MATERNITY CARE IN CRISIS: American women are dying from childbirth at a higher rate than in any other developed country.

Author:Johnson, Tahra

Kira and Charles Johnson were excited to welcome a second son into their family. Langston was to be delivered, like his older brother, by cesarean section on April 12, 2016. The Johnsons knew what to expect and were prepared for Kira's recovery. Or so they thought. While Kira was still in the hospital, Charles noticed blood in her catheter. He alerted the medical staff immediately, but hours went by before Kira could get a CT scan. By the time she went into surgery, it was too late. Kira died 11 hours after delivering her baby.

Like hundreds of other American women that year, Kira died due to a delayed response to complications from pregnancy or delivery. "Seven-hundred mothers die every year, and over 50,000 others experience dangerous complications that could have killed them--making the U.S. the most dangerous place in the developed world to give birth," Stacey D. Stewart, president of the March of Dimes, told the U.S. Energy and Commerce Subcommittee on Health in September last year. In fact, an American woman is three times more likely to die from childbirth than a Canadian woman and six times more likely than a Scandinavian woman. Kazakhstan and Libya have better rates than the U.S.

"This situation is completely unacceptable," Stewart said.

Uptick in Maternal Deaths

The national maternal mortality rate more than doubled between 1987 and 2012 and now sits at 20.7 deaths per 100,000 live births, according to the Centers for Disease Control and Prevention. The average maternal mortality rates for each state from 2011 to 2015 varied from 4.5 to 47 deaths per 100,000 live births.

Any time a woman dies while pregnant or within one year of the end of a pregnancy from any cause related to the pregnancy or its management, the CDC considers it a pregnancy-related death. The agency does not include deaths from accidental or incidental causes, such as dying in a car wreck while pregnant.

Different recording practices used over the years, however, make it hard to draw definitive conclusions on maternal death rates. According to a 2017 article in the journal Obstetrics & Gynecology, the current coding rules can negatively affect data quality. If the "pregnancy or post-partum within 42 days" box is checked, for example, the record is coded as a maternal death, regardless of what is written in the cause-of-death section. In some states, better information is available because maternal mortality review committees examine death records and decide whether the cause was pregnancy-related.

A 2018 report from nine review committees shows that most deaths are preventable, especially those involving delayed emergency care, as in Kira Johnson's case, or a lack of protocols for responding to labor and delivery complications.

Severe Maternal Morbidity

Deaths are not the only concern. For every...

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