via Pregnancy: maternal death rate ‘higher in London’ – Health News – NHS Choices.
NHS Choices examines the science behind the newspaper headlines.
The exact relationship between regional midwife numbers and maternal mortality rates is hard to determine, and the sources behind much of the news coverage do not point to a definitive link between midwife staffing levels and a higher rate of maternal mortality in London. That is not to say that such a link does not exist, but that the expert opinions and selected results suggesting a link do not prove that a shortage of midwives is behind any rise in maternal death rates.
Indeed, even the rise in death rates seen in London was not “statistically significant”, which means that we cannot be sure that the rises are not just part of normal fluctuations, even if they do appear to be much higher than in areas outside of London. However, even if the rise in maternal death rates is a reflection of a genuine phenomenon, it is hard to attribute it to midwife staffing levels or another single cause. For example, as the original journal letter pointed out, it could be due the complex demographics of London mothers, who may vary greatly in their background, health and age from mothers in other regions.
Overall, this news should not be a cause for alarm among expectant mothers, as the chances of maternal deaths in London are still extremely low, at a rate of 0.013% even in the peak year mentioned in the journal letter. Instead, the news is a reminder that local services need to be appropriately tailored to meet the needs of the people using them. There may need to be greater examination of where London maternity services can be further improved.
Cathy Warwick, chief executive of the Royal College of Midwives, sought to place London mortality rates into context. In particular, she highlighted London’s high standards in quality and safety overall: “NHS London has been one of the leading Strategic Health Authorities both in ensuring high-quality maternity services and attempting to increase midwife numbers. There have been some really big efforts in London, and for the vast majority of women their care will be of a very high standard.”
Links to the headlines
Doubling of maternal death rate blamed on shortage of midwives. The Independent, April 30 2012
Obesity and delayed motherhood behind DOUBLING of mums who die in labour. Daily Mail, April 29 2012
Deaths in childbirth rise amid struggle with complex cases. The Daily Telegraph, April 29 2012
Links to the science
Bewley S and Helleur A. Rising maternal deaths in London, UK. The Lancet, Volume 379, Issue 9822, Page 1198, 31 March 2012