The relatively high percentage of American women who die as a result of pregnancy, which exceeds that of other developed nations, is prompting a new national prevention campaign that relies on the states to take a leading role in preventing such deaths.
The effort encourages states to go beyond the information provided on a typical death certificate by having mortality review panels investigate the causes behind every maternal death that occurs during pregnancy or in the year after delivery. The hope is that the investigations will reveal causes for at least some of the deaths and lead to preventive measures to save the lives of more women.
A number of studies suggest that a third of deaths related to pregnancy are potentially preventable.
“It’s hard to do anything about a problem if you don’t have the problem fully defined,” said Cynthia Shellhaas, an associate professor in the division of maternal-fetal medicine at the Ohio State University Wexner Medical Center who supports the campaign.
The effort is led by the Association of Maternal & Child Health Programs (AMCHP), an advocacy group, and the Centers for Disease Control and Prevention. They want every state that doesn’t have one to create a maternal mortality panel of medical and forensic experts. They want the panels to collect as much information as possible related to every maternal death, including matters related to prenatal care, other health conditions, use of medications, drug and alcohol abuse, violence and previous medical procedures.
They also are encouraging states to standardize the data they collect. And they will provide a digital application to help them collect it, to make it easier to analyze the data for possible trends and remedies.
About half the states have such panels, although each devises its own ways of classifying information and determining which cases to investigate. For example, some look at any woman’s death up to 42 days after a pregnancy. Others examine any death up to a year after delivery.
In the United States, there are 18.5 maternal deaths for every 100,000 live births, according to the Institute for Health Metrics and Evaluation at the University of Washington, which tracks mortality trends worldwide. The CDC says that about 700 maternal deaths occur in the United States every year, with the rate for African-American women three times higher than the overall national figure.
Typical causes include hemorrhage, infection, hypertensive disorders and obstructions in labor.
Maternal mortality is down from a recent peak — in 2009, when it was 22 deaths per 100,000 — after rising steadily for more than a decade. But preliminary numbers suggest that the rate began to rise after 2013, the institute said. The figure is significantly higher in the United States than in other developed countries. For example, the rate is 8.2 in Canada and 6.1 in the United Kingdom and Japan.
Possible reasons for the higher U.S. rate include better reporting, mothers giving birth at older ages (which increases the odds of pregnancy-related complications) and the growing percentage of expectant mothers with chronic conditions such as obesity, hypertension and diabetes. The upsurge in opioid overdoses also may be a factor.
Maternal deaths often signal broader health problems. The Joint Commission, a nonprofit that accredits health-care organizations and programs, calls maternal deaths “sentinel” events. “For every woman who dies, there are 50 who are very ill, suffering significant complications of pregnancy, labor and delivery,” William Callaghan, a senior CDC scientist who studies maternal morbidity, said in an alert issued by the Joint Commission in 2010.