Most US Maternal Deaths Preventable, Expert Argues
A leading childbirth safety expert, Dr. Elliott Main, emphasizes that the majority of maternal deaths in the U.S. are preventable with timely recognition and intervention. He calls for systemic reforms, enhanced teamwork, and better communication to combat persistent barriers like fragmented care and health disparities. Suicide and opioid overdose remain leading causes of pregnancy-associated deaths nationally.
- Dr. Elliott Main is the medical director for the California Maternal Quality Care Collaborative (CMQCC), which has developed standardized toolkits to address obstetric hemorrhage, preeclampsia, and other leading causes of maternal death. The implementation of these protocols in California hospitals led to a 55% reduction in the state's maternal death rate between 2006 and 2013. - While cardiovascular conditions and hemorrhage are significant causes of pregnancy-related deaths, mental health conditions, including substance use, were the leading cause of death, accounting for 23% of such deaths from 2017 to 2019. Deaths from drug or alcohol use more than doubled for women of reproductive age between 1999 and 2023. - Significant racial and ethnic disparities persist in maternal mortality. In 2023, the maternal mortality rate for Black women was 50.3 deaths per 100,000 live births, which is nearly 3.5 times the rate for white women (14.5). - The majority of maternal deaths, 63%, occur in the year after birth, highlighting the importance of postpartum care. States that have expanded Medicaid, which often extends postpartum coverage, have seen a smaller increase in maternal mortality rates compared to non-expansion states. - Maternal mortality rates are over 50% higher in rural areas compared to large urban areas. This is partly due to a lack of obstetric services in over half of rural counties. - The integration of doulas and midwives into maternal care has been shown to improve outcomes. Doula support is associated with lower rates of cesarean sections and preterm births, and midwife-led care is linked to an increased likelihood of vaginal delivery and decreased infant mortality. - Women over the age of 40 have a significantly higher risk of maternal mortality. In 2023, the maternal mortality rate for women aged 40 and over was 59.8 deaths per 100,000 live births, nearly five times higher than the rate for women under 25. - The Centers for Disease Control and Prevention (CDC) estimates that over 80% of pregnancy-related deaths in the U.S. are preventable. Dr. Main suggests that a key reason for this is that the normalcy of most pregnancies can lead to overlooking early signs of complications.
