One in five preventable in five years after childbirth, study finds

A world-first analysis from a team of Australian researchers has found one in five maternal deaths in the five years following childbirth are preventable.

Suicide has long been accepted as a leading cause of maternal death in Australia, but experts have warned previously reported statistics did not reflect the full extent of the issue.

One reason is the fact that maternal deaths data is usually limited to 42 days or one year after childbirth, but as the study in BJOG: An International Journal of Obstetrics & Gynaecology found, the risks “don’t suddenly go away” after the child’s first birthday.

More than 1.7 million live births from more than one million mothers in NSW from 2002 to 2020 were examined by a team of researchers led by western Sydney obstetrics and gynaecology registrar Dr Louise Makarious.

It is the first peer-reviewed study focused on maternal deaths from suicide, accidental poisoning, and undetermined intent beyond one year after childbirth.

The investigation, published on Tuesday, found those causes represent 26 per cent of maternal deaths within the first year after childbirth, 23 per cent within two years, and 22 per cent within five years.

Most vulnerable were first-time mothers, mothers aged 24 or under, mothers who identify as First Nations, and mothers who live in remote or socioeconomically disadvantaged communities.

“Deaths due to suicide and accidental poisoning, they’re completely preventable deaths,” says Makarious. “This study has demonstrated that this particular at risk population should have ongoing care beyond that one year.”

Makarious notes that obstetric-related causes of maternal death – such as haemorrhage, blood pressure disorders and infections – declined over the 18-year study period due to targeted improvements in clinical practice. In comparison, mental health-related maternal deaths remained stable.

But 60 per cent of mothers who died by suicide, and two thirds of mothers who died from accidental poisoning and undetermined intent, did not visit community mental health services within the 12 months before their death.

“This demonstrates that there are barriers to engaging with or accessing healthcare that need to be removed,” says Makarious, noting that while the shortage and cost of psychologists and psychiatrists are prohibitive, other influences include culture, negative experiences with authorities, and location.

Parental mental health services such as the government-funded PANDA national helpline and not-for-profit Gidget Foundation Australia aim to bridge this gap, with the latter supporting 26.7 per cent more clients in the past 12 months than the same period a year prior.

Offering mental health and substance abuse screenings to beyond one year post-childbirth is one approach to support at-risk mothers, says Makarious.

Another would be educating clinicians to look for risk factors in the antenatal period and encouraging clinicians to openly discuss substance use and mental health with parents, and using continuity of care models that facilitate rapport-building between mothers and clinicians.

Regular access to mental health workers, with telehealth or home visits readily available, would also make care accessible.

“We should aim to reduce the barriers these women experience to avoid preventable death,” says Makarious. “These are all deaths that are avoidable and preventable.”