A story my sister-in-law told several years ago has been on my mind today. She had been living in Denmark as a missionary and had a strong feeling one day that they needed to stop and visit a particular friend who had recently given birth. Upon their arrival at her home, the woman (visibly distressed) started crying and explained that she had become overwhelmed with thoughts of harming herself or her new baby, so she had been calling out to God to please send help. My sister-in-law’s arrival likely prevented a horrible tragedy that day.

This story was on my mind because of an alarming fact I discovered for the first time today. For so long I have read and believed that hemorrhage was the leading cause of maternal death. And hemorrhage does, in fact, account for a large portion of maternal deaths–25% of them, according to the World Health Organization. What I didn’t know was that there is (more specifically in the developed world) a larger and more disturbing cause of maternal death.  According to the 1997 to 1999 Confidential Enquiry into Maternal Deaths conducted by British medical researchers, the leading cause of maternal death (within pregnancy and the year following childbirth) wasn’t hemorrhage.

It was suicide.

Suicide accounted for 28% of maternal deaths. And those suicides differed from the majority of suicides among women in general:

The overwhelming majority of the suicides died violently, contrasting with the usual finding that women are more likely to die from an overdose of medication. Compared to other causes of maternal death, the suicides were older and socially advantaged. The Enquiry findings suggest that the risk profile for women at risk of suicide following delivery may be different to that in women at other times and in men. (Source: Margaret Oates, “Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality“)

Even if these statistics are solely a reflection of maternal deaths within the UK, they are a disturbing and likely accurate representation of what we might find here in the U.S. if our tracking of maternal deaths were as thorough and in-depth as the system in the UK.  And, given that our birth outcomes and intervention rates are worse than the UK’s in general, I’d wager that maternal suicides in the U.S. are even more common here.

Upon further inquiry, I have found that the rates of maternal suicide have declined in the UK over the last decade.  A report gathering data between 2003 and 2005 listed suicide as the third leading cause of maternal death (rather than the first).  Even with the decline, I’m still shocked and highly disturbed.

How is it that these alarming facts aren’t widely known? How is it that this information has been around for years and I’m only now becoming aware of it?

The 2003/2005 Confidential Enquiry on Maternal Deaths showed this graph comparing the various causes of maternal death:

Suicides are shown in the bottom yellow bar, the section to the left with diagonal yellow stripes.  Can you believe it?

Drawing on maternal suicide statistics from 1997 up to 2005, these researchers identified some trends, including the following:

  • Most of the women committing suicide had a previous history of mental illness.
  • These women typically had an abrupt onset of symptoms and rapid deterioration.
  • There is usually an early onset of symptoms, with deaths typically occurring within the first three months of giving birth.
  • There is often poor communication between the mother and her various health and psychiatric care providers and a lack of adaptation of psychiatric services to the maternity context.
  • The majority of maternal suicides are violent deaths.

(Source: Why Mothers Die)

What can be done?  I can’t help but fear that very little is being done, particularly within the U.S. where maternal deaths are not tracked or reported as consistently or meticulously as they are in the UK.  The 1997/1999 report recommends that ” all women should be asked early in their pregnancy about a previous history of serious psychiatric disorder and that management plans should be in place with regard to the high risk of recurrence following delivery” (source).  Given the alarming incidence of postpartum depression and post-traumatic stress disorder, I can’t help wondering whether birth interventions are also a contributing factor in these tragic maternal deaths.  And with more and more women settling far away from their mothers and sisters, I fear that too many women enter motherhood isolated and without the support and encouragement they need.  There’s no doubt about it… mothers need far more emotional support.

Clearly we need more research into these disturbing trends.  But given that our American maternity care system has shown little regard for the rising maternal mortality rate, I wonder whether anyone even cares enough to dig deeper into this problem.  Or is it a matter of whether anyone is brave enough to ruffle the feathers that would inevitably be ruffled if they were to let the skeletons out of our maternity/health care closet?

Until a thorough and coordinated effort is put forth by doctors, midwives, psychiatrists, and communities, I fear that at-risk women will continue to fall through the cracks, suffer alone, and give up hope.  A few may be saved by in-tune family or friends (like my sister-in-law), but how many will continue to be lost?  Far too many, to be sure.  And I can’t believe I never knew until now.