Middle-class mothers at greater risk in childbirth

An audit of births in 2009 showed that, despite making up only 15.9 per cent of the pregnant population, the richest group of women accounted for 23.8 per cent of serious complications seen by NHS units.

One possible reason could be that more well-off women tend to have children at an older age, but experts said further work was needed to see if other factors could be behind the differences.

The Scottish Confidential Audit of Severe Maternal Morbidity, now in its seventh year, collected data from maternity units on women who suffered severe complications during childbirth.

The report showed the rate of morbidities in women in Scotland varied from year to year.

In 2009, there were 6.9 severe morbidities per 1,000 live births in consultant-led maternity units. This compared with 6.4 per 1,000 for the previous three years’ figures combined.

But for the first time, the report also looked at levels of deprivation among women suffering complications, such as major obstetric haemorrhage (MOH) and eclampsia.

The research showed that women in the most affluent fifth of the population appeared to be at greater risk of suffering a severe complication than less-well-off women.

While the most deprived group of women accounted for the largest proportion of complications overall (28.8 per cent), this group was also the most likely to have babies in 2009 – making up 25.8 per cent of all births.

This meant the percentage who suffered severe morbidity in the most deprived group was not significantly greater than the percentage of the population from this group who gave birth overall in 2009.

But for women in the most affluent group, the difference was much bigger. They accounted for 23.8 per cent of complications, despite making up only 15.9 per cent of the pregnant population.

One possible explanation is that more affluent women may be more likely to delay having children, with older mothers facing greater risk of complications.

Leslie Marr, reproductive health programme manager at Healthcare Improvement Scotland, which carried out the audit, said: “People traditionally expect women in the most deprived areas to have the worst outcomes. But, of these women in the most affluent areas, more of them had a worse outcome than you would expect.

“We are postulating that it might be an age thing. It might be that women in the most affluent areas are more obese, but we don’t know that. It could be caused by a number of issues.”

Ms Marr said if this trend continued in future years, it would need to be examined in more detail into why it was the case.

For the first time the report also looked at obesity levels to see if they had an influence on rates of complications in Scotland. The researchers found that the rate of complications in very obese women was over twice what would be expected.

Jane Norman, director of Tommy’s Centre for Maternal and Fetal Health at the University of Edinburgh, said: “This report underlines that obese pregnant women have an increased risk of a variety of pregnancy complications.

“Increasingly obstetricians and midwives are recognising this. The key is to try to understand what links obesity and pregnancy complications to try to prevent them.”

Prof Norman said the findings among affluent women were also interesting and could be down to the older age of mothers.

She said that, while obesity was more common in more deprived groups, more well-off women were not immune to it either.

Gillian Smith, from the Royal College of Midwives Scotland, said the finding of more complications in affluent women was much more than would be expected.

“Because this is the first year for these figures, that is an absolute indicator of what we need to look for to see if there’s a repetition of it next year. If there is, that is certainly something that needs to be looked into,” she said.

Overall in 2009, 381 women were reported as suffering from 441 morbidities, the most common of which was MOH – a severe loss of blood – which accounted for 78 per cent of cases.

The figures also showed a wide variation between units, ranging from 10.9 morbidities per 1,000 births at Glasgow Royal Infirmary to 2.7 in Dundee.

It is believed that these figures are affected by the different populations served by the units. For example, some areas have higher levels of deprivation and smoking, which increase the risk of complications. But the figures could also be influenced by some units being better at reporting the number of complications they experienced to the audit.

Despite disappointment about falling levels of consultant involvement in cases of severe bleeding, the report found an improvement in such cases where women were deemed to have been well cared for.

The figures showed that in 2009 the care of 71 per cent of women suffering a haemorrhage was found to be appropriate and well-managed – up slightly from 69 per cent the previous year –while in 19 per cent of cases units said lessons could be learned but the level of care did not affect the final outcome.

A Scottish Government spokeswoman said: “All women, irrespective of risk, should have one-to-one midwifery care in labour and access to obstetric care if required. The Refreshed Framework for Maternity Care is aimed at improving maternal and infant health outcomes for all women, and we expect health boards to ensure they have the right services and staff in place 24 hours a day, particularly in labour wards and neonatal units.”