The definition of maternal mortality or maternal death varies slightly amongst the different governing organizations. The standing definition is that maternal death is the death of a pregnant woman due to pregnancy-related complications and/or conditions that were made worse by the pregnancy. Death can occur anytime during the pregnancy or within six weeks or up to one year after delivery. One organization uses six weeks postpartum while others use up to one year postpartum.
The obstetric complications that account for the majority of maternal deaths are bleeding (hemorrhage), thrombotic events, high blood pressure and infection.
Homicide and unsafe abortions both contribute to maternal deaths in the United States causing the U.S. to rank 55th in maternal mortality compared to other higher-income countries.
Between 1955 and 1985, global maternal mortality declined significantly, however within the past ten years, the U.S. numbers are rising again.
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The incidence of maternal death in the U.S. is 24 deaths per 100,000 live births. The maternal death rate in the U.S. far exceeds that of other higher-income countries. Among these countries are the Netherlands, Japan, Germany and Canada to name a few where the death rate is one-third that of the U.S. This alarming statistic is three times higher in the African American community.
The causes of the increase in maternal mortality in the U.S., especially in the African American community, are quite entangled and difficult to isolate.
There are barriers to health care that are deeply rooted in discrimination and lead to socioeconomic factors that play a role in limiting health care access.
Such factors as inadequate education, suboptimal access to health care and a higher propensity to have chronic conditions such as diabetes, hypertension and obesity are affecting the Black community at a disproportionately higher rate.
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Providing access to health care is paramount in decreasing maternal mortality. Health deserts are far too common and these areas require women to travel great distances to obtain health care.
As pregnancy ensues, more visits are required and transportation becomes an issue. Social issues contribute to the steep incline in maternal mortality such as substance abuse, domestic violence and mental health problems.
There is no one answer to the problem of maternal mortality in the Black community. The increase in maternal mortality in the Black community is actually a manifestation of far deeper problems.
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Pre-pregnancy consultations are a vital way to evaluate a woman's health status before conception. For any patient considering conception, especially those with health issues, a pre-pregnancy consultation is important. Some diseases can be treated prior to pregnancy helping to reduce maternal mortality.
Directing patients to community resources for housing, infant care, immunizations, and even postpartum home visits can be beneficial. Ultimately empowering each woman to be an ambassador for her health care is the goal.
I believe that the escalated maternal mortality rate in the U.S. is actually the tip of the iceberg and a greater manifestation of far deeper problems. In order to begin to fix the problem of maternal mortality the situations leading to it should be recognized.
Barbara A. Hannah, M.D., M.S. FACOG is the owner and CEO of Women's Center/HealthCare Physicians, PLLC.
