Maternal Mortality in the United States

Maternal mortality, according to the World Health Organization, is the “death of a woman while pregnant, or within forty-two days of termination of pregnancy … from any cause related to or aggravated by the pregnancy or its management.”[1] While one might think that maternal mortality would decrease proportionally with the increase in technology and medications, there is a shocking statistic that maternal mortality in the United States has nearly doubled from 1990. In that year, the rate of maternal mortality in America averaged at around seventeen maternal deaths per one-hundred-thousand pregnant women; in 2015, that number raised to twenty-six per one-hundred-thousand pregnant women.[2] The CDC reported that of these deaths, a staggering 60% were preventable; these figures, combined, pit the United States as one of the most dangerous developed countries for women who give birth.[3]

One possible cause for the increased maternal mortality rate may be the increase in cesarean section deliveries; the CDC reported that the national cesarean birth rate is 31.9%, one of the highest rates in the past 30 years.[4] Often, hospitals pressure expectant mothers into performing C-sections – many hospitals lack sufficient space in their labor floors, causing hospitals to pressure the physicians if their patients are taking too long in the delivery process. That pressure may result in physicians opting for a c-section which is a faster process. Additionally, providers are paid more for a C-section; studies have shown that a rise in the cost of C-sections are proportional with an increase in the rate of c-sections performed.[5] However, C-sections pose a great risk to pregnant women, as they may cause hemorrhaging or increased blood loss (one out of six women who have a c-section need a blood transfusion). C-sections also may cause infections in the uterus, other nearby organs, and at the incision site. A recent study found that women who have a c-sections are 80% more likely to have complications than women who delivered vaginally.[6] These complications, if untreated or not treated in a timely or proper manner, may result in fatality.

Another major cause of the increase in maternal mortality is the age at which women are becoming pregnant. With the increase in the number of females going to college and furthering their education, resulting in later marriage and a rise in longer term birth controls such as IUDs, women are more likely to have children older than ever before.[7] The average rate of a woman’s age at her first birth is twenty-six years old, a number that has risen gradually over the last thirty years from twenty-one years of age.[8] As women begin to have children at older ages, they are at greater risk for complications; women over the age of thirty-five have the highest rate of maternal mortality. Additionally, an older mother is at greater risk for high blood pressure and gestational diabetes,[9] which is particularly significant, given that high blood pressure during pregnancy is one of the major causes of maternal mortality.[10]

Chronic conditions are another underlying reason for maternal death rates. Women who have chronic conditions before pregnancy- and therefore put themselves at higher risks for complications during pregnancy- are rising. The rate of pregnant women who have pre-existing conditions has increased 40% over the last decade. The United States has one of the highest prevalence for chronic conditions amongst developed countries, with a staggering 60% of adults with a chronic condition. This decade, researchers are finding that pre-existing conditions are causing significant harm in pregnancy, and is even becoming a leading cause in maternal death.[11] According the CDC, an increase in pre-existing cardiovascular conditions were responsible for almost one-third of maternal death from 2011 to 2015.[12]

The highest prevalence of chronic conditions that are indicators of maternal mortality was among women who were living in rural areas and in the lowest socioeconomic communities.[13] The CDC notes that American Indian and Black women are three to four times more likely to have a pregnancy-related death than white women.[14] Limited access to care for these women- both prenatal and post- contribute to this dramatic difference. Approximately 32% of Black women and 41% of American Indian women do not receive the proper care while pregnant. Additionally, Black women have a significantly higher prevalence of cardiovascular disease and high blood pressure. These preexisting conditions, combined with a lack of proper and quality care, will likely cause the rate of maternal mortality to continue to increase.[15]

In order to stop or abate the maternal mortality rate in America stricter mandates on prenatal care need to be imposed. A clear indicator of the maternal death rate is the lack of safety and access to healthcare provided to pregnant women- both before, during, and after delivery. A federal mandate should require hospitals and clinics to prove and document their taking of proper steps in both prenatal and postnatal visits of patients. Documentation that the patients were seen at least eight times throughout their pregnancy, that they were given the proper vitamins and that any pre-existing condition was discussed should be required.[16] If a patient could not afford at least eight appointments they should be covered by the government. Lastly, this mandate will include the safety of the actual delivery. A physician will have to provide significant proof as to why a surgical delivery was chosen over a vaginal delivery. A surgical delivery should be limited only to emergencies or any situations where a vaginal birth would be harmful to the mother and/or the child.

This proposed mandate will help make sure women are being seen by the providers at the proper intervals. Women who have chronic conditions will then be properly monitored, and the development of those conditions will be found and treated properly and timely. The coverage for the first eight visits will ensure that women who come from low-income or low socioeconomic backgrounds receive the care they deserve and need. Additionally, it may increase the patient-physician relationship, as the provider will need to spend more time with each patient. Further, the consistent monitoring will provide the medical team with the proper information as to whether or not the patient is in need of a surgical delivery; instead of making the decision based on hospital pressure, the healthcare providers will need to show proof for logical argument for performance of a C-section. Consequently, this will reduce the number of unnecessary surgical deliveries, reducing the number of potential hemorrhages, infections, and other post-operative complications.

A disadvantage with requiring the described documentation would be the forcing the physicians to see potentially fewer number of patients more frequently instead of seeing a higher number of patients. Further, it may also cause overcrowding in hospitals, as patients will not be delivering their babies as fast. Lastly, it may potentially raise the cost for government-provided healthcare, as they will now be paying for women who do not have the proper means or insurance.

[1] https://www.who.int/healthinfo/statistics/indmaternalmortality/en/

[2] https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Freproductivehealth%2Fmaternalinfanthealth%2Fpregnancy-mortality-surveillance-system.htm

[3] https://www.cdc.gov/vitalsigns/maternal-deaths/index.html

[4] https://www.cdc.gov/nchs/pressroom/sosmap/cesarean_births/cesareans.htm

[5] https://www.ncbi.nlm.nih.gov/books/NBK218656/

[6] https://www.reuters.com/article/us-health-cesarean/c-section-complication-risk-rises-with-mothers-age-idUSKCN1RN2SN

[7] https://www.nytimes.com/interactive/2018/08/04/upshot/up-birth-age-gap.html

[8] https://www.cia.gov/library/publications/the-world-factbook/fields/352.html

[9]https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02481

[10] https://www.preeclampsia.org/health-information/149-advocacy-awareness/332-preeclampsia-and-maternal-mortality-a-global-burden

[11] https://medicalxpress.com/news/2017-11-chronic-conditions-moms-babies.html

[12] https://www.americanactionforum.org/insight/maternal-mortality-in-the-united-states/