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Deaths of mothers in childbirth inching up
Ten fingers. Ten toes. Perfect in every way. Rachel Elizabeth Hiller's arrival brought equal parts relief and jubilation.
Rachel's mom, 26-year-old Jennifer Hiller, spent a few hours after the delivery cuddling her firstborn and making pictures with family excited to meet their newest member.
But after leaving Jennifer happily exhausted at Florida Hospital Ormond Memorial that evening, the family's bliss was shattered with the telephone's ring late that November night.
"They told me that Jennifer had taken a turn for the worse and that we should get to the hospital," her mother, Shari Thompson, recalled.
So began the nightmare -- and the questions -- about how Jennifer, a national college tennis champ and well-liked local tennis pro, became one of a growing number of U.S. mothers classified as dying within 42 days of delivering new life.
Thompson, who lives in Ormond Beach, made it to the hospital before the new father, Jennifer's husband, Joseph Hiller of Port Orange.
"The doctor and the nurse took me into a room and told me that she had passed away," Thompson said. "The nurse told me that she had checked on her at around 10 p.m. . . . And when she came back about an hour and a half later, she was already gone. They called a medical team that worked on her for half an hour."
Deaths on the rise To be sure, the risks Jennifer faced in delivery have been greatly reduced in the last century. Maternal mortality rates in 2004 (the last year for which statistics are available) -- with a little less than 600 mothers dying -- are just 2 percent of what they were in 1915 .
But the figure has been edging up in recent years. In 2003, the rate was 12 deaths per 100,000 live births, the first time the rate had risen above 10 since 1977. In 2004, the rate rose to 13 deaths per 100,000 live births, according to statistics released in August by the National Center for Health Statistics.
The rate is watched closely at Healthy Start of Volusia/Flagler. Often, according to Dixie Morgese, executive director of that organization, maternal mortality is related to access to health care.
"There are usually racial health disparities in maternal death," she said. And whether the baby is born vaginally or C-section is also a factor.
"A C-section is major surgery," Morgese said. "The difference (between vaginal delivery and C-section) is like having a tooth pulled and a gallbladder removed."
Still, despite the nation's rising maternal age and the increasing rate of C-section deliveries, the National Center for Health Care Statistics Division of Vital Statistics concluded in a report last year the rising rate could be attributed to better identification of maternal deaths.
Statistics from the state Department of Health show just three maternal deaths in this area in 2006 sent the rate from 0 to well above the state's average of 0.2 deaths for every 100,000 births.
Ongoing mystery Rachel Elizabeth is about to turn 3 months old, but her family still doesn't have any answers to why her relatively young mother, who was apparently healthy, is not here to comfort her when she wakes up in the middle of the night. An autopsy from a doctor the hospital hired has not yet been given to the family, Joseph Hiller said last week.
A report, called a Code 15, that the Agency for Health Care Administration requires of a hospital when a death like this occurs is not accessible to the public. So Jennifer's family members and friends are left to wonder.
"As a top tennis player, it's hard to believe," Hiller said, his voice trailing off as he explained the pregnancy had been uncomplicated aside from a few days of spiking blood pressure just before the delivery.
"We were picking up the baby at the hospital and then going to the funeral home to make arrangements," he said.
He's not the only one wondering why, either. In her tennis career, Jennifer had been named a National Junior College Athletic Association (NJCAA) All-American for two straight years, won a tennis scholarship to Arkansas State University and, more recently, been one half of the top-ranked doubles team in the state, with her husband.
"A lot of people are looking for an answer and would like to know" why she died, said Ken Ouellette, director of tennis at Oceanside Country Club where Jennifer taught tennis and worked in the pro shop.
No one had an inkling Jennifer would face complications in delivery, friends and family say. She'd intended a natural delivery, her mother said, but the baby's heart rate was showing some distress with every contraction, so a C-section was ordered. And things seemed to be going fine.
The use of certified nurse anesthetists at Florida Hospital Ormond Memorial instead of anesthesiology physicians led the area's largest obstetrical practice to announce in 2006 it would no longer deliver there. And all but one of the area's multi-physician obstetrical practices have stopped delivering babies there since then.
But there hasn't been a determination that was the reason.
"Words cannot express our heartfelt sadness over Jennifer's death," said Joanne Magley, Florida Hospital Memorial System spokeswoman. "Over the past 10 years, since the inception of our BirthCare Center, we have had more than 10,000 successful births. Our thoughts and prayers go out to Jennifer's husband and family at this difficult time."
So, Jennifer's family is left to cope with caring for an infant and remembering the vivacious young woman who made decorating the nursery with pink borders and cartoon animals the first thing she did after she and her husband bought their Port Orange home. Rachel Elizabeth started smiling in the first week of life, her father said. And her development -- hitting other milestones such as sitting up well ahead of schedule -- gives him something to smile about.
But he's left to contemplate what might have been when his daughter's cries wake him in the middle of the night. And what it will be like in the future, simultaneously marking his little girl's birthday and her mother's death.
"There was so much all at once," he said. "We had a new baby and then the whole world fell apart."
The rate of U.S. maternal mortality -- at 13 deaths for every 100,000 live births in 2004 -- still pales in comparison to the nation's infant mortalities; 679 infants died for every 100,000 live births that same year. But, even beyond the recent increase in maternal deaths, it's a matter of concern because black mothers are three times more likely to die in the 42 days following a birth than white mothers.
Over the past century, the overall trend shows technological and other medical advances have made huge strides in keeping mothers alive to raise their babies, beginning in the 1930s. Here are the statistics from the Centers for Disease Control showing the rate of mothers who died for every 100,000 births in the U.S.: