Maternal suicides – more could be prevented | University of Oxford

Maternal suicides – more could be prevented

8 December 2015

A UK-wide study of pregnancy-related deaths in women has found that while overall numbers are falling, some women could receive better care, particularly in relation to their mental health.

The report, Saving lives, Improving Mothers’ Care, is the latest analysis from the MBRRACE-UK** Confidential Enquiry into Maternal Deaths, based at the University of Oxford. The report focussed particularly on maternal mental health, and includes lessons learned from reviews of the care of more than 100 women who died by suicide during pregnancy or in the year after giving birth between 2009 and 2013. One in eleven of the women who died during or up to six weeks after pregnancy died from mental health-related causes. However, almost a quarter of maternal deaths between six weeks and a year after birth are related to mental health problems, and one in seven of the women who died in this period died by suicide.

There were 69 deaths from direct causes – pregnancy complications – a number which has been falling steadily. Conversely, ‘indirect deaths’ – those due to medical and mental health problems - have not fallen significantly. The number and rate of indirect deaths have not shown the same year-on-year decline. For the three-year period 2011-2013, there were 145 indirect deaths. Overall, this is equivalent to nine direct and indirect deaths per 100,000 pregnancies*, down from 10 in the previous three-year period.

Professor Marian Knight, who led the work, said: ‘This analysis has shown that there are clear opportunities for improving mental healthcare for women during and after pregnancy. Specialist perinatal mental health care is particularly important. Although severe maternal mental illness is uncommon, it can develop very quickly in women after birth and the woman, her family and mainstream mental health services may not recognise this or move fast enough to take action. A pattern of declining mental health may not be identified as women are seen by doctors, midwives and nurses in different parts of the health service and no-one joins up the dots and sees the warning signs. The ‘red-flag’ symptoms for women, their families and staff to be aware of are: new thoughts of violent self-harm, sudden onset or rapidly worsening symptoms, and persistent feelings of estrangement from their baby. If you, a member of your family or a friend experiences any of these symptoms, it is important to let your doctor, midwife or nurse know.

‘Completion of some basic checks early in pregnancy will help. All women should be asked about any previous mental health problems as this could provide an opportunity for an early warning of potential future issues. Staff in mental health crisis teams need to be trained to understand the distinctive features and risks of maternal mental illness if they are going to provide emergency care for pregnant and postnatal women.’

Similar messages were identified to improve care for women who were victims of domestic violence. All women should be asked about domestic violence, but this does not always happen. Falling through the cracks between multiple agencies is a particular problem for women with social issues or drug and alcohol addiction. These women are particularly vulnerable after pregnancy when care is passed from maternity health services to community services. This vulnerability increases when their baby is taken into care.

The report also contains messages for the future care of women with cancer and those at risk of blood clots, the primary cause of direct deaths.

Professor Jenny Kurinczuk, Programme Lead for MBRRACE-UK said: ‘The message to mothers is that whatever concerns you have, whether they are about your health or your personal situation, it’s okay to tell. The more information health services have, the better they can care for you and your baby. Don’t wait to be asked – whether you are worried about your state of mind, a lump or any other issue, speak to someone about it.’

The report, executive summary, lay summary and infographic will be available at www.npeu.ox.ac.uk/mbrrace-uk/reports

For more information or to request an interview, please contact Tom Calver in the Oxford University News & Information Office: 01865 270046 or news.office@admin.ox.ac.uk

  •  Table of causes of maternal deaths in 2011-2013
 


Cause of death

2011 -13 
 Number of deaths Rate per 100,000 women giving birth
 All Direct and Indirect deaths 214 9.02
 Direct deaths   
 Genital tract sepsis 7 0.29
 Pre-eclampsia and eclampsia  6 0.25
 Thrombosis and thromboembolism 24 1.01
 Amniotic fluid embolism 10 0.42
 Early pregnancy deaths  6 0.25
 Haemorrhage 13 0.55
 Anaesthesia 3 0.13
 All Direct  69 2.91
 Indirect deaths    
 Cardiac disease 49 2.06
Indirect Sepsis - Influenza90.38

Indirect Sepsis – Pneumonia/ others 

210.89
Other Indirect causes220.93
Indirect neurological conditions241.01
Psychiatric causes190.80

Indirect malignancies 

10.04
Coincidental deaths261.10

Late deaths 

33514.12
   

 

  • The UK Confidential Enquiry into Maternal Deaths, which has been running for 60 years, collects statistics and information about all deaths of women in pregnancy, during birth, and up to one year after birth where the death is pregnancy-related. It also looks in detail at particular topics over five-year periods. It forms a part of the Maternal, Newborn and Infant Clinical Outcome Review Programme is commissioned by the Healthcare Quality Improvement Partnership*** and run by MBRRACE-UK, a collaboration led from the National Perinatal Epidemiology Unit at the University of Oxford with members the Universities of Leicester, Liverpool, Birmingham and University College London, Bradford Teaching Hospitals NHS Foundation Trust as well a general practitioner, and Sands, the stillbirth and neonatal death charity.
  • The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. HQIP’s aim is to promote quality improvement, and it hosts the contract to manage and develop the Clinical Outcome Review Programmes, one of which is the Maternal, Newborn and Infant Clinical Outcome Review Programme, funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands. The programmes, which encompass confidential enquiries, are designed to help assess the quality of healthcare, and stimulate improvement in safety and effectiveness by systematically enabling clinicians, managers and policy makers to learn from adverse events and other relevant data. More details can be found at: www.hqip.org.uk/clinical-outcome-review-programmes-2/

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The Maternal Mental Health Alliance (MMHA) (http://maternalmentalhealthalliance.org.uk/) is a coalition of UK organisations committed to improving the mental health and wellbeing of women and their children in pregnancy and the first postnatal year. This acknowledges the extensive evidence that investing in mental health at this early stage can have a dramatic impact on long-term outcomes for mothers, fathers, children, families and society. The MMHA currently comprises over seventy organisations, including professional bodies such as Royal Colleges and organisations that represent, or provide care and support to, parents and families, and including women with personal experiences relating to maternal mental health. For further details please contact Maria Bavetta, Campaign Communications Officer (Maternal Mental Health - Everyone's Business) via maria.bavetta@everyonesbusiness.org.uk.