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.
Each year, about 700 pregnant people and new mothers in the United States die, according to the Centers for Disease Control and Prevention (CDC).
“A maternal death is a heartbreaking devastation that affects an entire family,” said Dr. Nawal Nour, an obstetrician-gynecologist and chair of the Brigham and Women’s Department of Obstetrics and Gynecology. “Unfortunately, the United States has one of the highest rates of maternal death in developed countries.”
That’s the bad news. The good news is that the Brigham is taking important steps to protect women from problems that can put their lives at risk.
Understanding the causes of maternal death
Four conditions cause most maternal deaths:
- High blood pressure: 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.
- 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 delivery. It may also develop when tissue remains in your uterus after birth.
- Heart disease: Certain types of heart disease can put a woman’s life at risk. Some women start pregnancy with heart disease. Others develop it while they’re pregnant.
- Infection: Bacteria can cause a serious infection in the uterus known as sepsis.
“This is the time to be vigilant. If you sense that something is wrong, you can’t afford to ignore it. If you have any issues at all, we want you to call or come in and be seen. There’s so much on the line.”Dr. Nawal Nour
Women of all races are at risk of maternal death. But women of color bear an especially high risk. For example, Black women are more than three times more likely to die from pregnancy-related causes than white women.
Many social issues play a role in maternal health risks in women of color. These include food insecurity, chronic stress, trauma, violence and systemic racism. “We need to focus on paying closer attention to these patients because of their higher risk,” Dr. Nour said.
Preventing maternal death
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 women safe during and after pregnancy and delivery.
Women with high-risk health conditions are receiving 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 has also developed strict new guidelines related to bleeding during delivery. Women with certain risk factors are identified so their care teams can be on alert. Blood loss is measured very carefully. And care providers are ready to provide treatment quickly to mothers who are bleeding too much. Care teams receive 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 women,” Dr. Nour said.
To help protect women of color, the Brigham is focusing 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 said. “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 are also focusing on creating a more welcoming space for patients. “It’s important for women to have open and transparent relationships with their providers,” Dr. Nour said. “We want them to feel comfortable asking questions and advocating for themselves.”
Brigham doctors encourage pregnant women and new mothers 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, you can’t afford to ignore it,” Dr. Nour said. “If you have any issues at all, we want you to call or come in and be seen. There’s so much on the line.”