On Monday, July 31, Definitive Healthcare’s news database reported a statewide probe into the recent rise in maternal mortality rates following the deaths of two women at MetroWest Medical Center in Framingham, Mass.
Three weeks prior to this announcement, MetroWest released two statements. The first statement was in regard to new quality improvement measures instituted after a patient died of preeclampsia in October. The second detailed issues in implementing said patient safety measures after a second woman died of the same condition in February. According to hospital reports, the patient safety measures had not been fully implemented in January, leading to the incident in February.
But the rising occurrence of pregnancy-related deaths is not limited to MetroWest Medical Center, or even to the state of Massachusetts. Unlike the rest of the developed world, maternal mortality rates have steadily risen in the U.S. since the late 1980s—and experts aren’t exactly sure why.
Top 10 Hospitals with the highest number of reported pregnancy complications due to
hypertension and pre-eclampsia in 2015
|Rank||Hospital||State||Number of Diagnoses|
|1||University of Mississippi Medical Center||MS||287|
|2||University of Colorado Hospital||CO||212|
|3||Oklahoma University Medical Center||OK||211|
|4||Henry Ford Hospital||MI||210|
|5||University Health Shreveport||LA||209|
|6||Sentara Norfolk General Hospital||VA||208|
|8||Tampa General Hospital||FL||186|
|9||Community Regional Medical Center||CA||185|
|10||Memorial University Medical Center||GA||174|
Figure 1 Data provided by Definitive Healthcare. Based on all-payor claims data.
According to the Center for Disease Control (CDC), maternal mortality rates in the U.S. have risen from 7.2 maternal deaths per 100,000 live births in 1987 to 16 deaths per 100,000 live births in 2015—more than triple that of Canada. African-American women are currently at the highest risk for pregnancy-related complications and mortality, with a rate of 43.5 deaths per 100,000 live births.
Doctors and researchers are split on the reasons behind the sharp uptick in maternal deaths in the U.S., and whether it is really a result of an increase in complications, or a clearer definition of what constitutes a pregnancy-related death.
Causes of maternal death are historically difficult to track, as there are many factors involved in a new mother’s health. Additionally, though pregnancy-related death is defined as occurring within one year of giving birth, the vast majority of fatal incidents occur within the first six weeks.
A common misconception surrounding maternal mortality is the cause of death itself.
Traditionally, hemorrhaging and seizures were the issues women primarily faced during childbirth, but their occurrence has remained steady—and low—since the start of the 20th century. The issues more likely to cause fatal complications now are chronic illnesses like diabetes, heart disease, and hypertension. Many of these are difficult to treat, and are exacerbated during pregnancy. They can also be challenging to diagnose, as they resemble normal pregnancy and labor symptoms. Other potentially fatal complications include perineal infections and amniotic fluid embolisms.
In Texas alone, the maternal death rate has doubled from 2000 to 2014, with other particularly high rates in the District of Columbia, New Jersey, Georgia, and Arkansas. Women in the south—especially African-American women—are more likely to live below the poverty line, increasing their chances of being overweight and of being diagnosed with a chronic illness like diabetes or heart disease.
Some researchers have seen a troubling trend—an intense focus on newborns while overlooking or underestimating the needs of a new mother. While the CDC reports infant mortality at its lowest rate in U.S. history, the maternal mortality rate continues to creep upward. According to Definitive Healthcare data, more than 850 children’s and short term acute care hospitals have active prenatal or neonatal intensive care units (NICUs).
Figure 2 Data provided by UNICEF (top) and the CDC (bottom).
This data is particularly shocking compared to global maternal mortality rates, which have fallen by more than a third from 2000 to 2015. A woman in the U.S. is three times more likely to die during the maternal period—from the beginning of pregnancy to one year after giving birth—than a woman in Canada, and six times more likely than a woman in Nordic countries like Sweden.
Only 9 countries saw an increase in maternal death rates from 1990 to 2015, including South Africa, Venezuela and North Korea. Among countries with lower maternal mortality rates than the U.S. are the United Arab Emirates, Macedonia, Singapore, and Libya.
Data not provided by Definitive Healthcare is from UNICEF and the Institute of Health Metrics and Evaluation.
NOTE: An earlier version of this blog highlighted claims data on "other unspecified pregnancy complications." This has been replaced with claims data on hypertension and pre-eclampsia.
Definitive Healthcare has the most up-to-date, comprehensive and integrated data on hospitals, physicians and other healthcare providers. Our database tracks quality and financial metrics on nearly 9,000 hospitals across the U.S., including nearly 900 hospitals with prenatal and neonatal intensive care units.
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