Violent maternal deaths in North Carolina.

OBJECTIVE: To describe the frequency of domestic violence and substance abuse among a series of injury-related maternal deaths, determine awareness of the obstetric provider of domestic violence in those deaths by intimate partner homicide or depression in those deaths by suicide, and examine the relative risk of violent maternal death for unmarried status and non-white race.
METHODS: A follow-up investigation was carried out for a case series of 41 injury-related maternal deaths identified from 1992 to 1994 in North Carolina. Death certificates, police records, newspapers, and records from medical examiners were used to ascertain mechanism and intent, history of alcohol or drug abuse, and, in cases of homicide, the relationship of the perpetrator to the victim. The obstetric provider was asked about his or her knowledge of domestic violence, depression, and drug or alcohol abuse relevant to the deceased victim.
RESULTS: A total of 21 women (51.2%) were known to have or suspected of having been abused by either an intimate partner or an acquaintance. Of the 41 women, 11 (26.8%) were known to have abused drugs and/or alcohol. The obstetric provider was aware or suspicious of abuse in one third of homicides committed by an intimate partner. In three of the five suicide deaths, the obstetric provider was aware of depression.
CONCLUSION: Domestic violence and drug and alcohol abuse were common in this series of injury-related maternal deaths. Domestic violence and depression were often unrecognized by the obstetric provider in these severe cases.