Maternal Death

Maternal DeathMaternal death is one of the most tragic topics to talk about when it comes to pregnancy conditions. No one likes to imagine the idea that an expecting mother who was looking forward to having a child suddenly passes away, leaving friends and family devastated. Maternal death is often the small thought that lingers in the back of a mother’s mind, usually brushing off the chance that it could happen to them.

But new statistics are showing that maternal death in the United States is on the rise, and it’s crucial that expecting parents are equipped with the necessary knowledge needed to recognize potential warning signs. Maternal death can be preventable if the mother takes the right steps to maintain her health and wellbeing. If we work together to spread awareness about this pregnancy complication, we can help save lives.

What is Maternal Death? How is it Different From Pregnancy-Related Death?

Maternal death and pregnancy-related death are terms that are often used interchangeably, but they don’t mean exactly the same thing. Here’s the difference:

Maternal death, also known as maternal mortality, is when a woman dies during pregnancy or up to 42 days after the termination of pregnancy from health problems or conditions related to the pregnancy.

Pregnancy-related death is when a woman dies during pregnancy or up to 1 year after the termination of pregnancy from health problems or conditions related to the pregnancy.

As you can see, the definitions sound very similar but pregnancy-related deaths cover a longer period of time after birth. Both maternal death and pregnancy-related death occur due to complications related to the pregnancy itself, meaning that if a pregnant woman dies from an accident, such as a car crash, it isn’t categorized under either term. You might be wondering: why are there two different terms for conditions that are so alike? Well, it’s mainly for research purposes. Researchers who track these two conditions use several methods to determine how certain cases are classified and to understand the differences in how women die.

What Causes Maternal Death and Pregnancy-Related Death?

Maternal DeathThere are several different types of complications that can contribute to or cause maternal death and pregnancy-related death, and fortunately, doctors have been able to identify the most common ones. Nearly 75% of all maternal deaths are caused by:

Maternal death can also have different causes depending on the timing:

  • During and after pregnancy: Complications generally arise due to heart disease and stroke. In fact, both of these conditions cause more than 1 in 3 pregnancy-related deaths.
  • During birth: Complications generally occur due to some type of emergency in the process of delivery. Severe bleeding (hemorrhaging) and amniotic fluid embolisms are common.
  • 1 week after birth: Death is often caused by severe bleeding, high blood pressure, and maternal infection.
  • 1 week-1 year: Death is most often attributed to cardiomyopathy, which is a weakened heart muscle.
What are the Statistics on Maternal Mortality?

Globally, maternal mortality has significantly decreased by 38 percent between 2000 and 2017. Unfortunately, that isn’t the case for the United States itself. The United States maternal mortality rate increased from 7.2 deaths per 100,000 live births in 1987 to 16.7 per 100,000 live births in 2016. Other studies showed even higher rates, with results showing figures as high as 23.8 in 2014. This means that the United States is becoming one of the most unsafe countries for women giving birth, at least for developed countries.

These are quite some alarming statistics, and the data taken from the research indicates that the wide majority of these deaths are preventable. The CDC even released a report that said 60 percent of these deaths could have prevented if the mothers had better knowledge about the importance of prenatal and postnatal care, and had better access to quality healthcare.

Research also gives us insight into what is contributing to so much maternal mortality. It’s been found that unnecessary C-sections, limited access to prenatal/postnatal care, and racial/ethnic disparities all have a big impact on the surging death rate. African-American and Native American/Alaskan Native populations are three to four times more likely to die from pregnancy complications compared to White and Hispanic populations.

Who is at risk for pregnancy-related deaths?

As stated above, certain racial ethnicities are at a higher risk of maternal mortality, but there are other factors to be aware of as well. Some other factors that have been associated with maternal death include:

  • Your type of living environment, such as living around and being exposed to harmful chemicals that could impact your pregnancy
  • What your community is like. Influences include poverty, access to public transportation, schools, housing, and police presence.
  • Your relationship with your significant other, friends, and family
  • Your personal health and your quality of healthcare
  • Your education level and income
  • Maternal age. Women aged 35 to 39 are around two times more likely to die from pregnancy-related complications compared to women aged 20 to 24.
  • Your mental health. Mental illness that is not treated properly can cause problems that lead to deadly complications.
How can I Prevent Maternal Mortality?

The most obvious answer to this question is to make sure you get regular and quality healthcare throughout your entire pregnancy, including before and after you’re pregnant. Having frequent check-ups on your health can help doctors identify health problems before they turn into a bigger issue. It’s beneficial to talk to your doctor about all the warning signs and symptoms of serious complications so you can also know when to seek help if needed. If you’re worried about something in your pregnancy, never ignore your gut instinct. It’s always better to be over-prepared and cautious about your health.

Before You get Pregnant
  • Schedule a preconception checkup. A preconception checkup is used to analyze your health and decide whether you’re healthy enough to get pregnant.
  • Tell your provider about any and all medications you take. There are many medications that may not be suitable to take during pregnancy, and you might need to switch to a different kind. Make all of your doctors aware that you are trying to get pregnant so they know what kind of approach to use in regards to your health.
  • Take action to prevent maternal infections. Make sure you’re up to date with all your vaccinations. Frequently wash your hands and avoid people who are sick. Avoid eating raw meat, fish, and eggs. Always use a condom to protect yourself from STIs until you try to conceive.
  • Stay physically healthy. If you’re overweight or obese, it may be necessary to lose a small amount of weight before getting pregnant. Stay active by using daily exercises, even if they’re small. Try to stay on a healthy diet.
  • Do not smoke or use illicit drugs in any way.
During Pregnancy
  • Schedule a prenatal appointment ASAP when you suspect you’re pregnant.
  • Make sure you attend all prenatal visits, no matter how healthy you may feel. Doctors need to keep a regular and updated track of your health and can identify problems early on.
  • Prepare to handle any existing problems or potential problems. If you know you’re at risk for a condition such as preeclampsia, discuss with your doctor about the best way to manage it.
  • Do we need to say it again? Absolutely do not smoke, drink alcohol, or use illicit drugs. If you’re struggling with substance abuse, contact your doctor about resources to help you quit.
After Pregnancy
  • Carefully monitor your health and watch for any symptoms of a potential complication. Don’t downplay or underestimate an issue if you’re worried about it.
  • Contact your doctor immediately if you are experiencing any symptoms of the health complications we list below.

Call your doctor immediately if you show signs of these conditions:

  • Cardiomyopathy: Common symptoms include swelling in the legs, excessive fatigue, chest pressure or heart palpitations, fainting, feeling out of breath, feeling dizzy or lightheaded.
  • Heart disease: Symptoms include chest pain or discomfort, dizziness and fainting, excessive fatigue, nausea, irregular heartbeat, shortness of breath, swelling in the legs, ankles, or feet.
  • Preeclampsia and eclampsia: Symptoms include change in vision, persistent headache, nausea and vomiting, dizziness, pain in your upper right belly area or shoulder, sudden weight gain, swelling in the legs, hands, or face, and trouble breathing.
  • Stroke: Symptoms include numbness or weakness in the face, feeling confused, trouble walking, trouble understanding words, having trouble seeing, dizziness, severe headache.
  • Thrombotic pulmonary embolism: Symptoms include shortness of breath, chest pain, cough, fever, dizziness, leg pain or swelling, fast heart rate, and sweating.
Outlook

Maternal death is unfortunately turning out to be a big problem in the United States. We don’t have all the solutions, but it’s clear that something needs to be done about this tragic reality. If you’re planning to get pregnant, take your health seriously. Just because you feel healthy does not mean you do not need to go to regular check-ups. Every expecting mother should be extra cautious about how they take care of themselves, and if you’re struggling to do it yourself, reach out to friends and family! You never have to be alone in this process. Like we said above, maternal death IS preventable in most cases. Make sure you take the steps needed to keep you and your baby safe.

Sources and Additional Literature

Williams, et al. (2019). Maternal mortality rates in the United States.

Petersen, E. E., et al. (2019). Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. Morbidity and Mortality Weekly Report, 68(18), 423.

Wolfe, D. S., et al. (2019). Addressing maternal mortality: the pregnant cardiac patient. American journal of obstetrics and gynecology, 220(2), 167-e1.

Anderson, B. A., et al. (2019). The Maternal Health Crisis in America: Nursing Implications for Advocacy and Practice. Springer Publishing Company.

Sisolak, S., et al. (2019). Severe Maternal Morbidity. Office of Analytics – Department of Health and Human Services.

Eidson, K. (2019). America’s Maternal Mortality Crisis: Policy Proposal.

Mann, S., et al. (2019). What We Can Do about Maternal Mortality: And How to Do It Quickly. Obstetric Anesthesia Digest, 39(1), 17-17.