Deaths of women in childbirth stop falling

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DEATHS of mothers in childbirth have stopped falling for the first time in 40 years, according to figures published yesterday by the Department of Health.

Women are still dying unnecessarily because of inadequate standards of medical care, often by junior doctors, a report from a committee headed by the government's deputy chief medical officer, Dr Jeremy Metters, says.

The news will severely embarrass the Government after decades of steady improvement in the maternal mortality rate. Yesterday, the Department of Health emphasised that the mortality rate for the years 1988-90 remains low - at 10 deaths per 100,000 - and had not altered from the last survey, covering the 1985-87 period.

However, a spokesman for the department confirmed last night that it was the first three-year period since the survey began in 1952 in which the maternal death rate had not fallen. Maternal mortality in general has been in decline since the Thirties.

Although the exact figure is not given, it is understood that in the most recent three-year period there were about 325 deaths of mothers in childbirth.

Just under half - 49 per cent - involved 'sub-standard' medical care, the report says, a figure which 'it is disappointing to have to report' remained similar to that of the previous period.

The actual numbers of deaths directly or indirectly related to pregnancy have increased by 15 since the previous report, but this reflects a parallel increase in the number of pregnancies.

The report highlights a significant number of cases in which major problems were handled by junior doctors, a recurring theme of past reports.

Dr Metters comments: 'These are matters of concern and there is a need for a critical reappraisal of the administration and delivery of maternity care, as well as the standards of clinical care.'

Referring to deaths due to hypertensive disorders of pregnancy - involving raised blood pressure - where there was sub-standard care in 88 per cent of cases, compared to 81 per cent in the previous report, the report says: 'Underlying factors were delay in taking clinical action, inadequate control of blood pressure and failure to appreciate, often at too junior a level of clinical responsibility, the seriousness of the symptoms and signs.'

These disorders are now the main direct cause of maternal death in the United Kingdom. 'Lack of improvement is both disappointing and perplexing,' the report adds.

The inquiry team defined sub- standard care as failure in clinical care, together with circumstances produced by the action of the woman or her relatives.

It also takes account of shortage of staffing facilities, administrative failure in maternity services, and in back-up facilities such as anaesthetics, radiology and pathology services.

Report on Confidential Enquiries into Maternal Deaths in the UK 1988- 1990; HMSO; pounds 12.50.