More than 4 in 5 maternal deaths can be avoided: ‘We have much more work to do’

A recent CDC report says most maternal deaths are preventable. Advocates call for more research to examine the causes of maternal mortality.

Almost all maternal deaths are preventable, a federal study has found, and advocates say that should be sounding an alarm to help protect mothers.

Over 84% of pregnancy-related deaths could have been prevented, according to a report from the Centers for Disease Control and Prevention. The study examined maternal deaths from 2017 through 2019 in 36 states.

The new report found a much higher percentage of maternal deaths than a similar CDC study in 2019, which found 60% of fatalities could have been avoided, said Iffath Abbasi Hoskins, president of the American College of Obstetricians and Gynecologists.

The American College of Obstetricians and Gynecologists has pushed for extending Medicaid benefits for all postpartum patients from 60 days to one year. More than half of the states have done that, but Abbasi Hoskins said others should follow suit.

“The CDC data reinforce that extending postpartum Medicaid coverage is sound policy, and states that have not done so are missing an opportunity to save lives,” she said in a statement.

The new CDC report “demonstrates that we have much more work to do to effectively address the underlying causes of maternal mortality in order to save the lives of pregnant and postpartum patients,” she said.

More than half (53%) of pregnancy-related deaths took place from seven days to one year after giving birth, the CDC reported. About 22% of the deaths occurred during pregnancy, while 13% of deaths happened on the day of delivery, and 12% of the fatalities occurred within one to six days of giving birth.

For the first time, the CDC found that mental health was a leading cause of pregnancy-related deaths, which Abbasi Hoskins said was significant. Mental health causes contributed to the largest number of deaths among white, Hispanic, and American Indian or Alaska Native mothers.

“These results demonstrate the impact that mental health issues have on our patients’ lives and that mental illness can be deadly,” she said in the statement.

Among Black mothers, cardiac conditions and cardiomyopathy were found to be the leading cause of death, the CDC report found. Abbasi Hoskins said that’s critical to understand the risk factors for Black patients.

However, the CDC report doesn’t include the fact that Black patients are three times more likely to die from pregnancy-related complications than white patients, she said.

Abbasi Hoskins said it is “necessary to evaluate data using a health equity and racial lens. This is how we will be able to inform focused solutions that will eliminate inequities in care and outcomes that exist for Black pregnant and postpartum people.”

Lethenia Baker, an obstetrician/gynecologist at Wellstar Health in Georgia, told USA Today there need to be improvements in diagnosis and treatment of postpartum conditions. “These are things that need to happen systemically,” Baker told USA Today. “It can't just be a few practices here or there who are adopting best practices. It has to be a systemic change.”

Boston Medical Center launched a remote patient monitoring program to monitor the blood pressure of patients who have had babies. Christina Yarrington, director of labor and delivery at Boston Medical Center, said some patients are at higher risk of hypertension and stroke within days after giving birth, and the greatest risk can occur after patients have been discharged from the hospital.

“This is the rub with hypertension,” Yarrington told Chief Healthcare Executive. “They feel fine. They feel fine. They measure their blood pressure and it comes up as 180 over 110 … That’s high enough to give you a stroke. That’s high enough to cause cardiac damage.”

Virtually all of the patients checked their blood pressure with simple cuffs that required just the touch of a button. Boston Medical managed to identify some patients that needed treatment before suffering a stroke or heart attack.

“I think we’ve had a lot of near-misses, quite honestly,” Yarrington said. Boston Medical is now remotely monitoring the blood pressure of some patients during pregnancy. (Christina Yarrington talks about the remote monitoring program in this video. The story continues below the video.)

While the CDC study examined patients in 2017 through 2019, a separate study suggests the COVID-19 pandemic could have contributed to more maternal deaths.

The study, published in Jama Network Open, found “small but significant increases” in pregnancy-related complications and maternal death.

“The increase in maternal death during delivery hospitalization and pregnancy-related complications during the pandemic is alarming,” the researchers wrote. They speculated that disruptions in prenatal care in the pandemic could have led to the increase in complications and maternal deaths.

President Biden's administration has focused on reducing maternal mortality. The Centers for Medicare & Medicaid Services plans to identify “birthing friendly” hospitals. With the new "birthing friendly" designation, consumers can look for hospitals that have shown their commitment to excellent maternity care, CMS says.