WASHINGTON — Eleven days after her son Benjamin's birth by C-section, Linda Coale awoke in the middle of the night in pain, one leg badly swollen. Just as her doctor returned her phone call asking what to do, she dropped dead from a blood clot.
Pregnancy-related deaths like Coale's appear to have risen nationwide over the past decade, nearly tripling in California, the state with the most careful count. And while they're rare — about 550 a year out of 4 million births — they're nowhere near as rare as they should be. The maternal mortality rate is four times higher than a goal the federal government set for this year.
"It's unacceptable," says Dr. Mark Chassin of the Joint Commission, the agency that accredits U.S. hospitals and that recently issued an alert to hospitals to take steps to protect mothers-to-be. "Maybe as many as half of these are preventable."
Maternal mortality gets little public attention in the United States, aside from last year's worry over the swine flu that killed at least 28 pregnant women. Among the leading preventable causes are hemorrhage, DVT-caused pulmonary emboli and uncontrolled blood pressure.
It's not clear what's fueling the overall increase, although better counting is playing some role. But there are some suspects: a jump in cesarean deliveries that now account for almost a third of births; one in five pregnant women is obese, spurring high blood pressure and diabetes; and more women are having babies in their late 30s and beyond.
More startling, black women are at least three times more likely to die from pregnancy complications than white women, and research is too limited to tell why.
Then there are the near-misses. For every death, 50 additional women suffer serious complications of pregnancy or delivery, notes Dr. Jeffrey King of the University of Louisville, a spokesman for the American College of Obstetricians and Gynecologists.
At issue are deaths directly related to pregnancy or childbirth, up to 42 days after delivery. In 2006, the latest year for which data were available, there were 13.3 maternal deaths for every 100,000 births. A decade ago, the rate hovered around 7 — and by this year, the U.S. government had hoped to lower it to 3.3 deaths.