As I approached the arrival of my son, I became acutely aware of the alarming maternal mortality rate in the United States, which ranks the highest among developed nations. This unsettling fact loomed heavy over me as I prepared to welcome my third child.
A recent exposé by USA Today highlighted the alarming increase in maternal deaths in the U.S. and examined the existing protocols intended to safeguard new mothers. Despite hospitals having the knowledge and tools necessary to protect these women, many fail to implement them effectively.
Between 1990 and 2015, data indicated that while most countries experienced a decline in maternal mortality rates, the U.S. saw an increase. This troubling trend is not confined to rural areas or community birth centers; it permeates hospitals of all sizes, from bustling metropolitan facilities to smaller rural ones.
The primary culprits behind maternal deaths include severe hemorrhaging and untreated preeclampsia, or hypertension. Many hospitals lack standardized methods for accurately measuring blood loss after delivery, leading to delays in treatment and, consequently, higher mortality rates. Furthermore, preeclampsia can manifest during or shortly after childbirth, often going unnoticed until it becomes critical.
A healthcare expert noted, “Most of these deaths were entirely preventable. They stemmed from issues we could have addressed if we had recognized the emergencies sooner.”
One significant problem in U.S. hospitals is the inconsistent nature of care. For instance, one hospital may monitor blood pressure every four hours while another does so every six hours, or only once per shift. The visual assessment of blood loss is also often unreliable.
In contrast, the United Kingdom has made significant strides in standardizing maternal care, successfully reducing preeclampsia-related deaths to just one in a million. A report from NPR highlighted that from 2012 to 2014, only two deaths from preeclampsia occurred in the UK, compared to the U.S., which sees 50-70 fatalities each year from the same condition.
Countries with publicly funded healthcare systems can enforce standardization more effectively. Unfortunately, many of the life-saving practices utilized worldwide have yet to gain traction in U.S. maternity care, with California being a notable exception. In 2010, California began utilizing “tool kits” with childbirth safety practices aimed at reducing maternal death and injury, which appeared to yield positive results.
Alarmingly, data from various hospitals in North Carolina, including the Women’s Hospital in Greensboro, where I delivered my sons, showed that their statistics mirrored national averages. Women’s Hospital, one of the largest birthing facilities in North Carolina, delivered approximately 6,000 babies annually. However, between October 2015 and June 2016, they failed to provide timely treatment to 189 out of 219 mothers experiencing high blood pressure.
Cone Health, which operates Women’s Hospital, attributed these shortcomings to an initial lack of staff training to respond swiftly to maternal hypertension. Encouragingly, after implementing a federal quality program (not mandatory but recommended in 2011), the hospital improved its performance, with 84% of women with high blood pressure receiving appropriate care between June 2016 and April 2017. This led to a notable decrease in maternal strokes and seizures.
The Alliance for Innovation on Maternal Health, formed by a coalition of prominent medical organizations, aims to systematize safety protocols known to positively impact maternal health. They developed “safety bundles” detailing policies, equipment, treatment guidelines, training programs, and internal reviews that hospitals should adopt.
Hospitals that have implemented these safety measures have seen improved mortality rates. It seems intuitive that all hospitals across the country should adopt these life-saving practices. However, without central oversight of healthcare, pushing for these changes will require collaboration among various stakeholders, including hospital administrators, insurance companies, and malpractice attorneys.
How many more mothers must face the risk of death in one of the wealthiest nations on Earth? How many lives must be lost before we see meaningful reform? For me, even one preventable death is one too many.
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Summary:
The maternal mortality rate in the U.S. is the highest among developed nations, with alarming statistics showing that many deaths are preventable. Inconsistent care practices across hospitals contribute to this crisis. Countries like the UK have successfully implemented standardized care protocols, drastically reducing maternal deaths. Efforts in California have shown promise, but widespread change is needed to protect mothers across the country.
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