Over the past two decades, developed countries across the globe have witnessed a decline in maternal deaths but such cannot be said for the United States. Maternal deaths in the U.S. have been on a steady increase for years, and about 60 percent of those deaths are preventable.
The United States effectively has the worst record of maternal deaths in the developed world.
American women are more than three times as likely as Canadian women to die in the maternal period (defined by the Centers for Disease Control as the start of pregnancy to one year after delivery or termination), six times as likely to die as Scandinavians. In every other wealthy country, and many less affluent ones, maternal mortality rates have been falling; in Great Britain, the journal Lancet recently noted, the rate has declined so dramatically that “a man is more likely to die while his partner is pregnant than she is.” But in the U.S., maternal deaths increased from 2000 to 2014. In a recent analysis by the CDC Foundation, nearly 60 percent of such deaths were preventable.
One might be tempted to think that higher rates of maternal death in the U.S. are prevalent among low-income mothers who lack resources to obtain proper care, but as ProPublica notes, maternal death rates are high among all demographics:
While maternal mortality is significantly more common among African Americans, low-income women and in rural areas, pregnancy and childbirth complications kill women of every race and ethnicity, education and income level, in every part of the U.S. ProPublica and NPR spent the last several months scouring social media and other sources, ultimately identifying more than 450 expectant and new mothers who have died since 2011. The list includes teachers, insurance brokers, homeless women, journalists, a spokeswoman for Yellowstone National Park, a co-founder of the YouTube channel WhatsUpMoms, and more than a dozen doctors and nurses like Lauren Bloomstein. They died from cardiomyopathy and other heart problems, massive hemorrhage, blood clots, infections and pregnancy-induced hypertension (preeclampsia) as well as rarer causes. Many died days or weeks after leaving the hospital.
As a world leader in numerous ways, how could the United States fall so far behind its peers when it comes to maternal health and wellness? The answer is multifaceted.
- Women are waiting longer to have children, leading to new mothers who are older than before and with more complex medical histories.
- Half of pregnancies in the U.S. are unplanned, leaving those women unable to have addressed chronic health concerns beforehand.
- As Cesarean sections have become more commonplace, so have the associated life-threatening complications.
But perhaps the most notable factor in worsening outcomes for new and expectant mothers is the over-emphasis the U.S. has placed on fetal and newborn health - potentially to the demise of women.
The divergent trends for mothers and babies highlight a theme that has emerged repeatedly in ProPublica’s and NPR’s reporting. In recent decades, under the assumption that it had conquered maternal mortality, the American medical system has focused more on fetal and infant safety and survival than on the mother’s health and well-being.
The available data, along with anecdotal evidence, bear out such a conclusion:
- "As recently as 2012, young doctors who wanted to work in the field didn’t have to spend time learning to care for birthing mothers."
- "In the last decade or so, at least 20 hospitals have established multidisciplinary fetal care centers for babies at high risk for a variety of problems. So far, only one hospital in the U.S. — NewYork-Presbyterian/Columbia — has a similar program for high-risk moms-to-be."
- "In regular maternity wards, too, babies are monitored more closely than mothers during and after birth, maternal health advocates told ProPublica and NPR. Newborns in the slightest danger are whisked off to neonatal intensive care units ... staffed by highly trained specialists ready for the worst, while their mothers are tended by nurses and doctors who expect things to be fine and are often unprepared when they aren’t."
- "When women are discharged, they routinely receive information about how to breastfeed and what to do if their newborn is sick but not necessarily how to tell if they need medical attention themselves."
The good news is that identifying where the systems have failed allows for correction, and numerous other countries can provide road maps for how to arrive at lower maternal death rates. But progress will likely be slow - according to the Institute of Medicine, new medical protocols take about 17 years to become widely adopted.
Some states are already on the move:
As the maternal death rate has mounted around the U.S., a small cadre of reformers has mobilized. Some of the earliest and most important work has come in California, where more babies are born than in any other state — 500,000 a year, one-eighth of the U.S. total.
Modeled on the U.K. process, the California Maternal Quality Care Collaborative is informed by the experiences of founder Elliott Main, a professor of obstetrics and gynecology at Stanford and the University of California-San Francisco, who for many years ran the OB-GYN department at a San Francisco hospital.
Launched a decade ago, CMQCC aims to reduce not only mortality, but also life-threatening complications and racial disparities in obstetric care. It began by analyzingmaternal deaths in the state over several years; in almost every case, it discovered, there was “at least some chance to alter the outcome.” The most preventable deaths were from hemorrhage (70 percent) and preeclampsia (60 percent).
CMQCC set out to create a series of "tool kits" that enable medical professionals to improve their emergency response protocols.
By 2013, according to Main, maternal deaths in California fell to around 7 per 100,000 births, similar to the numbers in Canada, France and the Netherlands — a dramatic counter to the trends in other parts of the U.S.
“Prevention isn’t a magic pill,” Main said. “It’s actually teamwork [and having] a structured, organized, standardized approach” to care.