What Is Maternal Mortality?

Maternal mortality, the death of a pregnant person during pregnancy, birth, or the weeks after birth, is one of the most traumatic events that can happen in a family.

The Centers for Disease Control and Prevention (CDC) reports that in 2021, 1,205 women died of maternal causes in the United States compared with 861 in 2020 and 754 in 2019. The maternal mortality rate for 2021 was 32.9 deaths per 100,000 live births, compared with a rate of 23.8 in 2020 and 20.1 in 2019.

"A maternal death is a heartbreaking devastation that affects an entire family," says Nawal Nour, MD, MPH, an obstetrician-gynecologist and chair of the Department of Obstetrics and Gynecology at Brigham and Women's Hospital. "Unfortunately, the United States has one of the highest rates of maternal death in developed countries."

What are the leading causes of death during pregnancy and the postpartum period?

Four conditions cause most maternal deaths:

1. High blood pressure (hypertension): This is when your blood puts too much pressure on your blood vessels. Uncontrolled high blood pressure may lead to conditions such as preeclampsia or eclampsia. These can cause liver and kidney damage, seizures, stroke, coma, and death.
2. Postpartum hemorrhage: This happens when you bleed more than you should after having your baby. Heavy bleeding can occur when your uterus (womb) doesn’t contract (get smaller) quickly enough after birth. It also may develop when tissue remains in your uterus after birth.
3. Heart disease: Certain types of heart disease during pregnancy can put a pregnant person’s life at risk. Some patients start pregnancy with heart disease. Others develop it while they’re pregnant.
4. Infection: Bacteria can cause a serious infection in the uterus known as sepsis.

Maternal mortality and age

According to the CDC, maternal mortality rates increased with maternal age. Rates in 2021 were:

• 20.4 deaths per 100,000 live births for women younger than age 25
• 31.3 for those ages 25 to 39
• 138.5 for those age 40 and older

The maternal mortality rate for women age 40 and older was 6.8 times higher than the rate for women younger than age 25.

Maternal mortality and race

Pregnant people of all races are at risk of maternal death. But people of color bear an especially high risk. In 2021, the maternal mortality rates for Black women were significantly higher than rates for white and Hispanic women. The increases from 2020 to 2021 for all race and Hispanic-origin groups were significant.

Many social issues play a role in health risks in people of color. These include food insecurity, chronic stress, trauma, violence, and systemic racism. “We need to pay closer attention to our Black patients because of their increased maternal mortality risk,” Dr. Nour says.

In a maternal mortality interview with The Boston Globe, Dr. Nour reflected on leading causes and how patients can advocate for themselves.

Preventing pregnancy-related death

Brigham and Women’s Hospital has been a national leader in implementing efforts to protect pregnant patients from life-threatening conditions. As many as 60 percent of maternal deaths can be prevented, according to the Pew Charitable Trusts. With that in mind, Brigham care teams are taking a range of steps to keep patients safe during and after pregnancy and birth.

Pregnant people with high-risk health conditions receive extra attention from their care providers. For example, patients with high blood pressure now receive blood pressure monitors to use at home. If their blood pressure goes up, they're asked to call their doctors right away.

The Brigham also has developed strict new guidelines related to bleeding during birth. Care teams identify patients with certain risk factors so their health care providers can be on alert. Providers measure blood loss very carefully and they’re ready to deliver treatment quickly to pregnant people who are bleeding too much. Care teams take part in routine training to prepare them to respond to bleeding emergencies.

"If we can catch these things early, we are so much better positioned to save these patients," Dr. Nour says.

Addressing unconscious bias in doctors

To help protect pregnant people of color, the Brigham focuses on addressing what's known as "unconscious bias" among doctors. Research has found that white doctors may treat patients of color differently even when those doctors are trying to be fair. For example, they may undertreat pain or underestimate blood loss. This can result in poorer care for people of color and a higher risk of maternal death.

"As physicians, we have to be sure not to allow our own biases to come into play when providing care to patients," Dr. Nour says. "Here at the Brigham, we are trying to bring about awareness of this issue, because this is something we care deeply about."

Warning signs to watch for during pregnancy

Brigham care teams also focus on creating a more welcoming space for pregnant people. "It's important for patients to have open and transparent relationships with their providers," Dr. Nour says. "We want them to feel comfortable asking questions and advocating for themselves."

Brigham doctors encourage pregnant people and new parents to be on the lookout for worrisome symptoms. These include:

• Confusion or slurred speech
• Headache or vision changes
• Heavy bleeding
• Lightheadedness or faintness
• Numbness in the face, arms, or legs
• Pain in the vagina, chest, or belly
• Racing heartbeat

“This is the time to be vigilant. If you sense that something is wrong, please don’t ignore it,” says Dr. Nour. “If you have any issues at all, we want to know. Please call or come in to be seen. There’s so much on the line.”