Saving the lives of pregnant women
Preventing maternal illness and death.
The quality of healthcare delivery when managing severe complications during pregnancy can mean the difference between life and death for pregnant women.
Severe maternal morbidity (SMM) is described by the World Health Organization as the near death of a woman who has survived a complication occurring during pregnancy or childbirth.
To help prevent maternal illness and life-threatening complications the Centre for Women’s Health Research, along with researchers from the University of Otago, conducted a study entitled Preventability Review of Severe Maternal Morbidity (SMM) funded by the Health Research Council of New Zealand and the Ministry of Health.
Our research showed:
- 36.5 percent of cases of severe illness in pregnancy were managed appropriately.
- More than one third (33 percent) of pregnant women had preventable SMM.
- One third (29.5 percent) of pregnant women received substandard care.
In addition, a number of ethnic disparities in care were discovered:
- On average, 6.2 women per thousand pregnancies were admitted to New Zealand intensive care units (ICUs) and high dependency units (HDUs) because of life-threatening complications during pregnancy.
- Pacific women were the most likely to be admitted at a rate of 10.4 per 1,000 deliveries, compared with 4.6 for New Zealand European women.
- The rate for Māori women was 5.6, for Indian women 7.2 and for other Asian women 8.2.
Preventable cases of SMM also demonstrated high levels of ethnic disparity:
- The rate of potentially preventable admissions with severe illnesses to ICUs and HCUs was 2.1 per 1,000 deliveries overall.
- The rate was higher at 3.6 for Pacific women—more than double the rate of 1.5 for New Zealand European women.
- The rate for Indian women was next highest at 2.9, followed by other Asian women at 2.5. The rate for Māori women was 1.8.
The study found that substandard care such as delay in diagnosis or inappropriate treatment occurred in more than 90 percent of preventable SMM cases and system factors (lack of treatment protocols, delays in getting to operating theatre) occurred in 60 percent. Findings also indicated that for SMM in Pacific women, patient factors contributing only 7.5 percent of preventability, contrasting with widely held views that women themselves are often to blame for their illness.
Based on our findings, the Ministry of Health has translated our research model into a SMM case review process through the Health Quality & Safety Commission. Through additional funding, this audit tool can provide information and knowledge to make necessary changes in clinical education, training and policy across New Zealand, to improve the care, health, and wellbeing of all pregnant women and babies.