PA Foundation | Melissa Rodriguez, DMSc, PA-C
Have you heard? Maternal mortality rates are increasing in the U.S. We now have the highest maternal mortality rates in all developed countries. The 2020 report from the National Center for Health Statistics, based on data from the National Vital Statistics System, showed that 861 women died due to maternal causes, up to 42 days after the end of pregnancy, with a general maternal mortality rate of 23.8 deaths per 100,000 live births in 2020 (Hoyert, 2022). When stratified by race, non-Hispanic Black women had 55.3 deaths per 100,000 live births, 2.9 times that of non-Hispanic White women. Several medical causes are identified, including cardiac disease, hypertension, hemorrhage, and venous thromboembolism. Social determinants of health also strongly correlate with mortality, as they contribute to preexisting health conditions and why people of color avoid seeking care.
Racism and inadequate access to care further isolate people in need. For instance, maternity care deserts, caused by the increasing number of hospital closures in rural communities, have increased and led to an increase in out-of-hospital and preterm births and births in hospitals without obstetric units in the following year after closure (Kozhimannil et al., 2018). The degree of isolation and lack of services may contribute to maternal mortality in the U.S. and exacerbate the socioeconomic differences within contrasting populations. This phenomenon was highlighted in a study in Louisiana, where those with a lack of maternity care experienced a 91% increase in the risk of death during pregnancy and up to one year postpartum (Wallace et al., 2021). Sadly, even with access, women of color may choose to deliver outside of the hospital due to racism and obstetric birth trauma. We need to improve our services.
Most pregnancies in the U.S. are considered low risk. “High risk” describes a pregnancy with risk to the woman, fetus, or both, increasing the likelihood of a complication, adverse event, or poor outcomes occurring during or after the pregnancy or birth. However, there is always a risk of complications in pregnancy and delivery. The rising number of obese patients, the increasing age at first delivery, the increasing use of fertility treatments, and societal factors play a role in increasing the risk of pregnancy. Women aged 35 or above are at greater risk of maternal mortality, preeclampsia, poor fetal growth, fetal distress, and stillbirth when compared to mothers aged 25-29 (SMFM 2014; Cavazos-Rehg et al., 2015), and this age range accounted for 18% of all births in 2017. Despite this risk, mothers ages 35 and older were more likely to birth at home (23.6%) or at a birth center (18.1%) compared to a hospital birth (17.5%), without available specialty-specific interventions.