It’s a grim reality: new mothers in the United States die at higher rates than any other developed nation in the world — nearly 24 deaths for every 100,000 live births, according to 2020 data from the Centers for Disease Control and Prevention (CDC).
Maternal mortality has more than doubled since the late 1980s, and the United States is one of few countries where the rates are increasing. It’s such a serious issue that the House Ways and Means Committee recently launched an investigation into how to prevent maternal death.
Maternal death impacts women disproportionately, too, with Black women and women in their 40s experiencing greater risk.
Though life-threatening complications from pregnancy or childbirth are rare, that doesn’t necessarily make them less scary. Experts across the country are working to understand better why maternal death rates are so high in the United States, but the answers are complicated. Here’s what you need to know.
How do pregnant people in Washington state fare?
Maternal mortality rates in Washington State are lower than in some other states, though still a problem — many maternal deaths are preventable and shouldn’t happen at all.
A 2019 report from the Washington State Department of Health, analyzing 2014-2016 data, shows that the rate of maternal mortality in the state has remained steady since the 1990s, neither increasing nor decreasing.
The report states that there were 30 pregnancy-related deaths in Washington between 2014 and 2016, and at least 60% were preventable. That means Washington state has a rate of 11.2 maternal deaths for every 100,000 live births.
Contributors to the 2019 report — including several UW Medicine doctors — found that suicide, overdose, hemorrhage and hypertension were the leading causes of maternal death.
Multiple potential causes of maternal death
Though experts still don’t know exactly why maternal mortality rates are increasing, they do know one thing: there’s no single cause.
Many factors — such as individual health, poor access to healthcare, inability of doctors to recognize an emergency and obstacles in delivering efficient care — likely combine to create a perfect storm.
Chronic disease can be a major factor. Women with high blood pressure, diabetes or another pre-existing condition are at higher risk for complications during pregnancy and needing a C-section. C-sections are generally riskier than vaginal delivery despite at times being medically necessary.
Mothers older than 35 or who are obese may be at greater risk for complications. Barriers accessing care and unplanned pregnancy can also contribute.
But even women without known risk factors can experience life-threatening complications like preeclampsia, blood clots, sepsis or hemorrhage, says Dr. Carol Salerno, medical director of the Childbirth Center at UW Medical Center – Northwest.
“Preeclampsia happens more in women with high blood pressure, but it can happen to a healthy woman as well. We, as providers, need to be aware and diligent even in the most low-risk patients,” she says.
In this way, the relative rarity of life-threatening pregnancy complications could contribute to the problem. Salerno says that many healthcare providers may not have enough experience in caring for women with high-risk pregnancies and may not know what to do if normal labor suddenly becomes an emergency. And, even if they were trained, they might never have had to use the skills in real life.
“You have to practice what you’re going to do, not just know what to do,” Salerno says.
Another cause of maternal mortality that is not well-studied is suicide, Salerno says. CDC data shows that as many as one in eight women who give birth to a child experience postpartum depression, which in some people can lead to suicidal thoughts and behavior.
“Women may not get the mental healthcare that they need postpartum because the need is not recognized or the help is not accessible. There has been a lot of effort put forth to educate the medical community on the postpartum period and how to recognize postpartum mood disorders,” says Salerno.
Though the CDC has been tracking maternal deaths since 1986, there is no standardization across individual states. Some states, like Washington, have programs and review panels to investigate potential causes and make recommendations. Other states don’t have such procedures in place.
What Washington state doctors are doing to help
Salerno is one of many UW Medicine providers who sit on a maternal mortality review panel for Washington state. The panel convenes each year to review statewide incidences of maternal death and make recommendations for preventing future deaths.
Recommendations from the group’s most recent report include things like improving care for pregnant women who have high body mass index (BMI), preventing ectopic pregnancy, improving health equity and access to care (Black mothers have nearly three times the mortality rate of white mothers) and offering pregnant people more mental health and substance use prevention services.
Salerno sees lowering the mortality rate as having two separate but interconnected pieces: work to prevent complications by helping future moms get healthier and get access to the care they need, plus better educate providers on how to handle complications should they emerge.
“In this state, we’ve been working hard at educating the medical community, encouraging all hospitals to have emergency protocols and looking for warning signs so nurses and providers can act quickly,” she says.
At UW Medicine hospitals, providers regularly review cases where patients had complications. Nurses follow protocols for emergency care that conform to national guidelines. Doctors hold training sessions and do drills about what might happen in an emergency. The hospitals follow the lead of the California Maternal Quality Care Collaborative, an organization that has helped California dramatically reduce maternal death in a short amount of time and serves as an example of success.
Additionally, providers prioritize health equity and recognize the disparities women of color face in maternity outcomes. Through training, regular review of care outcomes, and the work of a diversity, equity and inclusion council, they are working to create better maternity and delivery experiences for women of color.
“The majority of maternal deaths are preventable. We are aware of what the most common causes of maternal mortality are, and all hospitals should work toward early recognition of these complications that can lead to death,” Salerno says.
What future parents should know
Salerno wants parents to remember that life-threatening complications from pregnancy are still rare, and that people can lower their risk by taking good care of themselves before, during and after pregnancy. Eating healthy, exercising, not drinking alcohol and making sure they seek healthcare for any chronic conditions can only help.
And while the weight of maternal death rates shouldn’t be put on the individual, Salerno does recommend that people who are pregnant or are looking to be parents advocate for themselves. That means trusting in themselves and their knowledge of their bodies — and not letting others convince them they’re overreacting.
“If they have symptoms, they should call their doctor about them or seek emergency care if it’s something serious. If they think it’s an emergency, maybe it is,” she says.
It also helps for a woman to choose a prenatal care provider who she trusts and who she feels comfortable talking to about her concerns, no matter how big or small.
“I talk about warning signs with my patients who are pregnant or want to be pregnant,” Salerno says. “I tell them what they should look for and when they should call my office. Emergencies don’t always happen in the hospital, so raising awareness of medical emergencies is important.”