"The US spends more money on mothers' health than any other nation in the world, yet women in America are more likely to die during childbirth than they are in most other developed countries, according to the OECD and WHO. The BBC's Laura Trevelyan has been trying to find out why.
Four million American women give birth every year, and about 500 die during childbirth or from pregnancy-related complications.
In the richest nation in the world, giving birth is more risky than you would think.
"No American woman should die from childbirth in 2009, we can definitely do a lot better," says Dr Michael Lu, Associate Professor of Obstetrics at the University of California, Los Angeles (UCLA).
In New Jersey, Jim Scythes is bringing up his two-year-old daughter Isabella on his own.
His wife, Valerie, died from blood clots shortly after giving birth to Isabella by Caesarean section.
Jim still cannot believe that Valerie died after giving birth, here in America.
"When Isabella walked for the first time, I sat on the floor and cried, because Valerie should have been there. I believe this could have been prevented and now my daughter will never know her mother."
 | MATERNAL MORTALITY One woman dies every minute during childbirth, yet almost all of these deaths are preventable. In 2001, the UN set itself the goal of slashing maternal mortality by 75% by 2015, but it is nowhere near meeting that target. Health ministers from around the world are meeting in Ethiopia to work out how to make up for lost ground. The BBC is publishing a series of reports to mark the occasion. |
So why are women in America more likely to die during childbirth than they are in most other developed nations?
The answers are complex. A healthcare system which leaves what Dr Lu estimates are 17 million women of child-bearing age without health insurance could be one factor.
Obesity, poverty and the high rate of C-sections in America all play a part.
Dr Lu says about half of American women are entering pregnancy overweight. "Obesity is a major risk factor for pregnancy-related complications.
"First we need to improve the health of women before they get pregnant, and second we need to improve the quality of maternal care in America."
Shocking story
The Centres for Disease Control (CDC) in Atlanta is the US government agency that collects national statistics on the numbers of women dying during childbirth.
Dr Bill Callaghan of the CDC says the latest maternal mortality data suggests one in four to one in five women who die have heart disease, or diseased blood vessels.
|  To the extent that we don't explain racial disparity in pregnancy-related mortality, we're going to have difficulty making headway into it  Dr Bill Callaghan Centers for Disease Control |
Could that be due to women being overweight? I asked. "It could be," replies Dr Callaghan, "the obesity epidemic has not spared women of reproductive age."
Dr Bill McCool, at the University of Pennsylvania's School of Nursing, points out that America is far above the World Health Organization's goal of a 15% C-section rate.
"Surgery of any kind has risk," he says, and a C-section is, "still the riskiest way to have a baby.
"In the US, almost one third of women have that procedure for delivery of their baby."
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