When you talk about maternal mortality or death after childbirth, you might think “oh, that is a problem in only less developed countries.” According to the World Health Organization, less developed countries do have overall higher rates of maternal mortality compared to the United States and other developed countries.1 But, you would be surprised to learn that the United States still struggles with a lack in improvement in maternal mortality despite other developed countries around the world achieving decreases in their maternal mortality rates. Developed countries such as the Netherlands and Australia have seen significant decreases in maternal mortality since the 1990’s.2
Maternal mortality is defined as occurring soon after delivery and up to 1 year after childbirth.2 There has been a lot of discussion around why maternal mortality rates are not improving and may even be increasing in the United States. Compared to rates of maternal mortality in the United States from the 1980s which were around 7.2 deaths per 100,000 live births, current estimates report an increase to 17.8 deaths per 100,000 live births.2
Putting things into perspective
Although maternal mortality is a serious problem in the United States, if we put death rates into perspective, it is estimated that 1200 women die from pregnancy and childbirth-related complications every year in the United States.3 For 2016 specifically, National Highway Traffic Safety Administration (NHTSA) data shows 37,461 people were killed in 34,436 motor vehicle crashes, an average of 102 per day.
Although maternal mortality is a global health issue, there are several proposed reasons for why the United States doesn’t seem to be making as many improvements as other countries.1,2,4,5
- Overestimation of maternal death and record keeping issues
- Improved detection of maternal mortality
- Increasing maternal age
- Increasing number of pregnant women who are obese
- Increasing number of women with chronic conditions such as diabetes, high blood pressure, and heart disease
- Inconsistencies in access to care especially among minorities and rural or poorer communities
- Poor prenatal or postnatal care
- Increasing cesarean section rates and associated complications
What all of these reasons tell us is that the United States should focus more on preventing maternal mortality by providing consistent care and monitoring of women after childbirth. Most maternal deaths are considered preventable.1 In a large study of United States maternal deaths reported in one large healthcare corporation between 2000 and 2006, there were 95 maternal deaths out of a reported 1,461,270 births (6.5 per 100,000 births).7 In this population, the most common causes of maternal death were pregnancy-related complications including preeclampsia complications, blood clots, hemorrhage, heart conditions, and infection.6,7
The World Health Organization recommends the following prevention techniques to reduce maternal mortality: “timely management and treatment” and “all births attended by skilled health professionals.” So, how can deaths from reported causes of maternal mortality including blood clots, infection, high blood pressure crisis, and hemorrhage be prevented?7 Continuous monitoring, early recognition, and treatment of any issues such as bleeding, infection, or preeclampsia that may occur in women after childbirth.1
There are several critical factors for patient, provider, facility, and systems of care that contribute to maternal deaths.
Patient: Among patients, critical factors that contribute to maternal death include patients’ lack of knowledge about serious symptoms and warning signs of pregnancy-related complications and a high number of pregnant patients with chronic, unmanaged conditions such as obesity.6
Provider/facility/systems of care: Among providers and facilities, critical factors that contribute to maternal death include a lack of standardized policies; poor or inadequate clinical skills; delayed diagnosis and failure to consult specialists; and poor communication and coordination of care.6 To help address some of these provider issues, organizations such as the California Maternal Quality Care Collaborative have toolkits that help providers better respond to common causes of preventable maternal death.
Maternal mortality after childbirth is an important global health issue. There is a need for improvement in providing care to mothers after childbirth. Patients, providers, and healthcare systems can improve their understanding and ability to recognize pregnancy-related complications that contribute to maternal mortality. It is important that women serve as their own advocates by being knowledgeable about the signs and symptoms of serious pregnancy-related complications.