Maternal death rates have significantly reduced for the first time since 2006, a report by the Perinatal and Maternal Mortality Review Commission (PMMRC) says.
The PMMRC reviews deaths of mothers and babies in New Zealand and advises the Health Quality & Safety Commission on how to reduce these deaths.
A maternal death is the death of a woman while pregnant or within 42 days of the end of pregnancy.
A perinatal death is the death of a baby from 20 weeks’ gestation (pregnancy) up to 28 days after birth. This includes stillborn babies.
A neonatal death is the death of a live born baby from 20 weeks’ gestation (pregnancy) up to 28 days after birth.
A stillbirth is a baby who is born from 20 weeks’ gestation (pregnancy) without any signs of life.
The PMMRC began reviewing maternal deaths in 2006. Its 12th report, published today, shows that from 2006 to 2008 there was approximately one maternal death for every 5,500 births. From 2014 to 2016 this dropped to approximately one maternal death for every 10,600 births.
However, the neonatal death rate has not fallen in the past ten years, unlike in comparable countries such as the UK and Australia.
PMMRC Chair Dr Sue Belgrave says each death is a tragedy for the family and whānau involved, and more must be done to reduce these deaths in New Zealand.
‘While a significant ongoing decline in maternal deaths is positive, the number of babies dying in the first four weeks of life has not reduced and is of great concern,’ says Dr Belgrave.
‘We haven’t got all the answers, but we know the majority of neonatal deaths are in very preterm babies – 20-24 weeks’ gestation – who are born alive but then die. We are trying to understand what we can do in New Zealand to prevent these early preterm births and deaths.’
Recommendations in the report focus on preventing preterm birth, providing optimal care and reducing ethnic inequity. These include the following.
Investigating and implementing a preterm birth prevention programme.
Targeting women with a previous preterm birth at less than 34 weeks, including by ensuring they are able to register for antenatal care as soon as possible.
Developing a national approach to caring for women at risk of giving birth before 25 weeks, including assisting with transfer to a tertiary hospital before birth.
Lead maternity carers (LMCs) and DHBs should ensure every baby has access to safe place to sleep.
Regulatory bodies should require cultural competency training of the maternity and neonatal workforce.
Dr Belgrave says the report has further highlighted inequity in neonatal deaths.
‘Māori, Pacific and Indian women, and women under the age of 20, have a significantly higher risk of their baby dying from prematurity. This is something we need to explore further, and the report’s findings give us a good indication of where to focus our efforts.’
Key findings from the report:
From 2006-2008 the maternal death rate was 18.2 per 100,000 births. From 2014-2016 it was 9.4 per 100,000 births.
Suicide is the leading cause of maternal death, with Māori women over-represented in this category.
There has been a significant reduction in both the birth rate of small for gestational age (SGA) babies since 2008 and in the death rate in this group.
The rate of stillbirths fell from 5.7 per 1,000 births in 2007 to 5.1 per 1,000 in 2016.
The neonatal death rate was 2.6 per 1,000 live births in 2007 and 2.5 per 1,000 live births in 2016.
The perinatal related death rate was 10.1 per 1,000 births in 2016. There has been no significant reduction since 2007.
There were fewer babies diagnosed with neonatal encephalopathy in 2016 (1.0 per 1,000 term births) than in 2010 (1.4 per 1,000 term births).
‘Addressing these issues will not be easy,’ says Dr Belgrave. ‘It will require the coordinated efforts of government, health providers, iwi and communities. We need to work together to make sure every mother and baby receives the same level of care.’