A new report released by The Healthcare Cost and Utilization Project (HCUP), sponsored by the Agency for Healthcare Research and Quality (AHRQ) states that the rate of severe maternal morbidity during childbirth has risen sharply in the past ten years. Trends and Disparities in Delivery Hospitalizations Involving Severe Maternal Morbidity, 2006-2015 was  published earlier this month. Severe maternal morbidity captures unexpected outcomes during labor and birth that result in significant short-term or long-term consequences for a birthing person. They are generally considered life-threatening situations. 

Common examples of the 21 severe maternal morbidity events include complications such as acute myocardial infarction, pulmonary embolism, sepsis, hysterectomy or hemorrhage in addition to other events.  Additionally, the rate of severe maternal morbidity is disproportionately impacting people of color, most significantly Black families, along with people receiving Medicaid coverage.  The rate of serious complication for birthing people rose 45% in a ten year period from 2006 to 2015. 

In 2006, for every 10,000 births, 101 people experienced a significant complication.  In 2015, 147 people for every 10,000 were impacted by a serious maternal morbidity event. Black parents were 110 percent more likely to be impacted versus their white counterparts.  People of color who are not Black also had a disproportionately higher number of events.

83% of all severe maternal morbidity events involved the need for a blood transfusion in 2015. The rate of acute renal failure more than doubled between 2006 and 2015 (an increase of 134 percent, from 2.8 to 6.5 per 10,000 delivery hospitalizations), as did rates of shock (133 percent increase, from 1.9 to 4.3), ventilation (105 percent increase, from 0.6 to 1.2), and sepsis (104 percent increase, from 2.6 to 5.2).  

The youngest and the oldest birthing people were more likely to experience an adverse event and serious complication. The northeast and south regions of the United States also had higher rates of severe maternal events than other parts of the country.

The reasons for the increase in severe maternal morbidity cases are not clear but documentation indicates that there are several potential contributing factors. 

• changes in the overall health of the population of birthing people
• increased maternal age
• pre-pregnancy obesity
• preexisting chronic medical conditions
• cesarean delivery

For people who experience a severe maternal morbidity event, the consequences in the immediate short-term are significant and include medical costs and longer hospitalization stays. Longer-term, more difficult, painful and prolonged recoveries, decreased breastfeeding rates, loss of income, impact on future pregnancies and deliveries, increased birth trauma and postpartum mood and anxiety disorders to name a few.

Childbirth education can play a role in helping families understand prenatally how the decisions and choices they have may impact outcomes. In our classes, we can encourage families to seek out care from health care providers who use best practice and follow evidence-based care guidelines. We can also share resources that families can access post birth should a severe maternal morbidity event occur to help mitigate both physical and emotional recovery.

Families do not expect serious complications during labor and birth, especially if they are experiencing a healthy, low-risk pregnancy. Childbirth classes can help them be prepared for these significant unexpected outcomes that are on the rise for birthing families in the USA.  This is especially important for our families of color who are more likely to be adversely impacted. This is a public health issue of serious proportions. We all have a role to play.  Check out the entire report here.

Resources

Fingar KF (IBM Watson Health), Hambrick MM (AHRQ), Heslin KC (AHRQ), Moore JE (Institute for Medicaid Innovation). Trends and Disparities in Delivery Hospitalizations Involving Severe Maternal Morbidity, 2006-2015. HCUP Statistical Brief #243. September 2018. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/reports/statbriefs/sb243-Severe-Maternal-Morbidity-Delivery-Trends-Disparities.pdf. 

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