Researchers at the University of Alabama at Birmingham suggest barriers to care may be the primary cause of the high rate of black women who die during childbirth. National statistics show black women are nearly four times more likely to die in childbirth than are white women.Statistics over 20 years showed the rate of death during childbirth at UAB Hospital is about the same for black women as it is for white women. The findings, published Nov. 5 in Anesthesia & Analgesia, looked at 77 maternal deaths occurring between 1990 and 2010.
The study authors report that there was insufficient evidence to suggest racial disparity in the incidence of death and that there was no association between mortality status and insurance status, income, body mass index, marital status or parity.
“Our findings suggest that the next step toward understanding racial differences in maternal deaths should be directed at health care delivery outside the tertiary-care hospital setting, particularly at eliminating access barriers to health care for all women,” said Michael Froelich, M.D., associate professor in the Department of Anesthesiology and lead author of the study.
Froelich says gestational age, fetal survival, duration of hospital stay, lack of prenatal care and cesarean delivery rate were factors associated with greater mortality. He says that obesity was not a factor in this study, although obesity has been implicated as a risk factor in other studies.
“Women who lived farther away from the hospital were at greater risk of mortality, so proximity to appropriate health care may be a significant predictor of risk,” Froelich said.
AA2Day.org, a supplement to Anesthesia & Analgesia, published a commentary on the study by section editor J. Lance Lichtor, M.D.
“We do not know if the results at the University of Alabama at Birmingham are representative of outcomes at all tertiary teaching hospitals,” wrote Lichtor, chief of Pediatric Anesthesiology at Yale University. “If this is a representative outcome, then our major teaching hospitals appear to provide equally excellent care to all patients, regardless of race. It follows that we need to look elsewhere to understand the racial differences in maternal mortality evident in U.S. national statistics.”