The confidential enquiry into maternal deaths 1997–2005: implications for practice

Abstract

Most national policies for perinatal mental health in the UK have been influenced strongly by the Maternal Mortality Enquiries. These reveal that suicide in particular, and psychiatric causes of maternal death in general, are a leading cause of maternal mortality. In 1997–2002, suicide was the leading cause of maternal death (during pregnancy and for up to 1 year postpartum). However, the latest Enquiry (2003–2005) found a significant reduction in the number of suicides, which is now the second leading cause of maternal death. The majority of suicides had a previous psychiatric history. Those who died within 3 months of childbirth were suffering from severe mental illness, and most had a past history of severe affective disorder including puerperal psychosis. These identifiable risk factors were not detected in early pregnancy, or managed. There was often a delayed response to these women’s rapidly deteriorating illness. None had been admitted to a mother-and-baby unit, or cared for by specialized perinatal psychiatric services in either their current or previous maternities. A consistent finding of the Enquiries has been the violent method of suicide, with few women dying from an intentional overdose of prescribed or over-the-counter medication. Substance misuse made a significant contribution to maternal mortality, from both medical and psychiatric causes. The reduction in maternal suicide might suggest that the recommendations of the last three Enquiries have had some impact. However, complacency is not justified and it remains true that many maternal suicides were predictable and perhaps preventable.