In the last decade, the US the number of births decreased by almost 20%. Maternal mortality rates, however, are rising at an alarmingly high rate, which means that the number of babies being born is decreasing, while the number of women dying is increasing.
Despite having one of the most advanced health systems in the world, the US currently has the highest rate of death related to pregnancy among developed countries. Maternal mortality has increased by a staggering 40% in 2021 from just one year ago. While some of it is due to COVID, the pre-pandemic maternal mortality level is already continues to increase.
Back in the 1930s, the rate of pregnancy-related deaths in the US is higher than in other similar countries. With better maternity care, living conditions, and antibiotics, maternal mortality rates have increased worldwide. As rates also began to rise in the US, they began rose again in the late 1990s, in part due to deficiencies in the public health care system. Because of this, the US Department of Health and Human Services considers it a public health crisisand the current administration has heralds a call to action to improve parent and infant health outcomes.
How we got there
It’s simple: Pregnant women are not receiving the appropriate level of medical care. Racial and ethnic disparities only exacerbate the situation resulting in poorer birth outcomes and more deaths for minorities. In 2021, the maternal mortality rate for black women a staggering 2.6 times higher than their white peers.
This is unacceptable and we must do better. As an OB/GYN, I see many opportunities to change to improve maternal outcomes—starting with better access to health professionals, more patient education about prenatal care and postpartum, and continued investment in maternal health initiatives.
Prenatal and postpartum care
Expectant parents must have access to high-quality prenatal care, which is essential for successful outcomes. Babies born to mothers who do not receive prenatal care are more likely to suffer preterm birth and low birth weightor even die.
Postpartum care is another important component that is often overlooked or overlooked. More than half of deaths from pregnancy complications occurred during the postpartum period, with most occurring in the first 12 weeks. Up to 70,000 people per year experience severe postpartum issues, including cardiac and cerebrovascular challenges, leading to future deaths. And let’s not forget the huge impact on emotional and mental health that pregnancy can have, with symptoms ranging from decreased appetite and sleep loss to depression, PTSD, or even psychosis.
Access to skilled health professionals, starting with prenatal care, can significantly improve mortality rates. Unfortunately, the reversal of Roe v. Wade makes access more difficult in several ways. First, it limits the type of care pregnant women in states with strict abortion policies can receive. Studies show that maternal mortality rates 62% higher in the states with abortion restrictions than without. In addition, the maternal mortality rate rose almost twice as fast from 2018 to 2020 in states with restrictions. Second, this is the reason physician deficiencies, especially in rural areas, forcing some patients to travel hundreds of miles to get maternity care. Telehealth services can help bridge some of this gap, both in rural and urban areas, to ensure that pregnant women receive timely and consistent guidance and treatment, but they are only part of the solution to a larger problem. .
Doulas are another great resource when it comes to childbirth and postpartum support. Research shows labor support from doulas can reduce physical and psychological stress during childbirth and lead to higher satisfaction with work experience. Doulas can also provide support for healthy births, including prenatal and postpartum care for women with less access to health care.
Cesarean births are on the rise for the wrong reasons and can result in more harm than good
A cesarean delivery (also called a cesarean section or C-section) is usually recommended when a vaginal delivery is considered risky. However, the number of C-sections is growing rapidly, but it is does not result in healthier results. Cesarean births account for nearly a third of all live births in the US This increase, believed to be largely due to unnecessary C-sections, increases the risk of complications and disease in women and babies, and is at odds with the World Health Organization. recommended rate which is 15%. The data shows that between 2019 and 2021, so will C-sections highest among Black women (of 36%), compared to 31% for white women, which shows the role of subjectivity and bias can play in health decisions.
Patient education is necessary for expectant parents to understand their options at each stage of pregnancy and feel empowered to advocate for themselves and their babies. For example, education about birthing options, including pain management, and dealing with postpartum conditions can lead to more informed care decisions. When it comes to C-sections, people should talk to their doctors to understand the risks and recovery timelines, and in some cases, need to get a second opinion. Often, patients are scheduled for a repeat cesarean delivery without being advised of a vaginal birth after cesarean (VBAC) alternative. Experts too Suggest having a midwife or doula to increase the possibility of vaginal birth and provide postpartum support. While the costs may be prohibitive, many employers offer productivity benefits that help defray the costs for these types of services.
COVID materially aggravated the death of the mother
Another major reason for the increase in maternal mortality is Covid-19, which accounted for 25% of maternal deaths in 2020 and 2021 combined. CDC research shows that maternal mortality rates are tied to COVID-related deaths greater for Black and Hispanic women, at 13.2 and 8.9 per 100,000 live births, respectively, versus 4.5 for white women. In cases where the mother DOING survive, COVID still causes irreparable harm including premature births and long-term health issues for both parents and newborns, and worse for people of color.
With the government calling for action to address maternal mortality and morbidity, and the rise in COVID-related deaths, we are beginning to see more health resources across the public and private sector. For example, the Health Resources Services Administration launched a National Maternal Mental Health Hotline with trained counselors, and founded the Society for Maternal-Fetal Medicine maternal mortality review committees to prioritize interventions to improve maternal health. Communities like New York are provide free access to doulas to reduce unfair races. In addition, many companies have launched research and education-based programs to identify racial gaps to improve maternal outcomes.
We must act and advocate for change
The CDC estimates that 80% of pregnancy-related deaths are preventable. This is a clear indication that something in our health care system needs to change and we need to act quickly to stop the loss of more lives. We must continue to raise this topic and advocate for continued investment and development in government organizations, health systems, and local communities to make quality and consistent pregnancy care available to all, starting with those from underserved communities. Only then can we begin to undo the damage and save the lives of mothers and babies.
Asima Ahmad MD, MPH, is the co-founder and chief medical officer of Carrot Fertility, a leading global fertility care platform for women, including people of every age, race, income, gender, sexual orientation , gender, marital status, and geography. She is a practicing double board-certified ob/gyn and reproductive endocrinologist with an interest in mechanisms affecting global maternal mortality.
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