CDC finds significant increase in maternal deaths

With federal data showing an increase in deaths among pregnant women during the pandemic, California advocates say they are strengthening their resolve to continue trying to prevent as many of those deaths as possible.

The National Center for Health Statistics reported Thursday that 1,205 pregnant women died in the United States in 2021, a 40% increase from 2020, when 861 deaths occurred. The total was 754 in 2019.

According to the report, pregnant black women continue to have the highest risk of dying. In 2021, the maternal mortality rate for black women was 69.9 deaths per 100,000 live births, 2.6 times the rate for white women at 26.6 deaths. Among Hispanic women, the report found there were 28 deaths per 100,000 live births.

The report did not specify causes of death or provide state-by-state data, but a Federal Government Accountability Office report released in October found that a quarter of maternal deaths in 2020 and 2021 were related to COVID-19.

“We were dreading to see the actual numbers,” said Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative, which brings together state agencies, hospitals and associations of health care providers to seek ways prevent pregnancy complications and death. .

“It kind of surpasses all the other work we’ve done to work on hypertension deaths, hemorrhage deaths, and blood clot deaths,” Main said. “All of these are now overtaken or downplayed by the pandemic.”

In recent years, California has become a national leader in reducing maternal mortality. The rate of maternal deaths in California in 2006 was 16.9 per 100,000 live births, according to the California Maternal Quality Care Collaborative. By 2016, the rate had dropped by 65%.

There were 18.6 maternal deaths per 100,000 live births in California in 2020, down 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 embolism. More than a quarter of the deaths occurred on the day of delivery.

The public isn’t aware enough of the seriousness of maternal mortality, said Sonya Young Adam, executive director of the California Black Women’s Health Project, an Inglewood-based nonprofit.

She said ‘it’s mind-boggling and heavy’ to constantly hear stories of black people reminiscing about bad childbirth experiences that happened to them or family members involving complications, or doctors who didn’t listen to them. . She said too often that these stories often include the person who felt something was wrong before, during or after giving birth.

But even amid the lack of awareness, Aadam said she and other advocates try to educate black communities about maternal deaths and pregnancy complications without causing fear to the point where people give up on the matter entirely. pregnancy.

“It’s about letting our community know that they have a voice and helping to build advocacy capacity around that so people don’t walk away from a situation thinking, ‘What is what I have done? ‘” Adam said. “[It’s so] they enter armed and ready to demand a happy birth, which they should be able to avail of in any state health system. At this time, we know that is not possible.

The new report comes as families, health advocates and healthcare providers express dismay at the number of deaths and at pregnant women who did not receive the physical, emotional and social support they needed. during the pandemic. Pregnant women often had to be isolated in hospitals to prevent potential COVID-19 infections, limiting potential support in hospital rooms.

Parent and community support groups have switched from in-person calls to Zoom calls out of concern for social distancing. Some pregnant women could not maintain social distancing because they were essential workers and were exposed to COVID-19. Additionally, public health officials at the federal, state, and county levels have struggled to send messages throughout the pandemic to encourage more pregnant women to get the COVID-19 vaccine.

Main said the women giving birth today “are much more complicated patients than they were 20, 30 or 50 years ago” because many are 35 or older and have high blood pressure, diabetes or other problems that can complicate pregnancies.

The federal report found 20.4 deaths per 100,000 live births among women under 25, 31.3 among those 25 to 39, and 138.5 among those 40 and older.

When it comes to tackling the severe mortality gaps between black and white mothers, Main said it partly comes down to differences in rates of high blood pressure, diabetes and obesity. He also cited the “altering effects” on black health of continued exposure to racism for years. But implementing protocols that all providers must follow for every patient can help reduce complications.

“That’s when you start to get into[to] subjective decision-making in which … biases come into play,” Main said. “The more we can reduce some of the subjective decision-making, the better we can do to reduce disparities.”

Part of the work of the California Maternal Quality Care Collaborative has been to help develop hemorrhage carts that are now found in every hospital in the state, so healthcare providers can provide care quickly if mothers lose weight. blood quickly. The collaboration has also worked with healthcare providers to develop protocols to help mothers with high blood pressure after childbirth, known as preeclampsia.

In recent years, California has also extended Medi-Cal benefits for new parents up to 12 months after birth and now allows doulas to become eligible providers under Medi-Cal.

Doulas are considered a key part of emotional and physical support and advocacy for mothers before, during and after childbirth, especially for black women. The state has also established a fund for midwifery education programs that prioritize admission for underrepresented groups.

The California Black Women’s Health Project launched training for black birth attendants and created a business toolkit to help them get started and create circles of support for birth attendants across the state. The organization is also developing training to help birth attendants apply to become Medi-Cal providers.

The organization has also been a fiscal sponsor to help birth attendants receive funding from the Los Angeles County Department of Public Health. As progress is being made, Aadam said, there is a need to make more “shameless investments” in black-focused community efforts.

“There are many, many, many, many of us who may even perish from this Earth before this issue is truly resolved,” Adam Adam said. “It’s going to take time, but no matter how we save someone along the way, that’s what we try to do to reduce these stories – arm our sisters with someone who’s by their side and a team. of support around them.”