Surge of new moms in America dying after childbirth raises concerns

There is a quietly rising, disturbing trend in American moms delivering a new baby – a shameful increase in maternal mortality. American women are dying more frequently in childbirth.  In fact, America has the distinction of having the highest maternal mortality rate of all industrialized countries by several times over – 26.4 deaths for every 100,000 live births (in 2015).  By comparison, in Canada, the rate is 7.3; in Western Europe, the average is 7.2 with many European countries such as Italy, Norway, and Sweden, having rates as low as 4.  In fact, a woman delivering a baby in the U.S. is more likely to die than a woman delivering a baby in Iran (20.8), Lebanon (15.3), Puerto Rico (15.1), China (17.1), and many more.

What is going on?

We tend to have certain expectations from our healthcare system here in the U.S.  Dying from childbirth has simply not been the outcome anyone expects when a woman goes into labor.  We expect possible complications or risks associated especially with a premature baby.  But hardly ever do we contemplate possible consequences associated with the new mom.

Around the world, maternal mortality has drastically reduced in the past three decades.  But in the U.S., the problem has significantly worsened.  Between 700 and 1,200 women die from complications related to pregnancy or childbirth every year in the U.S. Almost another 50,000 other women will narrowly escape death while up to100,000 women a year become gravely ill during pregnancy or after delivering a baby.

Part of the problem is the fact we have a poor system of record keeping on the number of deaths of women pertaining to maternal health and morbidity.  Death certificates, until the early 1990s, did not note if a woman who had died was pregnant or had recently given birth.  Finally, in 2017, all states have now added a check box concerning pregnancy related mortality on death certificates.  Because there is no standard or official method of tracking data on maternal health and mortality in the U.S., it creates an atmosphere of not recognizing a crisis happening under our noses.  If we are blissfully unaware of what is going on, how can we take measures to prevent these unnecessary increases in the deaths of new mothers?

Why the rise in maternal deaths?

The sharp increase in maternal deaths is varied and complicated.  When you look back in history of maternal mortality rates in the U.S., after World War II, the rates dropped until the late 1980s when the trend began to reverse.  The Centers for Disease Control and Prevention shows that at the turn of the millennium, the U.S. did not focus on policies to curb maternal mortality and it was during this time between 1990 and 2015, that the maternal death rate rose nearly 60%.

There are many possibilities that are likely contributing to this rise – steep increases in the prevalence of preexisting conditions of obesity, type II diabetes, hypertension and cardiovascular disease, coupled with the trend of more women deciding to delay motherhood until they are older, along with advancement in fertility treatments resulting in twin births.  There is also the fact that when a woman is pregnant, the focus is on the health of the baby, often at the cost of the mother.  Most of us don’t expect a woman to die in childbirth in the U.S. so the main energy of distributing healthcare goes to the newborn.  This is certainly a priority but the same care and concern also needs to involve the mother delivering the baby. 

Even after delivering the baby, many women may not be adequately monitored in the delivery room and in the weeks and months following delivery.  New moms in the U.S. typically have to wait six weeks for their first post-delivery obstetrician-gynecologist appointment.  During that time right after delivery is when new moms experience tremendous hormonal swings of going from being pregnant one minute to suddenly not which can manifest in postpartum depression, unanswered questions on what is normal with her bodily changes, and the feeling of being overwhelmed at a vulnerable time of her life.  There are no set maternity leaves of absences in the U.S. and many women could use the help of either doulas or other women to care for them. 

The U.S. also has one of the highest rates of cesarean deliveries that has steadily increased over the years to about one in three babies are born by C-section.  Cesarean deliveries do have their time of necessity but surgical deliveries also come with a higher risk of complications for the mother – from significant blood loss, blood clots, reactions to anesthesia, wound infections, surgical injury to increased risks during future pregnancies.  

What can be done?

This problem will not be solved overnight but there are many things that can be done starting with putting the “M” back in maternal-fetal medicine.  Making and keeping the focus on both mom and baby from the beginning of conception until several weeks after delivery, can make a huge difference on the outcome for both.   

Some changes that could help reduce maternal mortality include:

·      Better monitoring and managing chronic conditions during pregnancy especially being mindful of HELLP Syndrome, a variant of preeclampsia.

·      Providing high-risk pregnancy specialists during maternity care to help institute guidelines to improve care for the mother

·      Many hospitals have high-level neonatal intensive care units (NICU); the same should be done for moms who are high-risk

·      Counseling women about risks before getting pregnant can be key in improving outcomes – more than half of all pregnancies are unplanned.

·      Improving communication between doctors and staff – educating them on risk factors and signs of trouble during pregnancy, labor and delivery

·      Making sure women wear compression socks during C-sections to help prevent blood clots

·      Enforcing hospitals to do better education of doctors on guidelines and protocols concerning pregnancy

·      Hospitals should be promoting vaginal births while reducing C-sections

·      Using more nurse midwives who are trained to promote natural birth helping to reduce C-section rates and improves health outcomes.

Nationally, we need to do what we can to reign in this alarming increase in maternal deaths.  It is not acceptable, it is not what anyone expects when a woman goes in to deliver a baby and we can and must do better.