Maternal mortality in well-resourced countries: is there still a need for confidential enquiries?

The low maternal mortality rates in well-resourced countries are not an automatic consequence of prosperity. Morbidity cannot be avoided and preventing mortality requires good medical care. Now that deaths are infrequent in these countries, people expect investigation of every case and action to make pregnancy even safer. Confidential enquiries do this, and are appropriate when mortality rates are low enough for scrutiny of individual cases. Confidential enquiries have major advantages over other methods of investigation such as public enquiry or hospital audit. The function of confidential enquiries is to improve care, not apportion blame, and they receive frank comments as well as full facts. Analysis is by practising clinicians from many specialties and recommendations are disseminated to clinicians, managers, politicians and the public. The confidential enquiry method has now been adopted by other specialties and by many countries. In countries without confidential enquiries there is under-reporting of maternal mortality, particularly among the poor.