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Maternal Mortality: “Every mother who dies due to pregnancy or giving birth is one too many”
Professor Klaus Vetter; © private
Celebrities like Victoria Beckham and Heidi Klum show us how it’s done: Pregnancy and birth are celebrated like a lifestyle event. Pregnancy while working 60 hours a week? No problem. Return directly after birth lithe and lissom to work? Not only for models a must.
It is often forgotten that during gestation and birth medical problems can occur that can end with the death of the mother – a fact that does not only apply to the Third World! MEDICA.de spoke with Professor Klaus Vetter, a gynecologist from Berlin and patron of the German Academy of Gynecology and Obstetrics (Deutsche Akademie für Gynäkologie und Geburtshilfe – DAGG) about the reasons for a high-risk pregnancy, the path of research and the scandal of staff shortages.
MEDICA.de: Professor Vetter, is maternal mortality (also “obstetrical death“), meaning the death of a mother during or right after giving birth, actually still an issue?
Klaus Vetter: Absolutely, because every mother who dies due to pregnancy or giving birth is one too many. Maternal mortality still exists and that’s also why we tried to analyze it by studying the next to last age groups of 2008/2009 in Germany. Although these results have not been published yet, you might get some ideas as to why women still die while giving birth. There are some things that could be avoided. Unfortunately, many people today think that pregnancy and giving birth can be done blindfolded. But they are deluding themselves, because both are definitely risky and you need good medical science to ensure the safety of mother and child.
MEDICA.de: What do these women die from?
Vetter: On the one hand it’s from infections; the rate is particularly high in the Third World. The other issue is hemorrhaging. Death by exsanguination is still a problem that we don’t have under control 100 percent. With us – in the Western World – the fact is that most women when they start to give birth have healthy blood and iron reserves so that they don’t die as soon as they lose any blood. But if you don’t have any reserves for example, like for instance in countries where there are very low hemoglobin levels, normal bleeding can already become deleterious for us. Yet even in our country, bleeding or infections can have severe consequences. In addition we are more and more confronted with diseases that are related to the advanced maternal age of women. These issues are further promoted by the possibilities of artificial insemination in women of advanced age, since in this instance women become pregnant whose bodies are no longer equipped for a pregnancy. For instance since the body no longer produces any eggs and because there are diseases that otherwise would not permit a pregnancy. If despite of all this there is a pregnancy, it can be deleterious.
Unfortunately, it happens time and again that women die during pregnancy or childbirth; © panthermedia.net/ Ron Chapple
MEDICA.de: Can you give us an example of a disease that can cause such severe issues during pregnancy?
Vetter: Autoimmune diseases for example cause problems, for instance Lupus erythematodes. If a woman suffers from it, it could be that her ovaries no longer produce eggs – this is a natural process where the body limits itself on its own. These women don’t become pregnant and that’s it. But if they go and get eggs through egg donation for instance, even if that is not allowed in Germany, and have them implanted, this could possibly lead to a catastrophe. I remember my first case of this nature: there was a woman who at first had a miscarriage at about twenty weeks of gestation. The woman had developed high blood pressure and also had other symptoms of preeclampsia. That’s why the advice to her was: no further pregnancies! Unfortunately, the couple nonetheless tried it again and they also progressed with this pregnancy a little more than in their first try. The woman actually gave very premature birth to the child, but it was severely disabled. What’s more, the mother suffered a stroke and needed trepanation. Although she did not die, afterwards she was also very severely handicapped – a disaster.
Another reason for the still existing maternal mortality is also the fact that medical care has gone down. Manpower is lacking and birth is given at the wrong place so to speak. This is to say, today we have a decrease in medical service, especially on the weekends, which is not insignificant. And within this scope of course it might happen that somebody “falls through such a crack” and is not properly being attended to in this case. To put it bluntly: that there is hemorrhaging for instance that is not being treated in time. And this means that in the end the mother then is either very sick or dead. So organizational and strategic issues arise and come to the fore.
MEDICA.de: What steps do you have to take to reduce mortality?
Vetter: That’s a complex subject. That’s why we set up a team to work on the issue of maternal mortality. There is a statistic for instance that has been carried out for many years by Professor Welsch in Bavaria, Germany. He has studied and analyzed data and knows the cases in Bavaria where death is attributed to pregnancy. He arrives at the conclusion that some things could be preventable by creating better structures and a better monitoring of pregnant women. However, these investigations need to be done all over Germany and this is happening at the AQUA-Institute in Göttingen for instance. So we are on it and it is important to know that: yes, we can make some improvements. You can improve prenatal care and minimize mistakes.
The interview was conducted by Simone Ernst and translated by Elena O'Meara