KEY POINTS:
Zane Blomfield lost his wife, Rachel, three days after the birth of their twin girls. It was almost seven years ago, but Blomfield says the drop from the elation of the birth to such immense grief is an ongoing battle.
Rachel's death falls into the category of a maternal mortality, but it is a group of fatalities that has been given very little research attention in the past - too little, suggest national health experts.
A new report from the UN World Health Organisation, UN Population Fund, the World Bank and the UN Children's Fund shows that New Zealand had a rate of nine maternal deaths per 100,000 live births in 2005 (a total of five fatalities), a figure that is more than double the Australian rate of four per 100,000.
Health experts and obstetrics professionals are at a loss to explain the transtasman discrepancy.
They have told the Herald on Sunday it is impossible to speculate on the reasons behind our higher maternal mortality rate, largely because a Ministry of Health committee set up to investigate the figures in detail stopped doing so 12 years ago.
The number of maternal deaths - classified as the death of a woman while pregnant or within six weeks of the end of a pregnancy (due to the birth of a baby, a stillbirth, a miscarriage or an abortion) - were recorded each year. However, there was no research into whether the cause of death was directly related to pregnancy or childbirth, or if there was an indirect cause, such as a car accident.
Dr Pat Tuohy, chief adviser of child and youth health for the Ministry of Health, says the original committee stopped investigating maternal deaths because doctors afraid of being prosecuted stopped reporting the occurrences, and the group "lost its way".
A new independent group, the Perinatal and Maternal Mortality Review Committee (PMMRC), has since been established, in 2005, and is conducting thorough research into each maternal fatality last year.
Tuohy says the work the committee is doing is important. "You can identify the causes of every death, but the issue is 'how preventable was it?'."
However, Kumeu GP and former GP obstetrician William Ferguson says the lack of information on the maternal death rate during the 1990s has caused concern among those interested in obstetrics. "We now have a committee, but what we don't have is close analysis of what happened when the maternity service was reconfigured in the mid-1990s."
Ferguson argues the medical care of women before, during and after pregnancy had substantially diminished since changes to the maternal health system, and funding for maternity services saw many GP obstetricians stop practising, particularly in rural areas.
Ferguson believes Australia and New Zealand were comparable in standards of healthcare, but he could not offer an explanation as to why the Australian rates were so much lower now, particularly as our maternal and perinatal mortality rates had been consistently lower than Australia throughout the early 1990s.
The UN report shows New Zealand is on a more equal footing with other developed countries: France has a rate of 8 per 100,000, as does Britain, while the US has a rate of 11.
But the New Zealand Medical Association's maternity spokesman Dr Mark Peterson agreed that the health professionals simply "don't know" why the Australian rate is so much lower, due to the lack of research.
"It's very strange [not to have records]," he said, "but the numbers of deaths are too small to judge the maternity system as a whole. That's not to say you shouldn't record it, but it's only one indicator of the success of the maternal health system."
Cindy Farquhar, postgraduate professor of obstetrics and gynaecology at the University of Auckland and chair of the PMMRC, warns that because the number of deaths each year was so few, rates could change dramatically.
"If it were two fewer deaths our rate would be five per 100,000 which is very close to the Australian rate. In my view, the numbers are too small to describe as a doubling." The number of maternal deaths in one year did not exceed eight in the period from 1995-2005.
She is also sceptical of the Australian mortality figures, saying the data may not be reliable in this case.
Alec Ekeroma, spokesman for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, says the organisation had been asking the Ministry of Health for some years to "analyse the causes of death and therefore put together a strategy or some sort of programme to make sure that [the rate] is minimised".
Considering the gap in that information, Ekeroma says it would be wrong for him to comment on the figures. "I think it's better to look at trends, instead of a one-off report... Unless we can look at a trend, and at each individual case within that trend, then it is hard to draw conclusions."
Tuohy says: "We have some information now, and we can make some changes, but we need to get that information across the whole country... That's what the PMMRC will do."
Figures collected by New Zealand Health Information Service since 1993 show maternal deaths vary from only 3.5 per 100,000 in 1995 to 6.8 per 100,000 in 2004.
However, a newspaper report in April claimed the PMMRC investigated a total of 12 maternal deaths last year, an unusually high number.
While the report into the deaths will not be released until next year, the Herald on Sunday understands that up to half of those may have been indirect deaths, such as death in a car accident.
Elation at birth turns to grief at mother's death
It was a time of elation and joy for Zane Blomfield and his wife Rachel; but just three days after the birth of his twin girls, the proud father was plunged into the depths of grief when Rachel died suddenly.
"I don't know how you'd ever measure the polar difference between how I felt when the twins were born, and then three days later hearing that she had died. It's an indescribable shift."
Rachel, 28, died of a burst aorta connected with the birth of her daughters, Monique and Alexis. Due to a rare genetic condition, called Ehlers-Danlos syndrome, her body tissues, such as her skin and organs, were fragile. The extra volume of blood in her body after the birth of the twins weakened her aorta, and it ruptured after she gave birth.
"In hindsight, looking back at her medical records, there were indicators where if someone knew more about the disorder they could have done something," said Blomfield, who lives with his daughters in Orewa. "It doesn't necessarily mean that she could have survived, but there is always that chance that with the right team of people there, they could have done something."
Rachel, who had given birth to Jordan four years earlier, developed toxaemia during the premature labour in December 2000.
However, the following day she returned to her ward, and asked Blomfield to bring her a snack. On arriving at the hospital, he was told she had died.
He had confirmation only last year that her connective tissue disorder was the reason for her weakened aorta. Tragically, the twins also have the condition. Blomfield said he didn't blame anyone for Rachel's death, "But I would say if there is an unusually high amount of women dying through childbirth processes, I would say maybe we should look into that...
"If you just keep it quiet, that's the ostrich effect. But it doesn't make it go away."
