A world-first study from a team of Australian researchers has found one in five maternal deaths in the five years after giving birth is preventable.
There is suicide it has long been accepted as a leading cause of maternal mortality in Australiabut experts have warned that the previously reported figures did not show it the full extent of the issue.
One reason is the fact that maternal mortality data are usually limited to 42 days or one year after delivery, but as research in BJOG: International Journal of Obstetrics and Gynaecology found, the risk “do not suddenly leave” after the first birthday of the child.
More than 1.7 million babies born to more than one million mothers in NSW from 2002 to 2020 were studied by a team of researchers led by Western Sydney obstetrics and gynecology registrar Dr Louise Makarious.
It is the first peer-reviewed study to focus on maternal deaths from suicide, accidental poisoningand unknown intention more than one year after delivery.
The study, published Tuesday, found those causes account for 26 percent of maternal deaths within the first year after giving birth, 23 percent within two years, and 22 percent within five years.
Those most at risk were first-time mothers, mothers 24 years of age or younger, mothers who identify as First Nations, and mothers living in remote or socioeconomically disadvantaged communities.
“Deaths from suicide and accidental poisoning are completely preventable deaths,” says Makarious. “This study has shown that these at-risk individuals should have ongoing care beyond that one year.”
Makarious notes that obstetric-related causes of maternal mortality – such as haemorrhage, blood pressure problems and infections – have declined over the past 18 years due to targeted improvements in clinical practice. In contrast, mental health-related maternal mortality remained stable.
But 60 percent of mothers who died by suicide, and two-thirds of mothers who died from accidental poisoning with unknown intent, did not visit community mental health services in the 12 months before their death.
“This shows that there are barriers to getting involved or accessing health services that need to be removed,” says Makarious, noting that while the shortage and costs of psychologists and psychiatrists are high, other influences include culture, negative experiences with authorities, and location.
Parental mental health services such as the national PANDA helpline sponsored by the government and not for profit Gidget Foundation Australia aims to close this gap, with the client helping 26.7 percent more customers in the past 12 months than in the same period a year ago.
Providing mental health and substance use screening up to more than a year after delivery is one way to help mothers at risk, says Makarious.
Another would be to educate clinicians to look for risk factors during pregnancy and to encourage clinicians to openly discuss drug use and mental health with parents, and to use continuity of care models that facilitate understanding between mothers and clinicians.
Regular access to mental health professionals, with telephone or home visits readily available, will also make care available.
“We should aim to reduce the barriers these women go through to avoid preventable deaths,” says Makarious. “These are all avoidable and preventable deaths.”
Bronte Gossling is a reporter for The Sydney Morning Herald, The Age, WAtoday and the Brisbane Times.Connect through email address.
