State-based maternal death reviews: assessing opportunities to alter outcomes.

In 1950, the Journal of the American Medical Association reported that, for the first time, the US maternal mortality rate had dipped below 1 per 1000 live births and declared that “Childbearing has been made quite safe.”1 The Centers for Disease Control and Prevention called the decline from 800-900 maternal deaths per 100,000 live births in 1900 to 10-20 deaths per 100,000 live births in 2000 one of the 10 great public health achievements of the 20th century.2 There is no question that great strides were made in maternity care and that women and society benefited. But the story is not over. Women still die from conditions directly or indirectly related to pregnancy, and evidence is emerging that the trend that we so rightly celebrated is not continuing.