The maternal mortality rate in the United States is the highest of all developed nations and has been steadily rising since the 1990s. By definition, maternal mortality includes women who die during pregnancy, childbirth, or 42 days after birth during the postpartum period. The U.S. Department of Health and Human Services (HHS) has deemed this climbing maternal mortality rate a public health crisis and the Biden administration has announced a call to action to improve health outcomes.1 2
Maternal Deaths Spike 40 Percent in 2020-2021
During 2020-2021, the U.S. experienced a 40 percent increase in maternal deaths. While this has largely been blamed on SARS-CoV2 infections, it is unclear to what extent COVID vaccinations may have also contributed to this increase, given that the safety of the shots on pregnant women has not been established.3
Data from state committees that review maternal deaths have concluded that roughly 84 percent of pregnancy-related deaths may have been preventable. According to the U.S. Centers for Disease Control and Prevention (CDC), there are many reasons for the increased risk of pregnancy complications, ranging from the age at which women become pregnant, to health care inequities and a rise in chronic health conditions.2
U.S. Maternity Care is “Intervention Intensive”
Maternity care in the U.S. also tends to be “intervention intensive despite substantive evidence that the routine use of intervention without medical indication increases risks for mothers and babies,” says Judith Lothian, journal author for the Journal of Perinatal Education. Lothian states that the rates of high intervention reflects a system-wide, maternity care approach that is rooted in “expecting trouble.”4
U.S. maternal care has been criticized for following outdated guidelines based on inaccurate research. One example of this is routine intravenous (IV) fluids which are given to roughly 62 percent of women during labor and delivery. Despite this being the norm in an American hospital setting, a 2013 Cochrane systematic review found that IV fluids should only be administered for clinical reasons or if the woman becomes ketotic.4
The authors of the Cochrane study also noted that there is potential maternal and neonatal morbidity that may arise from unnecessary administration of IV fluids due to fluid overload in mother or baby and can increase uterine contractions. Other effects include causing hyperglycemia in the mother and baby and breast edema which affects breastfeeding.4
Additional examples of outdated routine interventions common to the U.S. maternal experience include continuous electronic fetal monitoring, epidurals, Pitocin usage, and augmenting “stalled” labors with intervention or cesarean sections. While these interventions do have a place in some births, data finds that for healthy and normal births, it is best to allow for the physiological process to unfold.4
One-Third of Births in U.S. Involve Surgical C-Sections
In addition to a high maternal mortality rate in the U.S., the number of cesarean sections (C-sections) continues to grow rapidly, but it is not resulting in healthier outcomes 1 The rise is thought to be due largely to nonessential C-sections, which increases risks of complications ad morbidity for both women and infants. Although caesarean sections are sometimes medically necessary, these increased rates stand in stark contrast to the World Health Organization’s (WHO) recommended C-section rate of 10-15 percent of live births. In the U.S. during 2021, 32.1 percent of live births were cesarean deliveries. Mississippi has the highest cesarean rates, reaching as high as 37.8 percent.1
Black women face a much higher risk of both cesarean section and maternal death than their white counterparts. The maternal death rate of black women is 2.6 times higher than white women and the C-section rate is at 36 percent.1
According to Monique Rainford, author of the book “Pregnant While Black: Advancing Justice for Maternal Health in America,” reasons for the higher incidences of death and C-section in black women include both overt and implicit bias from healthcare providers and an increased load of cumulative chronic stress due to factors such as socioeconomic status and the stressors of racism.2
It should come as no surprise that an unhealthy society is contributing to unhealthy pregnancies and births. The U.S. has some of the highest obesity and chronic disease rates in the world. More American women than ever are entering pregnancy with health conditions that put them at increased risk of developing new conditions during pregnancy or worsening existing ones. Yet, these women are being treated with one-size-fits-all approaches to their pregnancies and births.
With 84 percent of pregnancy-related deaths thought to be preventable, the maternal health care system in the U.S. may need to review its longstanding standard of care practices.
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1 Ahmad A. America has the highest maternal mortality rate among developed nations— and it’s on the rise. Here’s why we are facing a pregnancy health crisis. Fortune May 14, 2023.
2 Katella K. Maternal mortality is on the rise: 8 things to know. Yale Medicine May 22, 2023.
3 Hobley N. Maternal mortality rate in U.S. increased 40 percent during pandemic. The Vaccine Reaction Mar. 28, 2023.
4 Lothian J. Healthy birth practice #4, avoid interventions unless they are medically necessary. Journal of Perinatal Education Apr. 1, 2019.