Maternal mortality crisis in the U.S.
The U.S. faces a significant maternal health crisis, with alarmingly high maternal mortality rates compared to other developed nations. As of 2022, the overall maternal mortality rate was 22.3 deaths per 100,000 live births, with a disproportionately high rate of 49.5 deaths per 100,000 live births among Black women. These figures starkly contrast with much lower rates in countries like Germany, Australia, Japan, and Sweden.
Maternal Health Awareness Day is observed annually on January 23. This day was first recognized in New Jersey in 2018 and has since gained national attention. The purpose of this day is to: raise awareness about maternal health outcomes and disparities, educate health care providers and the public about maternal mortality, and encourage discussions about potential signs of emergencies during pregnancy and postpartum.
Anesthesiologists play a crucial role in ensuring patient safety during the perioperative period, particularly in labor and delivery (L&D) settings. Their responsibilities extend beyond routine anesthesia administration, encompassing a wide range of critical interventions and preventive measures.
Key roles of anesthesiologists in maternal care
- Emergency response: Anesthesiologists are readily available for emergencies, including maternal and neonatal airway issues, cardiopulmonary resuscitation (CPR), urgent surgical interventions, and management of postpartum hemorrhage (PPH).
- Pre-admission care: For high-risk pregnancies, anesthesiologists often engage with patients in pre-admission testing (PAT) clinics, providing early assessment and planning for complex medical conditions such as cardiovascular disease, pulmonary disease, substance use disorder, and more.
- Routine obstetric care: Anesthesiologists are experts in maternal pathophysiology in addition to anesthesia and analgesia. They evaluate patients for epidural analgesia during labor and administer anesthesia for cesarean sections.
- Peripartum maternal mortality prevention: Anesthesiologists are integral to reducing maternal mortality rates through their expertise in critical care and perioperative management.
How anesthesiologists can impact the maternal health crisis
Anesthesiologists can contribute to addressing this crisis through various initiatives:
- Continuing education and training
- Implement simulation training for obstetric and neonatal emergencies.
- Advocate for enhanced obstetric anesthesia education in medical schools.
- Encourage anesthesiology residents to pursue obstetric anesthesia fellowships.
- Quality improvement
- Provide peripartum anesthesiology consultations for high-risk patients.
- Implement safety bundles and early warning systems in birthing centers.
- Encourage reporting of neuraxial failure rates and peripartum complications.
- Leadership and advocacy
- Participate in local quality management teams and peripartum condition management.
- Join organizations like the Society for Obstetric Anesthesia and Perinatology (SOAP).
- Serve on state maternal mortality review committees (MMRCs).
- Engage in obstetric quality committees at various levels.
- Patient advocacy and innovation
- Develop initiatives to raise awareness about women’s health issues, from institutional campaigns (e.g., Maternal Health Awareness Day) to social media and educational platforms such as SafePartum (@safepartum).
Anesthesiologists are uniquely positioned to significantly impact maternal health outcomes. By leveraging their expertise in perioperative and critical care, engaging in continuous education, and advocating for systemic changes, they can play a pivotal role in addressing the maternal health crisis in the U.S. The upcoming Maternal Health Awareness Day Event at Rutgers Robert Wood Johnson University Hospital on January 24, 2025, exemplifies the type of multidisciplinary initiatives that can foster awareness and drive change in maternal health care.
Christina McGinnis and Alexandria Raab are medical students. Gloria Bachmann is an obstetrics-gynecology physician. Alopi Patel is an anesthesiologist.
