Maternal Deaths

Maternal Death – A National Tragedy

Maternal deaths in the United States in 1960 were 37 per 100,000 births with a decline during the 1980s into the late 1990s where it leveled off at nine per 100,000 births. After 1997, the rate of maternal deaths began rising again until 2008 when it plateaued at around 14 per 100,000 births. https://www.commonwealthfund.org/publications/issue-brief-report/2020/dec/maternal-mortality-united-states-primer With a death rate in 2020 of 23.8 deaths per 100,000 live births, the United States had far more deaths than 11 other developed countries. About 700 women die each year here from complications of pregnancy with approximately 60% of these deaths being preventable. https://www.cdc.gov/vitalsigns/maternal-deaths/index.html

Consider these death rates noted above because compared to other wealthy nations, the United States spends the highest percentage of its gross domestic product on health care. We are NOT getting what we paid for. https://www.ajmc.com/view/us-ranks-worst-in-maternal-care-mortality-compared-with-10-other-developed-nations.

American women at the highest risk for death are those age 40 and older, with a death rate of 107.9 per 100,000 live births compared to a rate of 13.8 for women under the age of 25. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm#:~:text=In%202020%2C%20861%20women%20were,20.1%20in%202019%20(Table).

When and why are mothers dying?

• One-third of deaths occur during pregnancy associated with hemorrhage and cardiovascular conditions.
• One-half of all deaths occur after the day of delivery with infection being a leading cause.
• In the period after discharge weakened hearts, substance abuse, and suicide are leading causes of death.

https://www.commonwealthfund.org/publications/issue-brief-report/2020/dec/maternal-mortality-united-states-primer

What is going on?

Limited access to health care

In the last two years, some healthcare providers have died of COVID and many have left the profession. Poorly staffed or unstaffed labor and delivery units have closed, requiring patients to drive further for obstetrical care.

This is particularly acute in rural areas. A recent study ranked Texas 50th among all states in access to high-quality prenatal and maternal care. Only 73.6% of women aged 18 to 44 had health insurance and only 57% in this age group had a primary care physician. https://www.texmed.org/Template.aspx?id=59688. Lack of access to health care is a leading cause of maternal mortality. https://www.dshs.texas.gov/mch/pdf/DSHS-MMMRC-2020-UPDATED-11282020.pdf.

Discrimination based on race, socioeconomic status, and geography

Death rates are highest for non-Hispanic Black women (55.3 deaths per 100,000), almost three times the 19.1 rates of non-Hispanic white women. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm#:~:text=In%202020%2C%20861%20women%20were,20.1%20in%202019%20(Table)

In some states, appeals courts have ruled to end Medicare funding to Planned Parenthood clinics, which provide services to low-income women, including pregnancy services and postpartum care. Other developed countries provide at least one visit within one week of birth. This is not a universal benefit in the U.S. https://www.ajmc.com/view/us-ranks-worst-in-maternal-care-mortality-compared-with-10-other-developed-nations.

Inadequately trained healthcare providers

Even before the pandemic, some healthcare institutions expressed concern about the increased liability aspects of allowing students to care for patients. This concern may often prevent students from taking responsibility for patients or performing key tasks with observation as the only option. Caring for multiple patients to prepare students for the transition to the actual practice environment cannot take place due to concerns such as student-to-faculty ratios, high patient acuity, and patient safety. This may lead to inadequate training for new nurse graduates expected to provide safe and effective care.
https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-26-2021/No1-Jan-2021/Disrupting-Nursing-Education-in-Light-of-COVID-19.html#Challenges

Training and clinical experiences for student nurses were suspended, restricted, or stopped during the height of the pandemic. Face-to-face teaching and learning were converted to virtual remote education. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014519/ Adequate education and training to prove safe patient care can get missed in remote learning.

Many within the medical legal and clinical world express concern about the lack of experience, critical thinking, and effective decision-making among recent medical and nursing graduates. How much of this goes into maternal deaths is not yet clear.

Analysis of the standard of care, decision-making, and circumstances surrounding maternal death is complex. OnPoint LNC provides expert witnesses to assist attorneys to wind their way through the complexities of maternal death. Call us for help with your obstetrical cases.

Kimm Ebersole, MHA, RN
Business Development
Kimm@OnPointLNC.com

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