Every year in the United States, an estimated 700 women die from pregnancy or childbirth complications, and more than 50,000 experience severe complications, from shock to kidney failure.
And the problem is growing.
The rate of severe complications related to labor and delivery rose almost 200 percent from 1993–2014, according to the U.S. Centers for Disease Control.
And while maternal mortality has declined globally in recent years, several studies indicate it’s on the rise in the U.S. The maternal death rate increased by 27 percent from 2000-2014 for 48 states and Washington, D.C., according to an analysis published in the American Journal of Obstetrics & Gynecology. Among developed countries, the U.S. ranks last and also falls behind many poorer countries, such as Serbia and Vietnam.
What are the causes of maternal deaths in the U.S., and how can we prevent them and the rising tide of near misses? We spoke with Dr. Mary D’Alton, who is drawing national attention to the problem and working toward making pregnancy and childbirth safer.
As chair of the Department of Obstetrics and Gynecology at NewYork-Presbyterian/Columbia University Irving Medical Center and director of services at NewYork-Presbyterian Sloane Hospital for Women, Dr. D’Alton specializes in high-risk pregnancies. She also serves as co-chair of the Safe Motherhood Initiative, which has implemented changes in New York State hospitals to reduce maternal deaths and serious complications. In 2018, NewYork-Presbyterian and Columbia University Irving Medical Center opened the Mothers Center, the nation’s first multidisciplinary center to focus specifically on caring for pregnant women with complex medical and surgical conditions.
Why aren’t maternal deaths going down in the United States?
The nature of women delivering children over the last 20 years has significantly changed. Number one, many pregnant women are older, and as women age they are more likely to have more complications medically and surgically. Obesity, which is on the rise, also increases risk in pregnancy, and women today are more likely to have chronic hypertension (high blood pressure) and diabetes.
Another factor we see in our center, thanks to medical and surgical advancements, is that women who have had organ transplants, have a history of cancer, or suffer from a chronic condition, such as cystic fibrosis or congenital heart disease, are becoming pregnant. These are women who previously were not considering pregnancy and are now becoming pregnant.
We also know that, nationally, non-Hispanic black women are three to four times more likely to experience a maternal death and considerably more likely to experience a severe complication. This is completely unacceptable, and we must address the factors that are driving these outcomes, including racism in our society and implicit bias in care.