Maternal Mortality in North Carolina

North Carolina

The World Health Organization (WHO) defines maternal mortality as “female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.” The United States consistently has the highest rate of maternal mortality among high-income countries.

In addition to maternal mortality, the Centers for Disease Control and Prevention (CDC) monitors pregnancy-related mortality at the national level. Their surveillance tracks an expanded measure of maternal mortality through a period of within one year of the end of pregnancy and conducts thorough reviews of each death. The leading causes of pregnancy-related deaths in the U.S. are cardiovascular diseases, infection or sepsis (including COVID-19), hemorrhage (excessive bleeding) and hypertensive disorders (high blood pressure). According to the CDC, cardiovascular conditions account for more than one-third of pregnancy-related deaths. Complications with cesarean deliveries also play a role in maternal mortality. Additionally, a significant amount of pregnancy-related deaths are attributable to mental health conditions

The maternal mortality rate is higher among: 

• Black women compared with white, Hispanic and Asian women.
• Women age 40 and older, who have a maternal mortality rate six times that of mothers under 25.
• Women living in rural areas compared with those who live in urban areas. Hospital closures in rural areas have decreased access to services such as obstetrics, further contributing to difficulties in maternal care.

According to the WHO, the majority of maternal deaths resulting from pregnancy-related complications are preventable. Approaches to reducing and preventing maternal mortality include:

• Focusing on preconception health: A healthy pregnancy begins before conception. Improving women’s health by preventing and treating chronic disease may result in healthier pregnancies with fewer complications.
• Collaborating with midwives and doulas: A study found that incorporating midwives as part of the care team during pregnancy, labor, delivery and postpartum recovery is associated with better maternal health outcomes. Areas without nearby hospital services, in particular, may benefit from midwifery care. 
• Improving medical care: Improvements to hospital protocol and patient safety tools have effectively reduced maternal mortality. In one study, a collaborative hospital quality improvement program reduced severe maternal morbidity from hemorrhage. Systems to detect early warning signs during prenatal visits may prevent delays in diagnosing and treating conditions that lead to maternal death. The Alliance for Innovation in Maternal Health program offers quality improvement toolkits, maternal early warning system training and other resources to support and guide quality improvement efforts in health care facilities. 
• Implementing Maternal Mortality Review Committees (MMRCs): These committees, composed of various medical professionals, are tasked with identifying and investigating maternal deaths. They attempt to determine the preventability of maternal deaths and recommend focused approaches to prevent future deaths and reduce disparities in maternal mortality. Nearly all U.S. states have standardized MMRCs, and many have established legislation requiring reviews of maternal deaths.

Reducing the maternal mortality rate is a leading health indicator for Healthy People 2030.

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