For most parents, the birth of a child is a profoundly joyous occasion — as the family grows and is changed forever.
But in a fraction of cases, pregnancy or childbirth is punctuated by the deepest of sorrows. “The death of a mother during pregnancy, childbirth, or postpartum is one of the greatest tragedies that can occur within a family,” writes Marian MacDorman, a research professor at the University of Maryland Population Research Center, with Eugene Declercq, a professor in the Boston University School of Public Health. Their commentary was published online last week in the journal Birth along with research MacDorman led evaluating an increase in maternal deaths in Texas. Maternal death has wide-ranging consequences for the child as well as other family members and the larger society, and it “represents the ultimate failure of perinatal medical care,” MacDorman and Declercq add, referring to the care delivered in the time leading up to and following childbirth.
For reasons that aren’t clear, the maternal mortality rate has increased sharply in the Lone Star State. “The 2011 through 2015 maternal mortality rate in Texas was 34.2 maternal deaths per 100,000 live births; and this was 87 percent higher than the rate in 2006 through ’10, which was 18.3,” MacDorman told U.S. News.
[See: How to Cope With Gestational Diabetes.]
What’s more, black women suffer maternal deaths at a markedly higher rate than white women. “The rates for black women were sky high. In 2011 through ’15, the maternal mortality rate was 85.6 [per 100,000 live births] for non-Hispanic black women; and that was more than twice the rate of 38.0 for non-Hispanic white women,” MacDorman says.
Overall, experts say, maternal deaths are still quite uncommon. “I think first of all, most pregnant women need to be reassured that maternal death is a rare event, and that the chance of having a maternal death is extremely low,” says Dr. Mary D’Alton, chair of the department of obstetrics and gynecology at Columbia University Medical Center in New York City.
For that reason, researchers weren’t able to get state-by-state maternal death rates. That’s because for a small state there might be one or two deaths per year — not enough to really get a statistically reliable rate or a trend, MacDorman says. But it’s clear that Texas had a higher than normal rate, compared with other states that were grouped together.
However, the rise in maternal mortality seen in Texas — and the disparities there, with black women disproportionately affected — are reflected nationally.
In the U.S., it’s estimated that between about 700 and 800 women die annually while pregnant or shortly after giving birth. But experts say imprecise methods for keeping maternal mortality statistics and a subsequent lack of solid data make it hard to get a handle on the actual scope of the problem on a state or national level. What’s clear, though, is that maternal mortality has increased in the U.S., running counter to a successful international effort, led by the United Nations, to reduce maternal mortality rates.
“It was quite shocking to us when we were investigating the issue of maternal mortality worldwide to just recognize exactly where we ranked in terms of the risk of dying in pregnancy and childbirth,” says Rachel Ward, managing director of research at Amnesty International USA. “At the time of our study, the risk of a woman dying of pregnancy-related causes in the U.S. was higher than in 40 other countries. That number has badly trended in the wrong direction.”
According to the report of Amnesty International’s own maternal mortality investigation, “Deadly Delivery,” issued in 2010, the five main causes of maternal death in the U.S. are embolism (20 percent), wherein a blood clot blocks an essential blood vessel, like in the lungs; hemorrhage (17 percent), or severe blood loss; pre-eclampsia and eclampsia (16 percent), issues associated with high blood pressure during pregnancy; infection (13 percent) and cardiomyopathy, (8 percent) a disease of the heart muscle.
Other research estimates more than half of all maternal deaths in the U.S. are preventable — though experts are quick to point out that it’s more difficult to fully engage in prevention with a dearth of data regarding precise, well-documented maternal death numbers and circumstances surrounding those deaths. Furthermore, the deaths are just the “tip of the iceberg,” Amnesty reported, noting that tens of thousands of women have experienced a “near miss” — nearly dying in childbirth due to severe complications. And many more women suffer from lingering childbirth-related injuries.
[See: 10 Ways to Make Your Childbirth Easier.]
Certainly, high-risk pregnancies — such as having a child at a later age or when dealing with a health condition (whether related to the pregnancy or not) — can increase risk. “We are now seeing an increased number of women with significant medical issues that we didn’t see 20 years ago — women with congenital heart disease, women who have liver and renal transplants,” D’Alton says. “Those kinds of patients should be seen prior to pregnancy, and get the appropriate advice and appropriate care prior to pregnancy, and that is something that couples can do.”
Experts say socioeconomic factors can also raise risks by undercutting an expectant mother’s ability to receive the standard of care. Many low-income women aren’t able, for example, to readily access prenatal care — which is recommended starting early and routinely throughout the pregnancy.
“We found that the barriers to ensuring that a woman has a healthy pregnancy and childbirth are significant in the U.S. We found that essentially the levels of maternal mortality in this country amount to … a human rights crisis,” Ward says. “The reason why it’s a human rights issue is because the majority of these deaths could be prevented with some very common sense measures that the U.S. is simply not taking.”
That includes ensuring that women have access to health care, especially during their reproductive years, she says, like timely prenatal care. Often low-income women who are pregnant aren’t able to secure health coverage — at least initially. Many are on the government insurance program, Medicaid. “However, there are tremendous bureaucratic barriers to getting onto the Medicaid system, including providing sort of copious amounts of documentation” that’s required to get covered, she says — which takes time to secure.
Efforts have been made to improve training of doctors to treat patients in emergency situations during childbirth, standardize care to reduce complications and spot problems that could cause life-threatening issues, like clots, during the postpartum period as well. In addition, many localities and states are doing more to count and review maternal deaths; however, experts say more still needs to be done to turn the tide in the U.S.
For expectant mothers, partners and others supporting them, experts say it’s important to also speak up about any health concerns — even if it doesn’t seem to be related to pregnancy — and to follow-up as needed after childbirth, like if significant pain following childbirth persists, not just waiting for a brief, standard visit at six weeks. While that may not be so simple, like getting in for prenatal care, where barriers (from language to insurance coverage to transportation issues) sometimes exist, it’s critical to the extent possible to stay engaged in care, clinicians say.
In addition to discussing all medical conditions and concerns, lifestyle changes — like eating well, exercising and working closely with a physician to manage weight if obese — can also help lower risks.
If a cesarean delivery, or C-section, is recommended, determine if the benefits outweigh the risks, like a blood clot. It’s important that women and their families are empowered to be able to question if the care they’re receiving is necessary, Ward says. “C-sections can be a lifesaving procedure, for both mother and the child, but not always in all instances,” she says. “After having had a C-section, the risk of infection increases, which can also cause death as well.”
[See: 10 Weird Mind and Body Changes That Are Totally Normal During Pregnancy.]
Overall, she adds, “making sure that women have full access to health care services, that they’re able to participate in the decisions that are made could go a long way to making sure that women are able to have a healthy and safe pregnancy, and give birth in a safe way.”
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Reducing Deaths and ‘Near Misses’ Related to Pregnancy and Childbirth originally appeared on usnews.com
