The Cardiologist's Wife: The Rise of Maternal Mortality
by Lisa Tedder
Welcoming a new child into the world should be a happy time and cause for celebration, but for far too many women in the United States, pregnancy ends in tragedy. A new study published in the Journal of American Medical Association revealed that the U.S. has the highest maternal mortality* rate among developed nations despite having one of the best health care systems in the world.
Between 1999 and 2019, pregnancy related mortality rose dramatically, more than doubling, with the worst outcomes among Black, Native American and Alaskan women. The study was the first to look at maternal mortality disparities across all states and include differences by race and ethnicity. The U.S. is the only industrialized nation in which maternal mortality rates are consistently rising. Sadly, some 84% of those pregnancy-related deaths are thought to have been preventable.
In other wealthy nations, women fare much better. For example, Germany has four deaths per 100,000 live births, England has 9.6, Norway, 2.7, and France has eight. Overall, the U.S has 24 deaths per 100,000, but Black women are more than three times likely to die. There are several reasons for these differences. Other countries invest more money in social services, primary care and mental health. The U.S. has a shortage of maternal care providers, underutilizes midwives and some hospitals are not prepared for emergencies during childbirth. Some countries offer up to a year guaranteed paid leave to new mothers, while the U.S. is the only high-income nation that does not. Home visits and postpartum care varies across the U.S. but is guaranteed in other countries.
There are many more issues affecting U.S. mortality rates. More women than before have pre-existing health problems that may not be well treated before becoming pregnant, which can worsen during pregnancy or lead to new problems. Cardiac conditions like high blood pressure can lead to stroke, preeclampsia or blood clots. Age is a factor, as many women are delaying families and older women are more likely to experience issues like gestational diabetes, preeclampsia or postpartum bleeding. They are also more likely to have multiples, which poses its own set of problems like premature delivery. Mental health conditions are also a risk factor for maternal deaths. Depression can lead to suicide, as can overdose due to substance abuse.
Why do Black women and women of color die at higher rates? Overt and implicit bias from health care providers is a factor. Doctors and staff may ignore or downplay symptoms and requests for help. Pregnant and postpartum Black women are far more likely to die from cardiovascular disorders, hemorrhage or embolism. Even those with more education and income are more than twice as likely to suffer severe complications during childbirth than low-income white women without a college education.
In addition, homicide is a leading cause of maternal death, especially among Black women, who are eight times more likely to be killed by their romantic partner than non-pregnant Black women. Often it is the pregnancy itself that is the cause for the homicide. As a society, the U.S. has been unable or unwilling to address ways to prevent women from dying at the hands of their domestic abuser. Even if women ask for help, the “help” comes too late or isn’t enough of a deterrent.
Lack of prenatal and postnatal care affects maternal mortality. Receiving regular health care to prevent or control chronic conditions before pregnancy helps ensure a healthier mom, while regular visits during pregnancy monitors the health of mom and baby, heading off problems before they develop. Women should also receive follow up visits after delivery to check for complications that may occur. Excessive bleeding and infection are two causes of death that could be eliminated with postnatal visits. Medicaid coverage is vital for maternal care, as 43% of all births in the U.S. in 2018 were covered by Medicaid; in Arkansas it was 45.7%. More than half of the states in the U.S. extend Medicaid coverage to a full year postpartum, but Arkansas coverage ends two months after childbirth.
Those planning to have children, should establish a good relationship with a doctor they feel they can trust, have a thorough check up and address any health concerns at that time. Starting out as healthy as possible is the best way to have a positive outcome for both mother and baby. Quit smoking, eliminate or cut back on alcohol, eat nutritious foods and have an exercise routine. Manage chronic health issues like diabetes by taking medication as directed and following doctor’s recommendations. After becoming pregnant, schedule an initial visit with your doctor and then expect to see your doctor monthly during weeks 4-28, every two weeks during weeks 28-36 and every week thereafter until you deliver. After the baby is born, women should have several postpartum checkups, the first within three weeks. Always, always report any problems or concerns during pregnancy and after delivery. To further prevent maternal deaths, all women, even adolescents, should have access to contraceptives to prevent unintended pregnancies.
Editor’s Note: Maternal mortality is when a mother dies from a pregnancy-related health issue, an existing condition exacerbated by pregnancy occurring any time during the pregnancy or up to a year after giving birth. The maternal mortality rate is the number of deaths per 100,000 live births.