In order to determine how many fatalities may have been avoided and how, maternal mortality review committees search for hints as to what caused the deaths, such as unfilled medications, missing postnatal appointments, and warning indications that doctors failed to notice.
The committees are active in nearly 40 states across the United States, and according to the most recent and comprehensive compilation of data, which the Centers for Disease Control and Prevention released in September, an astounding 84% of pregnancy-related deaths were considered preventable.
As per NPR, for nurse investigators like Sheffield-Abdullah, the fact that 53% of the deaths took place between seven days and a year after delivery, well after the women had left the hospital, is even more startling.
She explains, “We are extremely baby-focused.” What we really need to be thinking about is that fourth trimester, that period of time after the baby is born. “Once the baby is here, it’s almost like the mother is discarded. Like a Reese’s Peanut Butter Cup. The mom is the wrapper, and the baby is the candy. Once you remove the wrapper, you just discard the wrapper.
Between 2017 and 2019, mental health difficulties were the main factor in the majority of maternal deaths. White and Hispanic women were more likely to die by suicide or drug overdose, whilst Black women were more likely to die from cardiac issues. According to the CDC analysis, these illnesses manifest disproportionately later in the postpartum period.
The results point out a number of flaws in the care system for new moms, including obstetricians who are not trained (or paid) to look for signs of mental illness or addiction, as well as laws that deprive women of health insurance soon after giving birth.
According to Sheffield-Abdullah, the main issue is that the standard six-week postnatal examination is far too late. According to the North Carolina statistics, new mothers who later passed away frequently skipped this session, usually because they had to return to work or take care of other children, she says.
In order to properly send patients to follow-up treatment “within one to two weeks after delivery,” Sheffield-Abdullah adds, “we really need to keep linked while they’re in the hospital.”
David Goodman, who oversees the maternal mortality prevention team at the CDC’s Division of Reproductive Health, which produced the report, recommends increased screening for postpartum depression and anxiety, beginning at the first prenatal visit and continuing throughout the year after birth. He also suggests better coordination of care between medical and social services.
When a parent’s substance abuse issue becomes so severe that child protective services removes the kid, it is frequently a crisis moment in the months following childbirth, which leads to a mother’s accidental or deliberate overdose. According to Goodman, preventing such deaths may depend on having access to care and ensuring regular child visits.
According to him, the expansion of Medicaid’s free health care has been the most significant policy reform highlighted by the data. Until recently, women were compelled to stop taking drugs or seeing therapists or doctors because they couldn’t pay the cost out of pocket because pregnancy-related Medicaid coverage often expired two months after delivery.
As a result of the early work of maternal mortality review committees, 36 states currently either have Medicaid coverage extended or plan to do so. For many years, the data indicated that around a third of pregnancy-related deaths took place one year after delivery, but according to this analysis, that number increased to more than half, underscoring the significance of having longer-term care.
Adrienne Griffen, executive director of the Maternal Mental Health Leadership Alliance, a nonprofit organization that focuses on national policy, said, “If this is not a call to action, I don’t know what is.” We’ve known for a while that the most frequent complication of pregnancy and childbirth is mental health concerns, but we’ve lacked the will to take action.