Maternal mortality seems like something that only happens in history books or in developing countries far from the U.S.
In reality, over 60,000 women in the U.S. experience life-threatening pregnancy and post-partum complications each year — including over 1,200 deaths in 2021. And the problem is getting worse. The U.S. maternal mortality rate has nearly tripled in recent decades.
While there are differences in the official definitions of terms like maternal and pregnancy-related mortality, generally speaking, when a mother dies due to a pregnancy-related complication during or after her pregnancy, this is referred to as maternal mortality.
“Maternal mortality rates have been higher in the U.S. than other developed countries and, unfortunately, we keep seeing them rise,” says Kathleen A. Young, M.D., a cardiologist who regularly works with pregnant women at Mayo Clinic.
What country has the highest maternal mortality rate?
Based on the data from a few years ago, South Sudan has the world’s highest maternal mortality ratio: 1,223 deaths for every 100,000 live births. In other words, more than one out of 100 women die in childbirth. Chad, Nigeria, Central African Republic and Guinea-Bissau rounded out the top five worst countries for maternal mortality.
H2: How does the U.S. maternal mortality rate compare to other countries?
According to data compiled a few year ago by the CIA, with around 20 deaths per 100,000 live births, the maternal mortality ratio in the U.S. was more than three times that of other high-income countries — such as Australia, Japan and Norway. The U.S. had a higher maternal mortality ratio than 62 other nations. Countries with mortality ratios similar to the U.S. included Iran, Malaysia, Uruguay and Grenada.
The Black maternal mortality rate in the U.S.
For more than 100 years, Black mothers in the U.S. have been more likely to die than white mothers. Based on most recent estimates, non-Hispanic Black women are 2.6 times more likely to die from pregnancy-related complications than white women. In addition, Black mothers who graduated from college have a 60% greater risk for maternal death than white or Hispanic women who didn’t graduate from high school. The reason for this disparity is unclear, but contributing factors include racial bias and limited access to community amenities, such as housing, transportation and health care.
Other minority populations, such as Native Americans and Native Alaskans, also have worse maternal mortality rates compared to white mothers, experiencing 31 deaths per 100,000 live births.
Why is the U.S. maternal mortality rate so high?
There are several reasons why maternal mortality in the U.S. is higher than other places. Some factors include:
- Women in the U.S. have higher rates of cardiovascular disease, type 2 diabetes, chronic kidney disease, asthma and thyroid disease before they become pregnant.
- Women in the U.S. are waiting longer to have children. Women 40 and over have a maternal mortality rate that’s more than six times higher than the rate for women under the age of 25.
- Being obese or overweight before pregnancy is a risk factor during pregnancy and the postpartum period. Being overweight can contribute to pregnancy loss, preeclampsia and postpartum hemorrhage.
- The overall risk of COVID-19 to pregnant women is low, but people who are pregnant or have been recently pregnant have an increased risk of severe illness.
- There are significant variations in care guidelines between states. Guidelines often reflect social and political factors in each state, leading to different standards of care.
- Education before, during and after pregnancy can help women learn about risk factors, make informed choices and notice warning signs when issues arise.
- The U.S. does not have universal health care, making it an outlier among wealthy nations. As a result, women of reproductive age in the U.S. are more likely to skip or delay health care because of costs.
- According to the Commonwealth Fund, women of reproductive age in the U.S. are less likely to have a regular doctor or place of care than women in other high-income countries such as Norway, Germany and the U.K.
Maternal mortality causes
The U.S. does have one thing in common with other wealthy countries: The leading cause of maternal mortality is cardiovascular disease, including cardiomyopathy and hypertensive disorders of pregnancy. Other top U.S. maternal mortality causes include infections, hemorrhage and mental health conditions.
According to Dr. Young, cardiovascular disease includes people who were born with heart problems (congenital heart disease) and those who later developed cardiovascular conditions or cardiovascular disease risk factors, such as hypertension and diabetes (acquired heart disease).
“While there has been an increasing number of women with congenital heart disease reaching child-bearing age, we also have seen a rise in maternal mortality among women with acquired heart disease,” says Dr. Young.
Commonly seen acquired cardiovascular disease conditions in pregnancy include heart failure, heart attacks, heart rhythm problems and diseases of the aorta.
Maternal mortality prevention and treatment tactics
There are ways we can help lower the maternal mortality rate in the U.S. Here are just a few ways health care professionals are tackling the problem.
The risks of pregnancy for people with cardiovascular disease are not only related to their underlying cardiac disease, but also to their functional status and other medical conditions. It’s a good idea to discuss these factors with your health care team at an appointment before you get pregnant, known as preconception counseling.
“Preconception counseling allows us the opportunity to review the woman’s health risks before they become pregnant,” says Dr. Young. “We may recommend additional testing or changes to medications before a woman becomes pregnant. This process is important for women with underlying heart disease, as there are certain high-risk cardiovascular conditions in which we may counsel women to avoid pregnancy.”
Integrated care for high-risk pregnancies
Women with high-risk pregnancies benefit from having an integrated care team. For example, at Mayo Clinic, if a woman has cardiac risks, early multidisciplinary care by a dedicated Pregnancy Heart Team is recommended.
As part of the Pregnancy Heart Team, a cardiologist like Dr. Young will work with doctors who specialize in obstetrics and maternal fetal medicine as well as obstetric anesthesiologists, nurses and social workers — all with expertise managing high-risk pregnancies in women with heart disease.
“With the Pregnancy Heart Team, we coordinate care so that women often meet with their obstetrician and cardiologist on the same day. Together, we provide care and monitoring of mom and baby and help address any questions or concerns,” Dr. Young says. “We feel the Pregnancy Heart Team is essential to help improve cardiovascular outcomes and reduce maternal mortality for women with underlying cardiovascular disease.”
Education around symptoms
“What can be difficult in pregnancy is that some normal pregnancy symptoms — like swelling of the legs or feeling short of breath — can overlap with symptoms related to heart disease,” says Dr. Young. “I think it is important that expectant mothers are educated on symptoms to monitor for and to have a ‘high index of suspicion’ and reach out to their care team if something feels worse than expected.”
Online or video consultations
For some women, regular visits to a clinic or hospital might be difficult. Dr. Young explains, “For someone who lives in a rural area or lacks transportation, it might be hard and expensive to travel to every appointment. So, having tools like video consultations and remote monitoring devices (such as blood pressure monitors) could improve access and care for women.”
Staying vigilant during the “fourth trimester”
More than half of maternal deaths happen in the months after the baby is delivered. According to Dr. Young, it takes around 8 to 12 weeks for the physiologic and hemodynamic changes of pregnancy — the way blood flows through your body — to return to normal.
“During this time women can experience cardiovascular conditions such as a type of heart failure (peripartum cardiomyopathy) or a torn blood vessel in the heart (spontaneous coronary artery dissection),” she says. “It is important to have an increased awareness in the medical community and to routinely ask women if they are pregnant or were recently pregnant when they seek health care for acute concerns.”
Working with doulas
Working with a doula often leads to better outcomes, such as lower rates for cesarean births, fewer birth complications and decreased maternal distress. Especially for women of color, doulas can be an advocate for expectant mothers, providing critical support as they navigate the health care system.
Discover the harsh reality of higher black maternal mortality rates. Learn about systemic factors contributing to this health disparity and how we can reduce rates.
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