Maternal mortality is preventable. So why are death rates rising?

The United States maternal mortality rate rose by about 40 percent from 2020 to 2021, according to new data from the Centers for Disease Control and Prevention (CDC) National Vital Statistics System.^[] Some experts suggest COVID-19 may have driven this spike, as the virus introduced new health risks, limited people’s access to in-person care, and heightened burnout among providers.

“That was year one of the global pandemic,” says Parijat Deshpande, a somatic trauma professional, consultant, and author who works with women experiencing high-risk pregnancies. “I am concerned about the role SARS-CoV-2 will continue to play in reproductive health, and I am concerned about the impact that immensely burned-out practitioners, and overburdened hospital systems will have on preventable pregnancy-related deaths.”

The mortality report shows that 1,205 maternal deaths occurred in the US in 2021, at a rate of 32.9 deaths per 100,000 live births. This is an increase from 861 deaths in 2020 and 754 deaths in 2019.

COVID-19 may have impacted the entire globe, but it placed unique burdens on pregnant people.

For starters, because of the pandemic, pregnant people often could not have a partner or support person accompany them to doctor‘s visits or delivery rooms. This could have been detrimental to their health, as studies have shown that having a partner or doula in the delivery room can reduce adverse outcomes during birth. ^[] Further, COVID-19 deterred some people from seeking general care in person or online, and pregnant women were—and still are—more likely to be hospitalized or die from the virus than those who are not pregnant, according to a study published in the American Journal of Emergency Medicine.^[] 

Older patients and patients of color are more likely to die from maternal causes

The overall maternal mortality rate rise strikingly affected Black and older-aged pregnant people.

According to the CDC’s report, the maternal mortality rate for Black people in 2021 was 69.9 deaths per 100,000 live births—2.6 times higher than rates of non-Hispanic white birth-givers in that year. For people 40 and older, overall maternal deaths occurred at 138.5 deaths per 100,000 live births—more than four times higher than rates for people between the ages of 25 and 39 and more than six times higher than for people under the age of 25. These changes in race-based and age-based maternal mortality rates were both statistically significant, according to the CDC.^[]

Systemic racism has various manifestations, such as when practitioners don’t believe their patients’ experiences, ignore them, or deny them necessary care. Patients may be hesitant to seek extra care if they have previously experienced racism in healthcare.

“All of these factors of racism together can start to paint the picture of why we disproportionately see a large increase in maternal mortality for Black mothers,” says Deshpande.

How can we reduce maternal mortality rates?

Despite the growing numbers, maternal mortalities can be prevented. Taking careful steps to address a patient's health conditions and concerns can help keep patients alive and well.

According to the World Health Organization (WHO), both systemic and social health barriers need to be broken down to best protect pregnant people’s lives.^[]

Deshpande lists other tips for reducing patient risk, with particular attention given to the following:

Forming, or re-forming, trust between patients and providers.

Creating a trustworthy relationship with patients and ensuring their voices are heard can be integral to a healthy, successful pregnancy. It is important for practitioners to recognize the vital role of listening to their patients' concerns, as not doing so could place them in a life-or-death scenario, Deshpande says.

“Too often we hear of people's experiences where they raised concerns with their providers after birth, only for those concerns to be waived off,” she adds. “Later, we hear that far too many of these patients have died despite having raised concerns.”

Filling maternity-care deserts with high-quality access points.

Similar to food deserts, some patients may live in maternity care deserts, where they cannot access high-quality maternity care near their homes. 

Advocating for better conditions for yourself and your coworkers to address provider burnout.

Doctors and nurses—not just patients—have borne much of the brunt of COVID-19. And burnout from health anxieties, long hours, and workplace shortages may be taking a toll on the quality of work.

Some of these issues may require top-down intervention—and require healthcare systems and governmental institutions to take such actions as adding necessary access points and providing better working hours and environments for practitioners. But practitioners can make some changes for the better, too, like prioritizing trust-building, instituting trauma-informed prevention, and listening to patients’ concerns. 

WHO also advises practitioners to keep a keen eye out for conditions like preeclampsia prior to their patient’s giving birth, and to monitor for post-birth complications like severe bleeding or infections, so that these can be treated immediately.

Deshpande encourages providers to receive trauma-sensitive training. This will help them learn about proper bedside manners, what to say and not say, and how to address concerns that could be life-threatening.

“This goes beyond solid bedside manner and being kind or compassionate,” she explains. “Tell them what you're thinking about their current pregnancy. What are you keeping an eye out for, what are your concerns, what is going well in your mind? Transparency is one of the cornerstones of trauma-sensitive practices and can help build safety and trust in your relationship with your patient, which plays a role in improving pregnancy outcomes.”