BellyBelly understands this is emotionally triggering content. We’re passionate about research (even if it’s hard to hear) and how we can learn from it – after all, we want the very best outcome possible. Therefore we’ve included a section down the bottom about how you can best reduce your chances of health complications.
We live in an era that has more medical technology than ever before.
We have access to prenatal care, health screenings, maternal fetal medicine doctors, and the most advanced obstetrical procedures and technologies for birth.
This means we’re seeing fewer childbirth related deaths, right? Wrong.
In the US there has been an increase, rather than a decrease, in childbirth related deaths.
In other wealthier countries, exactly the opposite is happening.
In Germany, Sweden, the UK, Australia, and Japan, there has been a marked decrease in maternal deaths since 1990. In the US, however, the number of women who have died in childbirth since 1990 has increased, and experts believe the number could continue to rise.
Maternal Deaths Rates In The US
In 1915, the rate of maternal death in childbirth was 607.9 in 100,000 births, or roughly 6%. By 1987 that rate had dropped significantly to 7.2 in 100,000, or 0.007%. There had been a definite decrease in maternal deaths.
There were many reasons women died in childbirth in the past. Infection, poor nutrition, and bleeding were common causes of maternal death during childbirth.
You can read more about this in BellyBelly’s article Why So Many Women Used To Die During Childbirth.
A proper understanding about hygiene between patients, prenatal screenings for anemia, and the use of medicine for stopping postpartum haemorrhage and/or administering blood transfusions all helped to reduce maternal deaths between 1915 and 1987.
Since 1987, however, the rate of maternal deaths has more than doubled in the US.
In 2013 the rate went up to about 17.8 deaths per 100,000, or about 0.017%. Maternal death during childbirth is still a rare event, but the fact that it’s increasing, rather than decreasing, is causing extreme concern.
Of even more concern is that the US is the only wealthy and developed country to experience this increase, rather than decrease, in maternal deaths.
Why Is The Maternal Death Rate Rising?
There are several possible reasons, but as current evidence shows, one reason is an increase in chronic, preexisting health conditions.
Overall, Americans are becoming less healthy than in previous generations. This means that more and more women are entering pregnancy with health complications.
Years ago, haemorrhage, and pregnancy induced hypertension spikes were major causes of maternal deaths during childbirth. With more screenings and medical advancements, the rate of deaths due to these complications has drastically decreased.
In the late 1980s and 90s, 28.7% of maternal deaths were related to bleeding. Today, bleeding accounts for 11.4% of maternal deaths.
Now, however, women are dying from pre-existing cardiovascular disease and diabetes.
The chief of maternal and infant health at the CDC, Dr. William Callaghan, said: “We’ve seen a big bump in cardiovascular disease and chronic disease contributing to maternal deaths. Underlying heart disease is common, diabetes is common. We now have a group of women bringing them into pregnancy”.
In the early 1980s and 90s cardiovascular conditions accounted for just 3% of maternal deaths. Today, they account for 14.6%.
When women enter pregnancy with preexisting conditions, there’s an increased risk of pregnancy and birth complications.
Reducing pregnancy related deaths might very well be rooted in reducing common health conditions in the US.
Dr. Callaghan also said: “It’s a larger problem than just dealing with women during pregnancy, it’s the health of our society. Imagine a woman comes in with a BMI of 40, and she’s 24 years old — that didn’t happen in the past year, it happened in the past 24 years”.
Diabetes, preexisting hypertension, and obesity have all increased since 1987. All of these conditions increase the risk of cardiovascular complications.
Women in the US don’t always have access to regular primary care, and preconception care. Most are aware that the state of preventative healthcare in the US needs reform. Women entering pregnancy with all of these preexisting conditions could be another symptom of the problem.
It’s also important to note that there is a drastic disparity among different demographics, including race-related factors. A black woman is more than three times more likely to die from pregnancy and birth related complications than a white woman.
There are various reasons for this, and several studies exploring this disparity. It is not clear how it can be reduced, but we do know that change in this area is vital for public health.
Are Women Still Dying From Infections?
Although not so much of a risk as earlier in the 20th century, infections still account for around 14% of maternal deaths. This figure has remained largely unchanged since the 1980s.
We now know that staff, nurses, and doctors need to wash and sanitise their hands properly between patients. This simple technique partly accounted for the drastic drop in maternal deaths from 1915 to 1987.
Unfortunately, simply being in a hospital can increase a person’s risk of infection.
When birth switched from being a primarily home based event to a hospital based event, there was an increase in deaths from infection. With growing knowledge of hygiene, and the use of antibiotics, the rate declined, but has remained steady since. This is reflective of our overall hospital care, and the need to continue to focus on protecting patients in the hospital.
The high c-section rate might also play a role in the risk of infections. It is important to note, however, that although c-section rates were lower in the 1980s, the rate of death due to infection has remained relatively the same.
It seems that while the risk of infection does increase with c-section birth, the overall risk of death from infections isn’t greatly affected by c-section rates.
Does Advanced Maternal Age Play A Role In Mortality Rates?
Having a baby after the age of 35 increases the risk of certain complications. Although women over the age of 35 account for 25% of maternal deaths, this figure is a drastic improvement on past rates, when they accounted for 50% of maternal deaths.
We might assume an increase in women delaying pregnancy could explain the increase in maternal deaths, but it’s important to note that the rate of advanced maternal age pregnancy has also increased in other developed and wealthier countries. Women in Australia, Germany, and so on, are also delaying childbirth, but those countries have not seen an increase in maternal deaths.
Based on this, it seems we cannot show a correlation between more advanced maternal age pregnancies and an increase in maternal death in the US.
Are More Birth Interventions Responsible For The Increased Maternal Death Rate?
In the US, more women than ever before are giving birth via c-section. We also see a high rate of induced and augmented births. While these interventions absolutely increase risks during childbirth, they do not seem to be the causes of increased maternal deaths.
More women are experiencing pregnancy complications due to side effects, but they aren’t leading to a significant increase in deaths.
The cascade of intervention and unnecessary c-sections account for longer and more complicated postnatal recoveries, NICU stays, and dissatisfaction with birth. For these reasons, it’s important that we work towards more evidence-based care. Reducing interventions, however, might not be enough to reduce maternal death rates.
How Can I Protect Myself?
The increase in maternal deaths in the US has several potential causes, and several possible solutions. As a large country, where data collection and policies vary drastically from state to state, it’s hard to say what will work, and how we can implement change.
What we do know is that maternal health prior to conception plays a large role in women’s health during pregnancy, birth, and the postnatal period. We also know that regular prenatal care, proper nutrition, and continuity of care, from the prenatal to the postpartum period can protect women from complications.
As an active participant in your healthcare, making good lifestyle and health choices prior to conception might be one of the most important things you can do to protect your health.
For example, studies show the rate of Gestational Diabetes can be reduced by up to 83% when a healthy lifestyle is adopted before conception, and around half when adopted during pregnancy.
Particularly, grains and sugars spike blood sugar levels, and are inflammatory in the body. For a healthy gut, mind, body and baby, a diet low in grains and sugars is a huge start for preventing chronic disease.
No more sodas or cereals. Have these delicious and filling foods instead.
Choosing a maternity care provider who offers education, evidence-based care, and continuity of care is another excellent way to protect your health, and the health of your baby.