So one of our readers asked us this question the other day: What actually happens that can cause women to die during childbirth? In ancient times child birth was quite dangerous and it’s still a danger today. I know that blood loss is a major factor but very few sites go into details about what actually happens that causes the bleeding or complications.
Things can go wrong, much like everything in life. Here is a short list:
- Amniotic fluid embolism
- Peripartum cardiomyopathy
- Pregnancy induced hypertension (PIH) and associated diagnoses of PIH with proteinuria (often referred to as preeclampsia), eclampsia
- Abnormal placental lie (vasa praevia, placenta praevia)
- Abnormal placental inplantation (placenta accreta, placenta increta, placenta percreta)
- Umbilical cord prolapse
- Uterine rupture
- Placental abruption
- Cephalopelvic disproportion
Childbirth in developed countries is pretty safe. Major complications are rare and things that kill women in developing countries tend to make you sick in developed countries rather than dead. Overall worldwide childbirth is getting safer though. Here is more information on worldwide mortality.
Haemorrhage (bleeding) is the main cause of death in developing countries and the main cause of morbidity (illness) in developed countries. The main causes of bleeding are:
- Atonic uterus: The big vessels which supply the uterus carry about 500ml a minute by the end of pregnancy. After the baby and placenta are delivered the uterus needs to contract (it is essentially a big muscle) to stop these vessels pumping all that blood out of the body. If that doesn’t happen it’s bad. Most women don’t bleed at 500ml/min but less than that is still pretty quick. Treatment is drugs to make uterus contract or surgical options which I’m not going to detail here.
- Retained placenta: If all or part of the placenta is left inside then the uterus can’t contract properly. See above. Removal of the retained tissue will sort this.
- Trauma: Squeezing a baby out of a vagina can be very traumatic depending on relative sizes of the parties involved and how the baby comes out. Chopping open an abdomen and then cutting open a very vascular uterus (see above) can also lead to bleeding. Repairing the trauma is the solution.
- Clotting disorders: This is unlikely to be a primary cause of bleeding but after heavy blood loss clotting can become abnormal which worsens the situation. Replacing clotting factors and blood will help this.
Obstetricians are highly trained individuals who work with a team which includes anesthetists, midwives and oftentimes neonatologists or pediatricians.
I’ll add here that maternal mortality in the USA is quite high and increased from 12 to 28 per 100000 between 1990 and 2013. Pretty shocking when you consider, for example, that in Australia (a similarly-developed country) this figure is around 7.1 per 100000 on average and in 2012 it was 4.4 per 100000.