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Are States Doing Enough to Stop Moms from Dying in Childbirth?

baby-1531060_640.jpgMaternal mortality rates in the United States are some of the highest in the industrialized world; a fact which highlights the ineffectiveness of existing policies and practices. Many of these deaths are due to treatable conditions and preventable causes. As regulators and legislators pour over statistics, mothers and infants are paying the price for their inaction.

Increasing Mortality Rates

Data collected by the Centers for Disease Control (CDC) showed that in 1987 the maternal mortality rate in the United States was 7.2 deaths per every 100,000 live births. That has risen to 16.7 deaths per 100,000 live births in 2016. The data indicates that more than 60% of these deaths are entirely preventable. In fact, it shows that the US is doing a horrible job of protecting mothers and infants from risk.

From 2000 to 2014, maternal mortality rates decreased in 157 countries studied by the World Health Organization (WHO). The US was one of only 26 countries where the rates increased. Currently, the rate of maternal death in the US is three times higher than it is in Canada or the United Kingdom.  

Further, for every mother who dies, another 84 suffer a serious complication that can negatively impact her health or the health of the baby. Nationwide, approximately 700 women per year die due to pregnancy related complications. 

While the official data shows the US as having one of the highest maternal mortality rates in the industrialized world, it's important to understand a significant difference in the way the data is collected. The WHO calculates maternal mortality up to and including any deaths that occur within 42 days post-pregnancy. The CDC's calculation extends to 12 months following pregnancy. However, even with this caveat, only 11.7% of deaths in the US occur after 42 days. This means that the US still has a higher maternal mortality rate than Mexico, Latvia, and many other developed nations.  

CDC data shows that approximately 31% of deaths occur during pregnancy, 36% occur on the day of delivery or within one week post-delivery, and 33% occurred within one week to one year postpartum.  

Reasons the Rates are Increasing  

There are many reasons the maternal mortality rate is increasing. These include performing unnecessary cesarean procedures which unduly put the mother's health at risk. Further, many mothers do not receive appropriate prenatal and postnatal care and treatment. The data also shows that these risks are greatest in lower-income or racially marginalized communities.

Approximately 60% of these deaths could be prevented by increasing access to prenatal and postpartum care. These treatments and services are widely available and accessible in other industrialized nations which have significantly lower rates of maternal mortality. 

Patient health is also a factor resulting in an increase in maternal mortality rates. Cardiovascular problems that can result in heart attack and stroke were responsible for nearly 33% of all pregnancy-related deaths. Infections acquired during or following delivery accounted for 12.5% of deaths, and 11.2% of deaths were caused by obstetric hemorrhaging. 

From 2011 to 2015, the CDC examined 3,000 pregnancy-related deaths. 460 of these were the result of cardiovascular conditions. 427 were caused by endocrine, renal, or hematologic failures. 360 were caused by infections. 329 were caused by hemorrhaging. Overall, 1 in every 15 deaths had no known cause identifiable during an autopsy. 

Strategies to Mitigate Risks

The CDC and WHO have made numerous recommendations that could reduce the rates of maternal mortality in the United States. These include increasing access to prenatal and postnatal care. More specifically, increasing these services within vulnerable populations including low-income families and immigrants.

It is also recommended that state and federal agencies do more to address inadequacies within the healthcare facilities responsible for providing prenatal, delivery, and postnatal services. This includes ensuring that each facility is equipped with the proper medical equipment and that staff receives thorough training in the use of such equipment.

Physicians, nurses, and others responsible for delivering and caring for newborns should also receive advanced training in up-to-date delivery procedures and patient care. In many cases, obstetricians are delivering babies using theories and strategies that are ineffective and contrary to best practices established by advances in medical technology.

Patients should also receive thorough and proper guidance regarding diet and effective strategies for reducing blood pressure, managing diabetes, etc. As the data shows, providing access to effective therapies and medications would have a significant impact on reducing many preventable causes of maternal mortality. 

Legislators are acting slowly and while the passage of HR 1318 addresses some of the causes of maternal mortality, many more remain ignored or under discussion. In the interim, mothers are dying at a rate that is simply unacceptable in a nation that has sufficient resources available to provide effective protection.  

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