Maternal fatalities surged in pandemic
Deaths of pregnant women in the U.S. rose 40%. California aims to turn the tide.
With federal data showing a surge in deaths among pregnant women during the COVID-19 pandemic, California advocates have strengthened their resolve to prevent fatalities.
The National Center for Health Statistics reported Thursday that 1,205 pregnant women died in the United States in 2021, a 40% increase over 2020, when there were 861 deaths. The total for 2019 was 754.
Black women continued to have the highest risk of dying during pregnancy, according to the report. In 2021, the maternal mortality rate for Black women was 69.9 per 100,000 live births, compared with 26.6 for white women and 28 for Latino women.
The report did not specify the causes of death, but a study released in October by the federal Government Accountability Office found that a quarter of maternal deaths in 2020-21 were related to COVID-19.
“We’ve been dreading to see the actual numbers,” said Dr. Elliott Main, medical director for the California Maternal Quality Care Collaborative, which brings together state agencies, hospitals and health provider associations to look for ways to prevent pregnancy complications.
“It sort of overwhelms all the other work that we’ve been doing to work on deaths from hypertension, deaths from hemorrhage and deaths from blood clots,” Main said. “All those are now overwhelmed or are minimized by the pandemic.”
The federal report did not provide state-by-state data. But in recent years, California has become a national leader in reducing maternal mortality.
The state’s rate of maternal deaths in 2006 was 16.9 per 100,000 live births, according to the collaborative. By 2016, the rate had declined by 65%. There were 18.6 maternal deaths per 100,000 live births in 2020 in California, up from 12.8 in 2019, according to the state Department of Public
Health.
Among pregnant women in California, cardiovascular disease was the leading cause of death between 2018 and 2020, followed by hemorrhage, sepsis, thrombotic pulmonary embolism and amniotic fluid embolism. More than a quarter of the deaths occurred on the day of delivery.
The general public lacks awareness of maternal mortality, said Sonya Young Aadam, chief executive of the nonprofit California Black Women’s Health Project, based in Inglewood. She said “it’s mind-blowing and heavy” to hear Black people recall bad birthing experiences involving complications or doctors who did not listen to them.
But even amid the lack of awareness, Aadam and other advocates try to walk a fine line of informing Black communities about maternal deaths and pregnancy complications without causing fear.
“It’s informing our community that they do have a voice and helping to build the advocacy capacity around this so that people don’t walk away from a situation wondering, ‘What did I do?’ ” Aadam said. “[It’s so] they go in armed and ready to demand a joyous birth that they should be able to avail themselves of in any healthcare system in the state. Right now, we know that that’s not what’s possible.”
Main said women today “are much more complicated patients than we were delivering 20, 30, 50 years ago” because many are 35 or older and come in with high blood pressure, diabetes or other challenges that can complicate pregnancies.
The federal report found 20.4 deaths per 100,000 live births for women younger than 25; 31.3 for those 25 to 39; and 138.5 for those 40 and older.
When it comes to tackling the severe mortality gaps between Black and white mothers, Main said, it comes down to differences in rates of high blood pressure, diabetes and obesity. He also cited the “weathering effects” on Black people’s health of years-long exposure to racism.
But the implementation of protocols that all providers must follow, with every patient, can reduce complications.
“It’s when you start entering in[to] subjective decision-making that ... the biases enter in,” Main said. “The more we can reduce some of the subjective decision-making, the better we can do to reduce disparities.”
The California Maternal Quality Care Collaborative’s work has included helping to develop hemorrhage carts that are now in every hospital statewide, so that health providers can quickly react if mothers lose blood rapidly. The collaborative has also worked with health providers to develop protocols to help mothers who experience preeclampsia, or high blood pressure.
Meanwhile, Medi-Cal in recent years has extended benefits for new parents to 12 months after birth and has allowed doulas to become eligible providers. Doulas are considered a key factor in providing emotional and physical support and advocacy for mothers — particularly Black women — before, during and after childbirth. The state has also established a fund for midwife training programs that prioritize admitting underrepresented groups.
The California Black Women’s Health Project has launched training for birth workers and created a business tool kit to help them get started and support circles statewide.
The organization has also been a fiscal sponsor to help birth workers receive funding from the Los Angeles County Department of Public Health.
While progress is being made, Aadam said, there is a need for more “unapologetic investments” in community efforts focused on Black people.
“There are many, many, many, many of us who are going to possibly even perish from this Earth before this issue is truly addressed,” Aadam said. “It’s going to take time, but however we save somebody along the way, that is what we’re trying to do to reduce those stories — arm our sisters with someone who’s by their side and a team of support around them.”