Maternal Deaths in NSW (2000–2006) from Nonmedical Causes (Suicide and Trauma) in the First Year following Birth

Abstract

Introduction. Trauma, including suicide, accidental injury, motor traffic accidents, and homicides, accounts for 73% of all maternal deaths (early and late) in NSW annually. Late maternal deaths are underreported and are not as well documented or acknowledged as early deaths. Methods. Linked population datasets from births, hospital admissions, and death registrations were analysed for the period from 1 July 2000 to 31 December 2007. Results. There were 552 901 births and a total of 129 maternal deaths. Of these deaths, 37 were early deaths (early MMR of 6.7/100 000) and 92 occurred late (late MMR of 16.6/100 000). Sixty-seven percent of deceased women had a mental health diagnosis and/or a mental health issue related to substance abuse noted. A notable peak in deaths appeared to occur from 9 to 12 months following birth with the odds ratio of a woman dying of nonmedical causes within 9–12 months of birth being 3.8 (95% CI 1.55–9.01) when compared to dying within the first 3 months following birth. Conclusion. Perinatal services are often constructed to provide short-term support. Long-term identification and support of women at particular risk of maternal death due to suicide and trauma in the first year following birth may help lower the incidence of late maternal deaths.

Perinatal suicide in Ontario, Canada: a 15-year population-based study

“…28 In our study, postpartum deaths occurred most frequently after the first 12 weeks, particularly after the sixth month postpartum. This is an important finding, given that many definitions of postpartum depression are restricted to women who gave birth within the past month, and maternal mortality up to 6 weeks postpartum is usually considered to be related to childbirth.…”

“…The more lethal means of suicide in the perinatal group (i.e., hanging or jumping) relative to the non-perinatal group (i.e., overdose) is consistent with previous reports. 2,[28][29][30][31] These findings suggest that perinatal women who are suicidal may be at higher risk for suicide completion than women outside the perinatal period. Similar to research in other countries, 32 most of the women who died perinatally had a mood or anxiety disorder, rather than a psychotic disorder.…”

Injury-related maternal mortality

“…1e3 Thereafter, injury-related deaths rose significantly, with more than one third of injuries being intentional, a similar proportion to that in a study of 129 maternal deaths in Australia. 4 This study did not capture out-of-hospital births, which are less than 1% of births in Ontario, or maternal deaths occurring antepartum. Although direct and indirect causes of death were not differentiated herein, the striking difference in maternal mortality rates following a stillbirth vs a livebirth deserves further study.…”

Psychosocial and obstetric determinants of women signalling distress during Edinburgh Postnatal Depression Scale (EPDS) screening in Sydney, Australia

“…When undetected these disorders pose a range of risks to the mother's health, psychosocial wellbeing, relationships and her infant's development [6]. In Australia, death by suicide or trauma remain the two leading causes of death in the first postpartum year [7], with the great majority of cases having had psychiatric diagnoses including substance use identified [8]. An increasing body of literature suggests perinatal depression and anxiety interrupt the mother-infant relationship leading to a range of neurocognitive, psychiatric and developmental problems in the offspring of affected mothers [9][10][11][12].…”