According to the Centers for Disease Control and Prevention (CDC), 700 women die annually from complications related to pregnancy or childbirth. The World Health Organization (WHO) estimates that 45 percent of maternal deaths occur approximately six weeks postpartum, and nearly 60 percent of all maternal deaths are preventable. These deaths have doubled in the past 20 years, which prompted the passage of the Preventing Maternal Deaths Act (H.R. 1318) in December 2018.
Prior to the Preventing Maternal Deaths Act, we lacked data necessary to help providers mitigate the risk of maternal deaths. This critical law aims to increase transparency regarding maternal death rates in states and will provide federal grants to investigate the deaths of women who died within a year of being pregnant.
Medically unnecessary C-sections
One of the factors responsible for the rising rate of maternal deaths is complications resulting from unnecessary cesarean sections (C-sections). Since the 1970s, there has been a 500 percent increase in the utilization of C-sections, making it the most commonly performed surgical procedure in the U.S.
C-sections are an important and effective life-saving measure for mothers and infants, but only when there is an explicit medical need. When performed without established need, they can increase patients’ risk for life-threatening adverse events. Dr. Neel Shah, Assistant Professor at Harvard Medical School, states that unnecessary C-sections may be responsible for up to 20,000 major surgical complications a year, some of which include:
- increased risk of infections;
- increased risk of sepsis resulting from infections;
- excessive postpartum bleeding;
- blood clots;
- complications with future births;
- and maternal death.
A 2017 Consumer Reports investigation discovered that C-section rates for low-risk deliveries vary dramatically from hospital to hospital, ranging from 7 percent to 70 percent across America. Factors from hospital location, convenience, or reimbursement rates are all responsible for the rise in medically unnecessary C-sections. Dr. Shah believes these factors have created a culture that places less value on maternal and child health, and instead prioritizes the hospital and providers where the delivery occurs.
Medically unnecessary C-sections have become a matter of contention among health professionals across the country, as well as a critical blind spot for patients. While patients can take measures to avoid unnecessary C-sections, many simply do not have the option to make changes in their birth plan.
Black maternal death is more than just a statistic
The most sobering reality of the maternal death crisis is that black women are 243 percent more likely to die from pregnancy or childbirth-related causes than women from any other racial or socioeconomic category.
In California, black women undergo C-sections at five percentage points higher than any other racial or ethnic group. In addition to higher C-section rates, black women often fall victim to bias when receiving medical care, where their symptoms are often treated less seriously and with less urgency.
In the case of Kira Johnson, racial bias and negligent postpartum care are believed to have played a critical role in her tragic death. After a routine C-section at Cedars-Sinai Hospital, Johnson experienced severe internal bleeding for over 10 hours before receiving medical attention. Since Johnson’s passing, her husband Charles has advocated on Capitol Hill urging Congress to address the maternal healthcare crisis.
From 2014 to 2016, the District of Columbia had the highest maternal mortality rate in the country–and 75 percent were black women. These staggering figures prompted healthcare providers in the city to create the Maternal Mortality Review Committee (MMRC). Before the MMRC, there was no data available explaining how these women died or the symptoms they presented that could have alerted physicians to their compromised state. The MMRC will work with multiple stakeholders in the city to establish transparency for maternal mortality trends and create interdisciplinary solutions to foster change and accountability.
The call for increased data collection and dissemination
In the United States, maternal death statistics are currently collected by states independently, but in most countries, the federal government assumes that role. The Preventing Maternal Deaths Act will provide the U.S. with data on practices that contribute to maternal deaths throughout the country.
The National Consumers League applauds Congress’ continued efforts to help mitigate the troubling increase in maternal mortality across the country.