"Near misses" are common during childbirth

Low maternal mortality encourages high expectations of childbirth but represents only the tip of the iceberg of morbidity. On p 1089 Waterstone et al report on a study investigating the incidence and predictors of severe obstetric morbidity in 48 865 women (a defined population). Over 1% of women were affected, two thirds by massive haemorrhage and one third by severe pre-eclampsia, sepsis, and uterine rupture. Even after exclusion of maternal thromboembolism, there were 118 "near misses" for each direct maternal death. Severe obstetric morbidity may more accurately reflect the impact of obstetric care on the wellbeing of women. It is a cause for concern that caesarean section quadruples the risk of morbidity and that national rates are rising.

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Relevant Article

Incidence and predictors of severe obstetric morbidity: case-control study • Commentary: Obstetric morbidity data and the need to evaluate thromboembolic disease

Mark Waterstone, Susan Bewley, Charles Wolfe, and Deirdre J Murphy
BMJ 2001 322: 1089-1094. [Abstract] [Full Text] [PDF]