Maternal death is imagined as something that happens in a delivery room. The
surveillance data says otherwise.
| When the death occurred | Share |
|---|---|
| During pregnancy | 31.3% |
| Day of delivery | 16.9% |
| 1–6 days postpartum | 18.6% |
| 7–42 days postpartum | 21.4% |
| 43–365 days postpartum | 11.7% |
One in three deaths happens more than a week after the birth — after
discharge, after the visitors have gone, and largely after the medical system
has stopped looking. **Nearly one in eight happens more than six weeks
afterwards**, beyond the traditional end of postpartum care entirely.
**Leading causes were cardiovascular conditions, infection and haemorrhage —
and which one leads varies by timing.** Haemorrhage kills at delivery;
cardiovascular conditions kill later. A system organised around the day of
birth is aimed at the smallest slice.
Who dies
**The national pregnancy-related mortality ratio for 2011–2015 was 17.2 deaths
per 100,000 live births.**
| Ratio | Compared with white women | |
|---|---|---|
| Non-Hispanic Black women | 42.8 | 3.3× |
| American Indian / Alaska Native women | 32.5 | 2.5× |
| Non-Hispanic white women | 13.0 | — |
And the finding that makes it unbearable
Approximately three in five pregnancy-related deaths were preventable.
**And preventability did not differ significantly by race and ethnicity or by
timing of death.** The disparity above is therefore not explained by some
deaths being unavoidable and falling unevenly. The same share of each group's
deaths could have been prevented; one group simply has three times as many.
Where the failures are
Multiple factors contributed to pregnancy-related deaths, and the review
committees sort them into five levels:
Community · health facility · patient · provider · system
The prevention strategies sit at the same five levels, and they come to one
thing: **improving access to, and the coordination and delivery of, quality
care.** Not a new treatment — the coordination of existing ones, across a year
rather than a day.
What the numbers are
CDC's Pregnancy Mortality Surveillance System for 2011–2015, plus
**detailed reviews of deaths during 2013–2017 by 13 state maternal mortality
review committees** for preventability and contributing factors. **Timing was
known for 87.7% (2,990) of the deaths.**
The conclusion is worth reading as an instruction about where to look:
**Pregnancy-related deaths occurred during pregnancy, around the time of
delivery, and up to 1 year postpartum; leading causes varied by timing of
death.**
Source: Centers for Disease Control and Prevention, MMWR Vital Signs.
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