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Mana is the source of magic in the world, and is connected to a person's life force. A witch contains the mana within their soul, and determines the physical constitution of the individual. Individuals are born with different amounts, which can grow as they age and will determine their potential of magical power. Those with large reserves are healthier and have a naturally longer lifespan than those with less reserves.

Powerful witches usually give birth to children. However, there is a downside to being at the top of the food chain. Maternity death rates are much higher among witches with larger reserves of mana. Stronger witches are at significant risk, as they are much more likely to have difficult pregnancies and die in childbirth. This has led to a strange situation in which the most successful, healthy, and powerful individuals have a higher likelihood of dying than those lower and less well-off in society.

How can childbirth death rates by higher among healthier people?

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Parasitic Babies and Undead Abomination Babies

Under normal circumstances the baby feeds off the mother's body (life force) to grow over a period of nine months. As part of this process the baby develops a soul. For a non-magical mother the process is gradual and rarely dengerous.

For a magical mother however the baby will also have a highly magical soul. Creating one of these is much more taxing on the mother's life force. If the baby is born succesfully chances are it will also be a talented spellcaster.

Best outcome: Mother and baby survive the pregnancy and the baby is born as a talented spellcaster.

Bad Outcome: The baby sucks the mother's life force faster than she can regenerate it. This kills mother and baby. One solution to this is a mana infusion from other witches. But the more powerful the mother is, the more powerful or numerous the infusions need to be.

Worst Outcome: The baby sucks all the mother's life force really quickly. This kills the mother but leaves the foetus with no soul, but enough life energy to survive for a while. It then roams the earth as a mana-empowered undead abomination that must feed on the mana and souls of others to survive. These guys are especially dangerous to their prey. They cannot be damaged by spells because they feed on spell energy. Moreover more powerful mothers produce more powerful abominations.

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Hormone fluctuations

Being pregnant kind of screws with the body's hormones, hence the reputation pregnant women have for having weird food cravings and also for mood swings. Not to mention the toll that it takes overall - for instance, morning sickness. Now, for a normal human woman this isn't an insurmountable problem. But it could very well be a problem if they have an incredible amount of mana at their disposal.

It's very simple - the hormone fluctuations of pregnancy causes the witch to have less control over her mana than she usually does, and the more mana there is, the more control is needed. Thus, it's entirely possible for a witch to lose control of her mana and die that way.

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Magic gets in the way of emergency interventions.

According to a study of maternal mortality, "Basic emergency obstetric interventions, such as antibiotics, oxytocics, anticonvulsants, manual removal of placenta, and instrumented vaginal delivery, are vital to improve the chance of survival." If you remove the ability to use any of those interventions, you increase maternal mortality. You said that magic keeps people healthy, so I imagine there's some method by which it protects a person. Now imagine how the magical health defenses would respond to someone trying to push a set of forceps into a witch's body. Or someone injecting a substance into her body. Or someone trying to cut her abdomen open for a c-section. The mana reserves could push back against these "attacks" and result in a midwife/obstetrician being unable to assist a laboring witch in distress.

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Passenger grabs the wheel.

Accumulated mana requires control. It is a balancing act and keeping the mana confined within a body is no mean feat. Especially for witches who accumulate many times more than what a human body is biologically equipped to handle. It is the equivalent of driving at 200 mph. You need to pay close attention and be quick to react.

When a pregnancy starts, the fetus has access to some of that mana, and can take some or contribute its own, or both. And unpredictably. Now she is driving down the road at 200mph with her passenger messing with the wheel, and gas, and brakes. It is a serious test of the abilities of the witch to keep her mana race car on the road under these circumstances. Those who have accumulated mana before pregnancy such that they are at their limit to control it can easily lose control when the fetus starts messing around. This is also why among witches, dying in childbirth is seen as a sign of weakness - it means a lack of control, or poor judgement, or both.

Obstetric complications caused by mana control issues are not your typical obstetric complications. Uncontrolled life energy fluctuations pluck at reality, and some very unusual and dangerous things can happen.

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Their health comes from their more vigorous immune systems, but it produces the danger of more and greater autoimmune diseases. Since the child has only half maternal DNA, both the child and the mother's immune systems might identify the other as an infection.

Severe immune system reactions can produce cytokine storms. These are thought to be why the Spanish influenza killed healthy young adults -- normally those who are the least likely to die of the flu.

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