MBRRACE – UK report shows more needs to be done to reduce maternal deaths and end health inequalities for ethnic minority groups

Most people expecting a baby, wouldn't think about the fact that in 2023 there's still a risk of the mother dying.  

MBRRACE – UK is a collaboration appointed by the Healthcare Quality Improvement Partnership to run the national maternal newborn and infant clinical outcome review programmes.  As part of the programme, it reports into the causes of maternal death with a view to making recommendations for improvements. 

When MBRRACE was set up, the government had an ambition to reduce maternal mortality by 50% between 2010 and 2025, but sadly, the conclusions of the report is that we're still far away from achieving that goal.

More than 240 women die in the weeks after pregnancy

On the 12 October, MBRRACE published its findings having investigated the deaths of women in the UK between 2019 and 2021 where women died during pregnancy or within six weeks of giving birth.   

Between 2019 and 2021, out of the 2,066,997 women who gave birth during that period in the UK, 241 died. That equates to 11.7 women per 100,000. 

The cause of death included COVID-19 where 33 women had died during pregnancy or up to six weeks of giving birth. In that group, most of the women who died of COVID-19 were from an ethnic minority background. 

Other causes of the deaths included cardiac disease, blood clots, mental health conditions, sepsis, epilepsy and strokes, bleeding, pre-eclampsia and cancer.    

Report finds significant disparity among ethnic groups 

When comparing the different ethnic groups the report found a significant disparity in the data between white, Asian and black mothers. The death rates of white mums was 9.7 per 100,000, whereas it doubled for Asian mothers and was four times more likely in the black ethnic minority group where 37.2 mothers per 100,000 died.

The inequalities extended to people living in the most deprived areas which was double the least deprived areas.

Key recommendations in the report

Key recommendations coming out of the report was to treat pregnant or recently pregnant mothers the same as a non-pregnant person. It found that some of the deaths after birth that services were working in silos. There needed to be greater collaboration across all services working with pregnant women and new mothers.

It was also found that there was a disparity in the care after babies were born and the report found that 300 women had died after pregnancy and concluded that those women needed continued and consistent support which had not been available.

Due to those women not being kept under consistent review and dangerous conditions such as sepsis which can occur up to six weeks after a woman has given birth, were missed.  The UK Sepsis Trust reminding people to look for the sepsis symptoms including slurred speech or confusion, extreme shivering or muscle pain, failing to pass urine, severe breathlessness, systemic illness and skin that becomes discoloured. 

A total of 9% of women had died from epilepsy or stroke and the charity SUDEP Action (Sudden Unexplained Death in Epilepsy) found that there was insufficient advice given to women who suffered from epilepsy. 

Women were being encouraged to stop anticonvulsant medication because it may damage their unborn baby but there wasn't a clear plan for managing their seizures and women were at risk of SUDEP. 

The charity recommended that women should be appropriately counselled prior to getting pregnant so that they could make an informed decision about the risks to them and their unborn baby.         

Increasing social complexities

The report found that there were increasing social complexities where the women living in deprived areas suffered from multiple disadvantages including mental health problems, substance use, domestic abuse, and due to the social complexities, these women were extremely vulnerable and hesitant to engage with services because of fear of social care involvement with their baby.   

The report emphasises the need to tailor care to the women’s individual needs and that support needed to stretch beyond the nine months of pregnancy and birth and to be shared across services and agencies. 

A total of 14% of women had died of bloods clots, 10% of mental health conditions and 8% of other physical conditions. 

Improving care for mums affected by mental health problems

The Maternal Mental Health Alliance work across the network and 120 organisations dedicated to ensuring all women and families impacted by perinatal mental health problems have access to high quality and compassionate care and have support from Royal College of Midwives, Royal College of Nursing and other organisations.

The Maternal Mental Health Alliance look to increase awareness of the risk to mothers of mental health problems during pregnancy providing the red flags to look out for when mothers need to seek advice as follows :-

• Do you have new feelings or thoughts that you have never had before, which make you disturbed or anxious?
• Are you experiencing thoughts of suicide or harming yourself in violent ways?
• Are you struggling to sleep?
• Are you feeling incompetent as though you can’t cope, or estranged from your baby? Are these feelings persistent?
• Do you feel you are getting worse?

Pre-eclampsia deaths

Deaths from pre-eclampsia affected nine women but found to have increased by five times since the lowest reported years in 2012-14 of MBRRACE-UK. Action on Pre-Eclampsia is an organisation promoting safer pregnancy and reported that factors which increased the risk of pre-eclampsia were first pregnancy, aged 40 years or older, pregnancy interval of more than 10 years, body mass index of 35 or more, family history and multiple pregnancies.

The risk of death in black mothers had historically been five times more likely and had reduced to four times more, but is still 37 women in 100,000 as against white women who are 10 in 100,000.

The charity FIVEXMORE campaigns against health inequalities and advise mothers who were concerned to speak up, find an advocate and never be scared to seek a second opinion from a medical professional if they were concerned. 

Conclusion

Sadly through my work I too often see the devastating consequences care issues can have and how clients are often left not only needing answers to their concerns but also access to specialist support and therapies. 

The conclusions of this report show that there are still too many unnecessary maternal deaths and that more needs to be done to support mums during pregnancy but also after birth where a number of complications could be picked up and treated. 

It also shows that there's a disparity in health care for minority groups and that a lot more needs to be done, to achieve the target of reduction of maternal deaths by 50%.