Of the nearly 1,000 pregnancy-related deaths in the U.S. between 2017 and 2019, more than 80% of them could have been prevented, according to a report by the Centers for Disease Control and Prevention released on September 19.
The agency’s Maternal Mortality Review Committees collected data from 36 states to determine the leading causes of pregnancy-related deaths by race and ethnicity.
“The majority of pregnancy-related deaths were preventable, highlighting the need for quality improvement initiatives in states, hospitals, and communities that ensure all people who are pregnant or postpartum get the right care at the right time,” said Wanda Barfield, director of the CDC’s Division of Reproductive Health at the National Center for Chronic Disease Prevention and Health Promotion.
Not listening to patient concerns may be a huge reason for many of these losses, says Parijat Deshpande, an integrative, trauma-informed high-risk pregnancy specialist.
Deshpande firmly believes the burden shouldn’t fall on patients, and that it’s the responsibility of practitioners to genuinely check in with their maternity patients about how they are feeling and to take their concerns seriously.
“Until we actually have a medical system that shows that they trust and center the patient above anything and everything else, we’re going to have an issue with medical trauma, medical gaslighting and a lack of safety inside that system that’s going to prevent people from accessing quality care,” says Deshpande.
“I really think the onus has to be on the system itself to show that it is a safe place for people to come to. It is not a safe place right now.”
Experts say there are clear ‘opportunities for prevention’
Though mental health conditions topped the list of underlying causes of pregnancy-related deaths in the U.S., heart conditions and hypertension — which can lead to cardiac issues — accounted for a combined 29% of all pregnancy-related deaths.
“That together was actually the leading cause of deaths,” says Alison Cowan, a practicing part-time OB hospitalist and head of medical affairs for Mirvie, a biotech company developing new technology to predict pregnancy complications before they occur.
“So, when we think about what to focus on first for pregnancy-related mortality, we should be focusing on high blood pressure and heart-related conditions,” Cowan says. “And a close second would be mental health and substance-use disorders.”
And both of those categories contain “a lot of opportunities for prevention,” she adds.
Though the leading underlying causes of death differed for each race and ethnicity, mental health and heart-related conditions were at the top of the list for most groups.
The top leading underlying causes for each race/ethnicity included in the report are:
- Non-Hispanic White people: Mental health conditions (34.8%)
- Non-Hispanic Asian people: Hemorrhage (31.3%)
- Hispanic: Mental health conditions (24.1%)
- Non-Hispanic, Black: Cardiac and coronary conditions (15.9%)
- American Indian or Alaska Native people: mental health conditions and hemorrhage (2 deaths related to each condition)
The report also indicated that 22% of the pregnancy-related deaths happened during pregnancy, and a fourth of them occurred on the day of delivery or within 7 days after.
One of the more notable stats in the CDC’s report is that, over half (53%) of the deaths related to pregnancy occurred up to one year after giving birth.
Most postpartum visits are scheduled six weeks after giving birth, and medical care for birthers specifically usually ends 6 to 8 weeks following delivery. Deshpande believes that to be part of the problem.
“We cannot stop postpartum appointments at the six week mark and assume everything is going to be fine,” Deshpande says. “We need to have more frequent check-ins, and those checkpoints need to not just be dependent on one provider.”
The importance of patient ‘education and empowerment’
Cowan’s office has taken initiative to change this issue by altering their postpartum care schedule.
They meet with birthers at the two-week mark instead of having them wait six weeks after delivery to see a doctor, she says.
On a federal level, the pregnancy care schedule for birthers has largely remained the same since 1930, she notes, including the scheduling of postpartum visits.
In 2020, the American College of Obstetricians and Gynecologists (ACOG) introduced the Redesigning Prenatal Care Initiative. ACOG’s plan strongly encourages assessing individual birther’s medical and social needs at the start of pregnancy, and then tailoring a plan of care for them throughout their pregnancy.
While effective, Cowan thinks it shouldn’t stop there. Many parents often prioritize the needs of their children above their own, especially when they have frequent check-ups for their baby. For this reason, she believes pediatricians should offer services for birthers to check in with their own health during their child’s visits, and some already do.
“There was discussion on postpartum depression and even hypertension screening maybe being brought into the pediatrician’s office,” Cowan says. “And ultimately, the other thing that just can’t be overemphasized is education and empowerment.”
Letting patients know what their individual risks are and teaching them the tools to manage them, including how to monitor their blood pressure, will help them to identify when something isn’t right, she notes.
“These were all preventable, and I think that word needs to really sit heavy with everybody right now. We are losing lives that never ever should’ve been lost,” Deshpande says.
“Because they’re preventable, we can actually save a lot of lives if we build the system right this time around.”
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