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Written on 22nd January 2021 by Susan Brown

MBRRACE-UK has published its latest report on maternal (mother) deaths and morbidity (serious illness) in maternity care. For anyone who has lost a partner, mother or baby during or around childbirth, or who has an interest in maternity safety, the lengthy and detailed report is not an easy read.

The increase in the overall maternal death rate for 2016-18 since MBRRACE-UK’s previous (2013-2015) report, suggests that without a well led and properly resourced commitment to improvement in maternity care the government will fail in its aim to halve the number of maternal deaths in England by 2025.

Key themes from the 2020 report, published January 2021, include the higher number of deaths in women with epilepsy, pre-existing or multiple health conditions, or from Black or Asian ethnic backgrounds. Other additional risk factors were age, social deprivation and obesity.

The most alarming findings from the report, are however, the findings of MBRRACE-UK’s panel of experts that:

  • only 29% of those women who received antenatal care (not all did), received care which complied with NICE antenatal care guidelines; and
  • 51% of all the women who died might have had a different outcome if they had received better care.

Key facts and figures from ‘Saving Lives, Improving Mothers' Care 2020: Lessons to inform maternity care from the UK and Ireland Confidential Enquiries in Maternal Death and Morbidity 2016-18’

In 2016-18:

  • 2,235,159 women gave birth in the UK;
  • 566 women died during or up to a year after the end of pregnancy in the UK and Ireland;
  • 242 women died within six weeks of the end of pregnancy but in 25 cases, their deaths were coincidental;
  • 217 women died during or up to six weeks after pregnancy, from causes associated with their pregnancy;
  • 9.7 women per 100,000 died during pregnancy or up to six weeks after childbirth or the end of pregnancy.

Of the 217 women who died within six weeks of the end of pregnancy:

  • 70 (32%) were still pregnant at the time of their death.
  • 51% of those who died whilst pregnant were at 20 weeks’ gestation or less.

What happened to the 217 women’s children?

  • The 217 women left behind a total of 356 children including 259 children from previous pregnancies;
  • 130 women gave birth to 139 babies;
  • 97 (70%) of those babies survived;
  • 36 babies were stillborn;
  • Six suffered neonatal death.

What were the highest risk factors for maternal death?

Maternal mortality rates were higher amongst:

  • older women;
  • women living in the most deprived areas;
  • women from particular ethnic minority groups.

Compared with white women, maternity mortality rates were:

  • four times higher amongst women from black ethnic backgrounds;
  • almost double amongst women from Asian ethnic backgrounds.

What health conditions caused or contributed to maternal deaths in 2016-2018?

  • cardiac (heart) disease was again the largest single indirect cause of maternal deaths;
    • 50 women (23%) died indirectly from cardiac disease;
    • 16 were already known to have heart disease;
  • neurological causes were the second most common indirect cause of maternal death and the third commonest cause of death overall;
    • neurological causes (epilepsy and stroke) - 29 women (13%) overall;
    • epilepsy - 22 women;
    • a statistically significant rise in maternal deaths from Sudden Unexpected Death in Epilepsy (SUDEP);
    • 68% of women with epilepsy may have had a different outcome with better care.
  • blood clots - 33 women (15%);
  • mental health conditions  - 28 women (13%);
  • sepsis (infection)- 23 women (11%);
    • 68% of women who died from infection may have had a different outcome with better care.
  • bleeding - 20 women (9%);
  • cancer - 6 women (3%);
  • pre-eclampsia - 4 women (2%);
  • 15 women (7%) other physical conditions;
  • 9 women (4%) other causes.

Helping the families of women who died from negligent maternity care

Each and every one of these women’s deaths represents a tragic loss to their family, and in the majority of cases, the irreplaceable loss of a mother to the newborn or older child. The valuable work carried out by MBRRACE-UK, RCOG and countless other professional organisations to identify, analyse and work towards reducing maternal deaths must not be wasted, if further unnecessary death and suffering is to be avoided.

Whilst working towards a better future for women in maternity care, it is essential that the needs of those who have suffered avoidable harm, loss or bereavement from negligent care are met. Our compassionate and experienced lawyers are committed to helping families affected by negligent maternity care receive timely support and full compensation.

If you or a member of your family have suffered serious injury or bereavement as a result of negligent maternity care and you would like to find out more about making a claim, contact us by email on