Research: Deadliest time for mothers is after birth
Sherri Willis-Prater’s baby boy was 2 months old, and she was about to return to her job at a school cafeteria in Chicago. But as she walked up the short flight of stairs to her kitchen one evening, she nearly collapsed, gasping for breath.
At the hospital, Willis-Prater, who was 42 at the time, was connected to a ventilator that pumped air into her lungs. Her heart, doctors said, was operating at less than 20% of its capacity. She had developed a rare form of heart failure that emerges after pregnancy.
The diagnosis was the last thing she expected to hear. After giving birth, Willis-Prater thought that she “made it across the finish line,” she recalled in an interview. “I don’t have to worry about anything anymore.”
Most people think of labor and birth as the most dangerous part of pregnancy. But new scientific research is challenging this assumption, finding that substantial risks persist for a full year after birth itself. The deadliest time for mothers is actually after the baby is born.
And for each woman who dies, an estimated 50 to 100 women experience severe complications that may leave them with lifelong health problems. The numbers are growing as more American women become heavier and high blood pressure and diabetes become more common.
More women are also postponing childbearing until later in life, so they are more likely to start pregnancy with chronic medical conditions that can lead to complications.
The new figures come amid a troubling rise in deaths of pregnant women and new mothers in the United States, which has the highest maternal mortality rate in the industrialized world. The figures soared during the pandemic, to 32.9 deaths for every 100,000 live births in 2021, up from 20.1 per 100,000 in 2019. Rates for Black and Native American women are two to three times higher than those for white women.
But those figures reflect a traditional definition of maternal mortality, deaths that occur during gestation or up to six weeks after birth.
A fuller extent of the problem came to light in September, when the Centers for Disease Control and Prevention took a more expansive look at mothers’ deaths, analyzing them for a full year after childbirth and including deaths resulting from mental health conditions.
Based on data provided by 36 states on 1,018 pregnancy-related deaths from 2017 to 2019, the CDC concluded about onethird of them occurred during pregnancy or on the day of delivery and roughly another one-third before the baby turned 6 weeks old. A full 30% occurred from that point until the baby’s first birthday, a period that had not been a focus of maternal mortality research.
The data has led to calls for closer follow-up care and more support for new mothers during what has been called the “fourth trimester,” with special attention given to vulnerable women.
“Our approach to birth has been that the baby is the candy and the mom’s the wrapper, and once the baby is out of the wrapper, we cast it aside,” said Dr. Alison Stuebe, a professor of obstetrics and gynecology at the University of North Carolina School of Medicine. “We need to recognize that the wrapper is a person — moms are getting really sick and dying.”