As we recognize Mother’s Day on May 14, let’s take this time to reflect on how we can help ensure all moms celebrate with us, year after year. A recent report by the Centers for Disease Control and Prevention (CDC) shows the U.S. maternal mortality rate rose once again in 2021 – an 89% increase for all women since 2018. Additionally, the maternal mortality rate for Black women has risen 87% since 2018, to about 2.5 times the rate compared to white and Hispanic women. Giving birth at a later age also showed an increased risk, with a 69% rise in maternal mortality since 2018 for women aged 40 and older. The majority of maternal deaths (53%) occur in the first year after giving birth, not before or immediately after delivery. However, improved data tracking and in-depth analysis can provide us with greater opportunities to reduce maternal mortality.
Unfortunately, racial and ethnic disparities are common throughout the health care system, especially for maternal health. Disparities can originate at the patient-level, provider-level, or health care system-level. Understanding the roots of these disparities is essential for discovering and implementing solutions to reduce inequities in maternal outcomes.
As leaders in patient safety, the American Society of Anesthesiologists (ASA) has actively led efforts to reduce racial disparities and improve outcomes for mothers and babies by creating and implementing standardized pain protocols after cesarean birth and providing educational and training resources related to health equity. The increase in state-level and local-level reviews of maternal deaths and improved monitoring, have allowed anesthesiologists to identify causes and potential areas of improvement in maternal mortality.
In 2021, the ASA Committee on Obstetric Anesthesia issued a statement and recommendations on Reducing Maternal Peripartum Racial and Ethnic Disparities in Anesthesia Care. ASA called for having anesthesiologists as part of state and hospital maternal mortality reviews, obtaining early consultation for pregnant women with co-existing diseases, and helping to identify and treat hypertension and bleeding at the time of delivery. Last year, ASA released its Statement on Anesthesiologists’ Role in Reducing Maternal Mortality and Severe Maternal Morbidity.
In the past, anesthesiologists’ focus have been on keeping moms healthy in the perinatal period, especially during and immediately after delivery. However, while 22% of maternal deaths occur during pregnancy and 25% occur during delivery or within the first week after giving birth, 53% occur during the first year after giving birth, putting attention on the need for new ways to help keep moms healthy. Anesthesiologists have led the way on preventing and treating pain in the perinatal period, which not only reduces disparities but also reduces complications in the first year after delivery.
CDC data shows that four out of five pregnancy-related deaths in the U.S. are preventable. Additionally, a CDC pregnancy mortality surveillance system shows cardiovascular disease, infection, hemorrhage, and embolism were the top causes of pregnancy-related deaths in the U.S. from 2017-19. The CDC pregnancy mortality surveillance system also reports specific information on the leading causes of pregnancy-related deaths by race and ethnicity. For Black mothers, it’s cardiac and coronary conditions. For Hispanic and white mothers, it’s mental health, including accidental drug overdose and suicide. For Asian mothers, it’s hemorrhage.
We also know that what happens during pregnancy can affect mom and baby later in life. People who develop pre-eclampsia, a hypertensive disorder of pregnancy, have a greater chance of developing hypertension and heart disease later in life. Also, children of women with preeclampsia/hypertensive disorders have a 25% to 100% increased chance of developing cardiovascular disease by the time they are 40 years old.
As a community, we can all help reduce maternal mortality if we become educated on the signs and symptoms that may signal an adverse condition or disease so mothers can get help at the right time and place by a health care professional. The CDC’s Hear Her campaign provides urgent maternal warning signs and symptoms to be aware of during pregnancy and in the year after delivery, such as headache that won’t go away, fever, severe swelling of the hands or face, thoughts about harming oneself or baby, etc.
Understanding the root causes of maternal mortality and racial and ethnic disparities in maternal health is what will help us identify opportunities for prevention and early intervention. Making sure that mothers get the right care at the right time is something friends, family, and the health care community can all help ensure. The gift of health is the best way to celebrate all the moms in our lives.
Mark Zakowski is an obstetric anesthesiologist.
