Anne-Marie Byrne hopes a national system will help save other women from the fate of her daughter, Sarah Turpin, pictured, who died of a rare pregnancy-related cancer in 2014, leaving three children behind.Supplied
Canada needs a national system of mandatory reviews for every case in which a woman dies in childbirth or within a year of delivering, according to maternal health experts who say some deaths could be prevented if lessons from past tragedies were widely shared.
Canada should also improve its tracking of maternal deaths, which are undercounted to such a degree that the World Health Organization estimates the real number is 60 per cent higher than Canada’s official figures.
Those were two of the most important calls to emerge from the first-ever summit on preventing maternal mortality in Canada held in Ottawa on Tuesday.
“The big ask is for a commitment from folks from every province or territory that every single maternal death will be reviewed in depth, with identification of factors that contributed to the death,” said Jocelynn Cook, the chief scientific officer of the Society of Obstetricians and Gynaecologists of Canada (SOGC), in an interview. The SOGC hosted the summit.
“No matter what kind of politician you are, no matter what part of government … everybody agrees that we should be able to understand what’s happening. We should be able to prevent the deaths that are preventable,” Dr. Cook added.
Although maternal deaths are rare in Canada, they are not as rare as they appear in official statistics, the summit was told. Statistics Canada reported 32 maternal deaths from obstetric causes in 2019 and 30 in 2020, but those figures, based on birth and death records, miss many deaths that are pregnancy- or childbirth-related but occur more than six weeks after delivery.
Still, the data that are available suggest Canada’s maternal mortality rate is creeping up. The rate was 8.4 deaths for every 100,000 live births in 2020, up from about five in 2011, although some of that increase may stem from better tracking, said Susie Dzakpasu, a senior epidemiologist in the maternal and infant health section of the Public Health Agency of Canada.
The Canadian rate is higher than that of many wealthy European countries but significantly lower than the rate in the United States, where 17.4 maternal deaths were logged for every 100,000 live births in 2020.
Dr. Dzakpasu said research drawing on hospital data from across Canada (excluding Quebec) from 2013-17 found there were more “indirect” maternal deaths than “direct” deaths during that period.
Indirect deaths include maladies such as cancer and diseases of the circulatory system that can be triggered or exacerbated by pregnancy, as well as suicides and drug overdoses that could be linked to postpartum depression. Indirect deaths are less likely to be counted in vital statistics databases, Dr. Dzakpasu said.
Six Canadian provinces have committees that review maternal deaths: British Columbia, Alberta, Manitoba, Ontario, Quebec and Newfoundland and Labrador. Although most make some of their findings public, including through annual reports, they don’t go as far as a long-standing confidential inquiry system that has helped Britain learn from deaths and near-deaths linked to pregnancy and childbirth.
Marian Knight, a professor of maternal and child population health at the University of Oxford who leads the British program, said the mandatory case reviews are not meant to assign blame, only to learn what could have been done differently to save a life. They also help health leaders spot trends in the causes of maternal mortality, including an recent increase in pregnant woman dying of COVID-19.
“My job is hard,” Dr. Knight told the summit. “But the hardest time for me was over the winter of 2021-2022 having to count one maternal death every week in unvaccinated pregnant women because of all the failures in messaging that had gone on beforehand,” she said.
Anne-Marie Byrne hopes a national system of confidential inquiries with public findings and recommendations will help save other women from the fate of her daughter, Sarah Turpin, who died of a rare pregnancy-related cancer called choriocarcinoma in 2014, leaving three children behind. She was 32.
Choriocarcinoma can be identified with a blood test and is treatable if caught early, but Ms. Turpin wasn’t diagnosed until three days before her death, despite multiple visits to doctors beforehand.
“If our family, in some small way, could help in the development of this initiative, we hope that it might save some other mothers’ lives,” Ms. Byrne said. “And just as importantly, it would keep other children from having to live without a mom.”