THERE was a time when most people were aware childbirth could kill.
Little more than 100 years ago, the chances of dying were around one in 250. In Scotland today, few will know anyone whose life will be put in danger.
That is why cases such as the death of Dr Fiona Agnew, who died after giving birth to a stillborn daughter, sent shockwaves through the community.
Dr Agnew – a GP who was already the mother to a young son – was 38 when she died last August. An investigation has been launched into the circumstances surrounding her death.
Emma Currer, national officer for the Royal College of Midwives in Scotland, said because it happens rarely many people do not believe apparently healthy women can still die during pregnancy and childbirth.
Yet the latest available annual figures show there were 34 deaths in seven years from 2003.
Six women died in Scotland after having a child in 2009.
The causes of death can include the condition pre-eclampsia, where the mother suffers very high blood pressure and major haemorrhages at the time of birth, and doctors cannot stop the bleeding.
There are also occasions when pregnancy exacerbates existing health problems, including mental health issues and cardiac defects.
Dr Catherine Calderwood, medical adviser for women's health with the Scottish Government, says the mortality figures for Scotland are too small to indicate any trend, but accepts they have stayed static.
She said: "There are several things which contribute. The women having babies are getting older and they are much more obese."
However, she also admitted there are areas where the NHS could provide better care.
She said: "We are not recognising when women are very sick because they are often very well patients and relatively young. They appear well yet suddenly crash and are then very unwell."
She flagged up the period after birth, particularly for women with underlying health issues, as a problem area.
She said: "People with cardiac problems can die a week after the delivery, by which time they have gone home and everyone thought they were fine."
Symptoms of internal bleeding can be dismissed as those any mother looking after a newborn baby may experience, she added.
Deaths are so rare health visitors and GPs will hardly ever encounter new mothers who are in grave danger, making it all the more difficult to spot them.
Ms Currer said the NHS is good at managing pregnancy and labour, but added the Royal College of Midwives is anxious about postnatal service provision.
She said: "We are concerned it appears to be the Cinderella of maternity services. If it is likely something will be compromised around a financial debate, for whatever reason, postnatal services appear to be taking the brunt of some of the pressures."
Other organisations have different concerns. Maureen Treadwell, research officer for the Birth Trauma Association, said the drive to cut the number of Caesarean sections puts women in greater danger than necessary.
She said: "What they have been doing is encouraging what they call normal births in women who have actually got a number of risk factors. It then goes horribly wrong and they have not got the right expert staff in the right place at the right time. That thing about the right expert staff in the right place at the right time keeps coming up."
Ms Currer added: "I guess we will never ever be able to stop maternal deaths. Our aim is to ensure those that are preventable are prevented."