norm based on pre-pandemic averages. 

An expert review - originally anticipated in autumn of 2023 - is now expected in the coming weeks. Was it Covid? Negligence? Overstretched maternity services?

Answers are badly needed.