Saving Mothers’ Lives (formerly Why Mothers die): Reviewing maternal deaths to make motherhood safer 2003–2005

The Confidential Enquiries into Maternal Deaths (CEMDs) in the UK have a long, honourable and frequently rehearsed history. They originated in the early days of the twentieth century and became formalised in 1952 ( Weindling, 2003 ; Lewis, 2004 ). The CEMDs developed in rather different ways in each of the countries of the UK. Because of the declining maternal mortality rate and in view of the fundamental importance of maintaining confidentiality, in the 1985–1987 report a UK-wide remit was adopted. The Confidential Enquiries for Maternal and Child Health (CEMACH) incorporated the CEMD and Confidential Enquiries for Stillbirths and Deaths in Infancy (CESDI) for England and Wales in 2003, under the funding umbrella of NICE and other agencies. These mergers reflect what may be perceived by some as the low number of maternal deaths in the UK. This low number may lead to the complacent impression of the effectiveness of the CEMD (henceforth Confidential Enquiries) as a form of quality assurance ( Ngan Kee, 2005 )