Information about deaths of babies and mothers in Aotearoa New Zealand

About the Perinatal and Maternal Mortality Review Committee

Since 2007, the PMMRC has reported on the deaths of babies and mothers in Aotearoa New Zealand. The PMMRC is appointed by the Health Quality & Safety Commission (the Commission). 

The PMMRC: 

• reviews the deaths of babies born from 20 weeks of pregnancy up until 28 days after birth 
• reviews the deaths of all mothers who die at any stage during pregnancy or in the six weeks after childbirth 
• looks at information about the pregnancy and birth, and the findings of medical tests, to try and understand why a baby or mother died. 

This incredibly important work is needed to support and improve how the maternity system works and the way things are done. 

Babies who died during pregnancy or childbirth

In 2020, there were 59,444 births in Aotearoa New Zealand. Of those, 642 babies died after 20 weeks of pregnancy or within the first four weeks after birth. This means that 10 babies died for every 1,000 registered births. This rate is very similar for babies born in the UK and Australia. 

This rate has not decreased since 2007 when the PMMRC started reviewing these deaths.  

The rates of deaths of babies of Māori, Pacific and Indian mothers continue to be higher than rates for New Zealand European mothers.  

Mothers under 20 years old and those living in areas of high deprivation experience worse pregnancy and childbirth outcomes.  

It is unacceptable that no significant progress has been made to reduce these deaths and that these inequities of outcomes continue. These inequitable outcomes mirror the same inequities across other areas of our health system. 

Urgent action, centred in equity, is required to help reduce the loss and grief that families and whānau are experiencing as a result of preventable death in Aotearoa New Zealand. 

The causes of deaths of babies

Congenital anomalies

Congenital anomalies continue to be the most common cause of death for babies. 

Congenital anomalies are caused by the baby’s genetics or something in the baby's environment that has caused a difference in the typical development of the baby. The exact cause is not always known. Congenital anomalies are the most common cause of death for babies during pregnancy or in the first month of life.  

In 2020, 165 babies died because of congenital anomalies. This accounts for over a quarter of the deaths of babies. 

We know that folic acid as a supplement in bread is safe for everyone. It is also a proven way to make sure all women get enough folic acid to support the development of babies in early pregnancy. From mid-2023, all non-organic wheat flour used for making bread must be fortified with folic acid in an effort to reduce the number of babies with congenital anomalies.  

Unexplained

In 2020, unexplained death was the second most common cause of death of babies. There were 104 deaths in 2020 that were considered unexplained. This is 27 more than in 2018 and the highest number (and rate) of unexplained death since the PMMRC started collecting information.  

For these babies, there were no obvious medical problems with the baby or the mother that could explain why the baby died and/or there were no or limited investigations done to try and find a cause of death.  

Full post-mortem (autopsy) provides the fullest possible information for families and whānau about why their baby died. 

Other options available to parents who would like to investigate the reason their baby has died include a partial autopsy and/or investigation of the placenta. 

A study of decision-making by mothers after their baby had died found that no woman who chose for their baby to have a full post-mortem regretted her decision. Ten percent of women who declined a post-mortem later regretted the loss of opportunity to understand more about their baby’s death (Cronin et al 2018). 

Premature labour

Premature labour was the third most common cause of death for babies in 2020. Premature labour is when a woman goes into labour or her waters break more than three weeks before the estimated due date. If a baby is born too early, their lungs and other parts of their body may not yet be fully developed. In 2020, 95 babies  died due to premature labour. 

Māori, Pacific and Indian babies are more likely to die from premature labour than any other ethnicity, which is an unacceptable outcome. 

The Carosika project, Taonga Tuku Iho, is a national preterm birth prevention initiative that was established in 2020 in an effort to reduce preterm birth and improve preparation and equitable outcomes for all pēpē who are born preterm in Aotearoa New Zealand. Several members of the PMMRC are also involved in this work.   

References 

Cronin Rs, Li M, Wise M, et al. 2019. Late stillbirth post mortem examination in New Zealand: maternal decision-making. Australia New Zealand Journal of Obstetrics and Gynecology 58(6):667–673. DOI: 10.1111/ajo.12790. 

Why mothers die during pregnancy and childbirth

The risk of death for mothers during pregnancy is low.

As the risk is so low, it can be difficult to measure whether there have been any changes over time. Each and every maternal death is a significant tragedy. 

On average, 10 women die every year in pregnancy or within 42 days of the end of pregnancy. Often these women had pre-existing medical issues that were made worse by pregnancy. It is important that these women receive early and regular antenatal care. In 2020, six women died. 

Deaths of women from unrelated causes that happen to occur in pregnancy, such as a car accident, are not counted in these deaths. 

Since the PMMRC began its reviews: 

• 57 women have died from non-pregnancy-related medical problems that were either pre-existing or medical problems that began during pregnancy and made worse by pregnancy 
• 31 women have died from suicide 
• 14 women have died from an amniotic fluid embolism around the time of childbirth. This is a rare pregnancy complication that occurs when the fluid that surrounded the baby during pregnancy enters the mother’s bloodstream and causes an allergic reaction. 

What needs to change

The PMMRC has made approximately 120 recommendations since its first report in 2007. These recommendations have been made to government departments, health practitioners, researchers, colleges and regulatory bodies.  

The PMMRC report includes a list of their previous recommendations that still require further work. You can find these in appendix B of the 15th report of the Perinatal and Maternal Mortality Review Committee. 

Many improvements have been made in the last 15 years, but greater priority must be given to putting previous recommendations into action. 

The most urgent need for greater priority and improvement is in reducing the number of deaths for families and whānau for whom too many are described in the PMMRC report. This includes whānau Māori, Pacific families, Indian families, mothers under the age of 20 years and those living in areas of high deprivation.  

Improvements to systems and services must be decided on and developed alongside the groups and communities for whom the death rates have not changed so that the right decisions and changes can be made. 

More information

• Sands New Zealand  (www.sands.org.nz) and Baby Loss NZ (www.babyloss.co.nz) are organisations that offer support for families and whānau whose baby has died. They have a lot of helpful information on their websites. 
• Whetūrangitia (wheturangitia.services.govt.nz) is a website that has been created to have a single collection of up-to-date information and resources for people who have experienced the loss of a baby or child.  
• Former PMMRC members Lisa Paraku and Dr Vicki Culling have created a short video (Postmortem for Babies in Aotearoa NZ) to explain post-mortem (autopsy) to families and whānau.   
• The PMMRC have developed a pānui about post-mortem, which includes information for parents who have had a baby die. You can find this on the Commission website. 
• The Ministry of Health website has useful information about miscarriage before 20 weeks. 

If you are pregnant, what can you expect?

There are multiple ways that health practitioners can support you and your baby during your pregnancy. 

First, www.findyourmidwife.co.nz is a good place to start to find a lead maternity carer (LMC). Your doctor or local hospital should also be able to help you quickly find an LMC. 

Your LMC will be able to answer your questions and help you through your pregnancy and the birth of your child. Your LMC should also:  

• offer tests to check that you and your baby are well. If any health issues are found, you will be able to get important treatment that will benefit you and your baby. This includes screening for health conditions such as gestational diabetes, sexually transmitted infections and urinary tract infections 
• arrange medical care if you already have a health condition or have had problems in a previous pregnancy. This will reduce the risks to you and your baby 
• arrange regular catch-ups. It is important that your LMC sees you regularly so any problems can be identified early 

• provide smoking cessation advice and referral to smoking cessation groups if needed. This is because babies grow better and are healthier if they are in a smoke-free environment, both inside the womb and after they are born 
• be on call for emergencies. Talk to your LMC, doctor or nurse straight away if you have any bleeding from your vagina, if you notice your baby does not move as much or if you feel unwell 
• provide information to keep you and your baby healthy, such as information on groups in your area that can support your nutrition or physical activity 
• check that you have a safe sleep space for your baby, such as a bassinet, cot, wahakura or Pēpi-Pod®. Hospitals can help with providing safe sleep spaces for those in need. 

You are just as important as your baby. Your LMC will be able to support you to access any extra care and support you need.