The head of the obstetrics programme with the HSE has warned that unnecessary anxiety might be caused among pregnant women by misreading Ireland's maternal mortality data.

Prof Michael Turner says despite all the recent public concern expressed about maternal mortality, our maternal death rates still compared very favourably even with other developed countries that spent much more money than us on their health services.

He said like was not always being compared with like when contrasting different maternal deaths rates reported by different sources for Ireland and other countries.

Prof Turner stressed, however, that the Savita Halappanavar case was a reminder that there was never room for complacency with it comes to promoting safe motherhood.

Recent media coverage highlighted that a major report showed that Ireland's maternal death rate, under newly-introduced criteria, was twice the rate reported by the Central Statistics Office (CSO).

The Maternal Death Enquiry (MDE Ireland) report, published for the first time last year, uses wider criteria* than the CSO for reporting maternal deaths. It utilises a UK system that involves proactive case finding among hospitals, GPs, public health nurses and other sources.

The CSO system, on the other hand, uses formal death notifications based on what is written on death certificates. Not all maternal deaths are always reported as such on death certs.

Based on the new MDE Ireland criteria*, its report, published last year, stated that Ireland, between 2009 and 2011, had a maternal mortality rate of 8.6 per 100,000 maternities (number of pregnancies that result in a live birth at any gestation or stillbirths after 24 weeks).

This compared to a rate of four per 100,000 live and stillbirths reported by the CSO for 2009, the report pointed out.

Prof Turner told irishhealth.com, however, that if comparisons nationally and internationally are to be made, the same system should be used, so that like can be compared with like as regards maternal death rates.

He said he was concerned that lack of knowledge of scientific details involved in reporting maternal deaths may inadvertently cause anxiety if reported in a sensational way.

Prof Turner, who is a former master of Dublin's Coombe Hospital, pointed out that the CSO figure was based on still and live births, whereas the MDE figure is based on maternities.

"The CSO figure used in the report is for 2009 and is based on year of notification. The MDE figure is for two years and is based on year of mother's delivery."

"If we want to make international comparisons, therefore, we should use the same system, the same definitions and the same timeframe. That is what the World Health Organization (WHO) does in compiling its maternal mortality statistics."

According to last year's MDE Ireland report, in 2008, Ireland, at three per 100,000 live births, had a lower maternal death rate, based on WHO criteria, than France, Norway, Sweden and the USA.

In 2009, using CSO death cert criteria, we had a rate of four per 100,000 live and stillbirths, the report stated.

However, using the wider MDE Ireland criteria, Ireland had a rate of 8.6 per 100,000 maternities in 2009-2011, compared with 11.39 per 100,000 maternities in the UK, using the same criteria, from 2006-2008

The report indicated, however, that the new MDE Ireland maternal death reporting system, through use of detailed case assessment, is the most reliable method of calculating maternal deaths and can assist healthcare policy in Ireland.

It said in the absence of active case ascertainment, under-reporting and misclassification of maternal deaths can occur, even in developed countries with advanced civil registration systems.

Last year, the CSO only reported one maternal death, whereas maternity units have to date unofficially reported at least six deaths.

Prof Turner said Ireland was unique in that the large maternity hospitals and units published detailed annual clinical reports covering half of all births in the country each year, including high risk in-utero hospital transfers.

Thus, direct and indirect maternal deaths in hospitals are unlikely to be missed, unlike other countries, which for this reason may be under reporting their mortality rates, he said.

Prof Turner said if the scientific details about reporting death rates were not taken into account, it may inadvertently cause anxiety if they are reported in a sensational way.

However, Prof Turner said as recent events in Galway have reminded us, there is never room for complacency when it came to safe motherhood and he believed 'we need to constantly review our efforts' in this regard.

*MDE Ireland Maternal Deaths Classification

Maternal Deaths

Deaths of women while pregnant or within 42 days of the end of the
pregnancy from any cause related to or aggravated by the pregnancy or its
management, but not from accidental or incidental causes.

Direct Deaths

Deaths resulting from obstetric complications of the pregnant state
(pregnancy, labour and puerperium), from interventions, omissions,
incorrect treatment or from a chain of events resulting from any of the
above.

Indirect Deaths

Deaths resulting from previous existing disease, or disease that developed
during pregnancy and which was not the result of direct obstetric causes, but
which was aggravated by the physiological effects of pregnancy. This includes most deaths from suicide related to pregnancy.

Coincidental Deaths

Deaths from unrelated causes which happen to occur in pregnancy or the
puerperium

Late Deaths

Deaths occurring between 42 days and one year after abortion, miscarriage or
delivery that are the result of direct or indirect maternal causes.