After a difficult pregnancy, weeks of bed rest and an emergency cesarean section, Liz Logelin got only a quick peek at her daughter before the newborn, healthy but premature, was whisked away to the neonatal unit.
The next day, a nurse arrived with a wheelchair to take the first-time mother to see her baby. With husband Matt by her side, Logelin rose, took a few steps, said, "I feel light-headed," and died.
She was 30.
"She never got to hold her baby," said Matt Logelin, who lives in Los Angeles with the couple's daughter Madeline, now 2. "That is one of the hardest things for me."
Each day in the U.S., two women die of problems related to pregnancy or childbirth. The numbers have been rising, for reasons that are not entirely clear. After plunging in the 1900s, maternal mortality rates in California tripled between 1996 and 2006, from 5.6 deaths per 100,000 births to 16.9.
Nationally, the rate, defined as deaths from obstetrical causes within one year of giving birth, rose from 7.6 per 100,000 to 13.3 per 100,000.
For each death, experts estimate, there are about 50 instances of complications related to pregnancy or childbirth that are life-threatening or cause permanent damage. According to a study published last year, such "near misses" — including kidney failure, respiratory distress syndrome, shock and the need for blood transfusions and ventilation —rose 25% from the late 1990s to 2005.
Childbirth-linked deaths are still rare in the U.S., numbering about 90 women a year for California. But health experts believe that at least one-third are preventable.
Furthermore, they add, it is a problem typically associated with poor nations, not a rich, industrial country like the U.S. It is one of the primary indicators of public health that improves dramatically as countries develop and strengthen access to, and quality of, medical care.
Though the U.S. spends more per birth than any other nation, maternal mortality is higher here than in 40 other industrialized countries, including Croatia, Hungary and Macedonia, and is double that of Canada and much of Western Europe.
That the United States is backsliding in this most basic of healthcare measures has triggered attention and alarm in medical circles. In January, the Joint Commission, an independent organization that accredits and certifies healthcare organizations and programs, issued a "sentinel event alert" warning of the rising maternal mortality rates.
In March, the human rights organization Amnesty International released its own report, "Deadly Delivery," calling for sweeping changes in maternal healthcare in the U.S.
The California Department of Public Health has commissioned a statewide review of medical charts in maternal death cases to identify reasons for the rise and seek ways to improve.
"Mothers shouldn't die in childbirth," said Dr. Elliott Main, chief of obstetrics at Sutter Health and director of the ongoing California review. The trend, he said, may signal a much larger problem with U.S. maternal healthcare.
Experts don't yet know what has caused the increase in deaths, but there are plenty of potential explanations.
A 1999 change in how maternal mortality statistics are calculated is believed to be responsible for about 30% of the bump; that still leaves the bulk unexplained.
Health experts point to a mismatch between the way American medicine delivers babies and the changing profile of the American mother. Traditionally, physicians have viewed pregnant women as both young and healthy. In this country, that is no longer the case for a growing portion of expectant mothers.
More women today are giving birth in their 30s and 40s, when risks of complications during pregnancy and childbirth significantly increase. Almost 25% of women of childbearing age are obese and thus at higher risk for conditions such as diabetes and high blood pressure. Physicians haven't adapted their approach to childbirth to accommodate these new risks, maternal health experts said.
Some experts implicate the rise in rates of cesarean sections, which account for one-third of all births — up from one-fifth in 1997. Although many are done to save the life of a mother and her baby, perhaps half are elective, meaning the surgery is medically unnecessary. After one C-section, cesareans are typically recommended for subsequent pregnancies.
Yet these are major operations and "should not be taken lightly," said Dr. Michael Lu, a UCLA associate professor of obstetrics and gynecology. Each additional cesarean increases the risk of placental complications that threaten the lives of mother and baby.