Why Are Women Dying During Childbirth in the United States?

America is the most dangerous place to give birth in the developed world, especially for black women. 

In November of 2019, USA Today reported that, “hospitals know how to protect mothers, they just aren’t doing it.” They found the U.S. has a significantly higher level of pregnancy-related injuries and deaths than other developed countries. Additionally, while other countries’ maternal mortality rates have declined, the rate in the U.S. has increased sharply. Furthermore, women aren’t dying from unforeseen medical or childbirth complications—they are dying from hospitals ignoring, or failing to treat obvious symptoms. 

Just two years before the USA Today investigation, NPR created a special series highlighting why so many women die from pregnancy-related issues. NPR specifically showcased the perils of being a black woman giving birth in the U.S. For years, hospitals have attributed the rising maternal deaths and injuries to problems beyond their control. Oftentimes, when there are racial and ethnic disparities, poverty and pre-existing medical conditions are blamed, rather than hospitals taking responsibility for subpar medical care. 

Maternal Mortality or Pregnancy-Related Death?

The CDC’s Pregnancy-Related Mortality Surveillance System (PMSS) defines a pregnancy-related death as the death of a woman during pregnancy or within one year of a pregnancy-related complication. It can also be defined as a sequence of events initiated by pregnancy; or the aggravation of an unrelated condition by the physiological effects of pregnancy.

Maternal mortality or maternal death refers to the death of a woman during pregnancy or up to 42 days post pregnancy. While there is overlap in these terms, there are caveats to what each covers. “Pregnancy-related” is more generalized and can cover injury or death not directly associated with pregnancy, while “maternal mortality” is focused on deaths exclusively related to pregnancy.

The CDC most commonly uses pregnancy-related or pregnancy-associated deaths as a catchall when talking about maternal injury or mortality, while the World Health Organization and National Center for Health Statistics uses maternal mortality or death.

Common Pregnancy Complications Endanger Women’s Lives

A large majority of women in America give birth without incident, however, each year more than 50,000 women are severely injured and nearly 700 mothers die. Half of these deaths and injuries could be prevented, reduced, or even eliminated through proper monitoring and rapid intervention.

There are five common pregnancy-related complications that can lead to maternal mortality which include: preeclampsia, eclampsia, both relating to blood pressure issues, and abruptio placentae, placenta previa, and postpartum hemorrhage all relating to blood loss issues. 

Many procedures that are already put in place to reduce complications are simple and do not require expensive technology. Despite this, these simple, life-saving tasks continue to be overlooked by doctors and nurses. More specifically, the lack of immediate action by healthcare workers when complications become apparent jeopardizes the safety of birthing mothers. 

According to the American Hospital Association (AHA), as many as 93 percent of women who bled to death during childbirth could have been saved. In hopes to reduce the number of these routine failures, the AHA holds training sessions aimed at getting maternity units to improve care. 

One factor of this sharp increase can be explained by unnecessary cesarean-section deliveries. Also known as a C-section, this procedure adds risk and financial burden. As of 2015, the proportion of C-sections at individual U.S. hospitals varied from 7 percent of births to a disconcerting 70 percent of births. C-sections may be profitable for hospitals, but not only do they put lives at stake, but their risk of complication can create a considerable financial cost to the patient. 

How are Black Women Disproportionately Affected?

Racial and ethnic disparities during childbirth are very apparent in America’s healthcare system. In fact, a black woman, specifically, is 243 times more likely to die from pregnancy-related complications than a white woman. This alarming number only increases when age, education, and other socio-economic factors are considered. 

The findings of a national study also found that black women were two to three times more likely to die than white women who suffered the same complication. Additionally, 36 percent of black women will give birth via C-section, compared to 30 percent of white women, putting them, again, at higher risk. 

The CDC suggests there are ways to combat these racial disparities. Hospitals and healthcare systems, specifically those that serve disproportionately affected communities, need to begin identifying and addressing bias, as well as implementing quality improvement.

Spotlight on Maternal Healthcare Done Right

Data gathered from 1990 to 2015 by the World Health Organization gave international insight to maternal deaths with a focus on which countries improved the most and what their strategies for improvement were. The data showed a surprising front runner, the Maldives. 

The Maldives, a small Island nation in south Asia, was able to reduce mother mortality rates by 90% during this time period with very little economic growth. Economic growth is taken into account in the data because it has long been believed that a wealthy country is a country with a low maternal mortality rate. This new data shows the correlation is not inherent.

Information from both the Maldives Health Strategy and research by the WHO help explain this surprising data. 

The Maldives approved the issue using a three pronged approach:

• Research
• Strategy based on research
• Prevention 

Before any new standards were put in place, the health ministry did an in depth review of how and why mothers were dying. They then worked from there to see what could be done to prevent these deaths. 

One of the issues that came from the study was the need to increase the number of skilled healthcare workers. Between 1990 and 2015, the number of midwives in the country increased by 12 percent. Today, more than 95% of births are attended by skilled health care professionals.

A prevention plan was put in place that included nutritional interventions for pregnant women to address possible health issues for both mothers and fetuses, including the use of prenatal vitamins.

Everyone Has a Right to Appropriate Care

With the access to advanced healthcare technology in the United States, the high level and rising numbers associated with pregnancy-related injury or death are astounding. The numbers show that not money, but a thoughtful and calculated approach, can vastly reduce the rate of maternal mortality. 

There is data showing clear successes among other countries, and the failure of ours. It is clear there are simple standards that could be put into place to save the 700 women who die each year, and the 50,000 women who suffer injury.

In these cases, legal action can be a powerful agent for change. 

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