While there is no consensus amongst Maternal Mortality Review committees in operation in almost all 50 states about what actually constitutes a maternal death, there is one thing that everyone can agree on.  More than two thirds of the deaths that do occur during or within a year of pregnancy are preventable! 

According to the Centers for Disease Control (CDC) -  “Maternal Mortality Review Committees (MMRCs) are multi-disciplinary committees that convene at the state or local level to comprehensively review deaths of women during or within a year of pregnancy. MMRCs have access to clinical and non-clinical information (e.g., vital records, medical records, social service records) to more fully understand the circumstances surrounding each death, and to develop recommendations for action to prevent similar deaths in the future.”

The CDC considers a death is to be preventable “if the committee determines that there was at least some chance of the death being averted by one or more reasonable changes to patient, community, provider, facility, and/or systems factors.”

I have been honored to sit on the Maternal Mortality Review Committee for the State of Washington in the past, and I encourage all perinatal professionals in the USA to locate their state’s committee and determine how you can get involved.  The work of MMRCs has been effective at identifying that Black parents are more likely to die during the childbearing year than their peers of other races and ethnic groups. The maternal mortality rate is 37.1 deaths per 100,000 live births for Black parents, and less than half that, 14.7, for white parents.  Hispanic parents have a rate of 11.8 per 100,000 live births  Infant mortality rates for different races and ethnic groups follow the same pattern.

Interestingly, rural parents are also more likely to die within a year of pregnancy versus their urban peers.  The reason for this is the growing presence of a maternity care desert as more and more rural hospitals are shutting down their obstetrical departments and obstetrical care becomes more scarce or further away.

A critical first step is to agree upon and standardize the data used by all 50 states when determining what actually is a maternal death.  Currently, every MMRC has different criteria that they use during the process of classifying the deaths that occur during or within a year of pregnancy.

Two causes clearly contribute to the disproportionality of maternal deaths:

• Institutional and implicit racism are a major contributor.  Black people have less access to obstetrical care, and receive worse care when they are being seen, resulting in poorer outcomes.  Also, ongoing racism and racist treatment throughout a Black person’s life ages their body prematurely, and leads to worse outcomes and forces them to start of pregnancies in a less than healthy condition.
• Lack of continuity of insurance coverage, particularly amongst Medicaid covered patients.  All 50 states do not extend coverage for the same amount of time after birth.  Many people experience a gap in coverage or no coverage at all, within just a weeks or months after giving birth.

Maternal Mortality Review Committees must be fully funded in all 50 states and there must be a consensus on the guidelines used to determine maternal deaths.  Additionally, Medicaid insurance coverage for one-year post birth needs to be available to all parents receiving care through the program.

The three most common causes of death during pregnancy or in the year following pregnancy are hemorrhage, pre-eclampsia and infection.  Consistent monitoring of blood pressure readings during pregnancy and after birth will help identify pre-eclampsia earlier.  A reduction in inductions and cesareans can bring down hemorrhage and infection rates.  Listening to parents when they say that something is wrong also plays a critical role.  Especially for Black parents who are the least likely to be believed when they communicate concerns.

When fully two thirds of deaths to expectant or new parents are preventable, there is simply no excuse for the abhorrent rates of maternal mortality that parents experience in the USA, and the unequal burden on Black families is unconscionable.

Tags