3 measures healthcare facilities should take to reduce maternal mortality rates post-Roe

In the wake of the U.S. Supreme Court’s Dobbs v. Jackson ruling overturning Roe vs. Wade, obstetric care teams are rightly focusing on how already-critical efforts to protect maternal health and reduce maternal mortality will be affected.

Tragically, maternal mortality in the U.S. has been increasing. In 2020, the maternal mortality rate was 23.8 deaths per 100,000 live births, up from 17.4 per 100,000 in 2018. The rate was 55.3 deaths per 100,000 live births among non-Hispanic Black women, which was 2.9 times the rate among non-Hispanic white women.

Black women face significant barriers in contraceptive access, and there are growing concerns that maternal mortality among Black women could increase even further, given that maternal mortality is associated with complications during delivery and unsafe abortions. A University of Colorado Boulder study found that a nationwide ban on abortion would increase maternal mortality by 24%.

Obstetric care clinicians are focused on finding new ways to mitigate maternal mortality and improve maternal health outcomes, but it won’t be easy.

Cardiovascular conditions, obstetric hemorrhage (excessive bleeding), eclampsia (seizures), obstructed labor, and overuse of cesarean delivery are among the leading causes of complications during delivery.

Reducing maternal mortality rates requires understanding why the rate of maternal mortality is so high in the U.S. relative to other countries – even those that spend far less on health care.

First, complex socioeconomic factors are at play. Globally, low-income regions have the highest prevalence of maternal mortality, and that’s true in the U.S. as well. Low-income women face difficulties traveling to medical facilities to receive care. Additionally, Black women experience higher rates of chronic conditions, such as hypertension and obesity, which are also risk factors for poor maternal health outcomes.

Second, care varies significantly across hospitals. Some healthcare facilities lack sufficient funding, skilled obstetric clinicians, or more advanced technology and equipment, all of which can result in some facilities being less equipped to respond to maternal emergencies.

Third, the U.S. still has a high rate of cesarean sections relative to other countries. Some American women believe C-sections are less risky. For working women or those lacking sufficient maternal health benefits, opting for a C-section gives them control over the timing of their delivery.

Obstetric care professionals can reduce maternal mortality and save mothers’ lives by using a combination of evidence-based tools, training, and precautions that address some of the above factors.

Steps obstetric care professionals should adopt immediately

• Improve preparation for maternal emergencies. When complications occur during delivery, every minute counts. Obstetric care professionals must respond effectively and make good decisions to save the lives of the mother and baby. Obstetric care teams should provide uniform education and training to care teams, not only on the risk factors connected with chronic conditions like hypertension and obesity, but also how to identify the warning signs of complications early. For example, when eclampsia and other hypertension-related conditions occur, the obstetric care team should be able to administer intravenous hypertension medication and magnesium sulfate promptly to prevent seizures. Comprehensive pre- and postnatal follow-ups are also critical to identify potential risk factors.
• Detect complications early. The care team should frequently monitor the mother’s blood pressure throughout the pregnancy, especially during delivery, as well as watch for obstetric hemorrhage as soon as labor begins. The obstetric team and hospital clinicians should be trained on how to identify pre-existing risk factors for obstetric hemorrhage and eclampsia. Low blood pressure, dizziness, and nausea are all signs that a hemorrhage has occurred. By detecting these issues early, care teams can minimize the loss of blood from a hemorrhage or prevent seizures. These measures can dramatically reduce the rate of maternal mortality.
• Educate obstetric care team and expecting mothers on C-sections. A C-section that is not medically necessary can lead to substantial complications, such as infection, blood loss or blood clots, injuries to internal organs, and even risks to the baby. Obstetric team members should be continuously educated on when C-sections are medically necessary for the health of the mother and baby. C-section rates vary significantly among hospitals and medical facilities. Comprehensive education and training of care teams on evidence-based best practices can reduce that variation so that C-section rates are more consistent across facilities. But even more importantly, expecting mothers should be educated on the medical advantages and data-driven research supporting a vaginal birth when a C-section is not medically required. Uniform strategies to reduce overprescribed C-sections can significantly reduce the risk of maternal health complications.

Though maternal mortality can affect anyone, concerning statistics show that mortality rates can vary greatly by state. For example, California has the lowest maternal mortality rate, at 4.0 deaths per 100,000 live births according to 2018 data. Louisiana has the highest rate, at 58.1 deaths per 100,000 live births — more than 10 times that of California. The rates are even higher among Black women.

Many of these deaths are preventable, especially when hospitals and obstetric care teams have the right technology, equipment, and tools, and above all, training and continuous education on the risk factors associated with complications during delivery. We may never reduce the maternal mortality rate to zero, especially with the deeper societal and socioeconomic factors involved that transcend effective maternal healthcare.

But especially today, when more mothers’ health may be at risk, we can reduce potential harm and save thousands of lives through more evidence-based education, continuous training, and awareness that will help our obstetric care teams make informed and accurate medical decisions with effective interventions that mitigate complications early and often.

Photo: Ridofranz, Getty Images