Is Maternal Mortality Really Rising in the United States? If so, How Can We Prevent It?

For this reason, she says patients must be counseled before or after conception and informed about methods of bringing about a birth without a C-section even when the patient has had a prior one. Marshall also suggests that the nation should follow the recommendations of ACOG and the CDC and mandate a standard method of reporting on maternal mortality so that present trends can be more effectively evaluated. 

One issue that leaps out with regard to current data is that of race. Black women are between three and four times as likely to suffer maternal mortality in the U.S. as White women. One study of maternal mortality in New York found that 82 percent of women who had died in the city from pulmonary embolisms after giving birth were Black but none were Caucasian.

Risks of maternal mortality rise dramatically for women over forty, too.

In third world countries, of course, maternal mortality remains a leading cause of death – as it was in the industrialized world throughout the nineteenth century and into the beginning of the twentieth. The World Health Organization reports that worldwide there were 287,000 case of maternal mortality in 2010 – 800 per day. 

Denman says that in poor countries the problem is not only a matter of the absence of trained doctors but of trained lay people. Knowing how to massage the fundus so that there is a more active delivery of the placenta can play a critical role in prevention of the sort of undue bleeding that can prove fatal. In the same way, she notes, it’s important to get the drug pitocin, a single use of which reduces bleeding, to care facilities. In 2010, the CIA’s Fact Book reported that Chad, Somalia, the Central African Republic, Sierra Leone and Burundi all still had more than 800 maternal fatalities per 100,000 live births. 

Here in the U.S. there is wide divergence of opinion about the role that access to care, poverty and level of education play in mortality rates. One recent New York Academy of Medicine analysis of state assessments questioned whether any of these are co-factors.

Plainly, more and better data are needed, and greater care must be taken in treating high risk patients, especially those who have had repeated C-sections.