Helping all moms survive labor and delivery

Published on Psychology Today

January 23 is Maternal Health Awareness Day—the one day a year where we highlight the maternal mortality crisis in the US and advocate for improved care for moms everywhere. Maternal mortality is the death of a mother during pregnancy or birth, and maternal morbidity is when labor and delivery nearly causes death and results in serious health consequences. You might assume with our advanced medical technology that the US would be a world leader in preventing maternal mortality, but it’s quite the opposite: Between 2003 and 2013, the United States was one of only eight countries that saw an increase in maternal mortality nationwide (Hirshberg & Srinivas, 2017). What’s worse is that in a lot of cases—approximately 28-40%—these deaths are entirely preventable (Clark et al., 2008; Hirshberg & Srinivas, 2017). The million-dollar question is why is this happening to our mothers and how can we prevent it?

What causes maternal morbidity?

Maternal morbidity is most often caused by hemorrhage or bleeding, but can also be caused by hypertensive disorders, infection, or issues related to blood clots (Hirshberg & Srinivas, 2017). There are various factors that put you at risk for maternal morbidity, including both younger (< 20) and older (> 35) maternal age, lower socioeconomic status, higher rates of preexisting conditions, poor access to insurance, and starting prenatal care in the second and third trimesters of pregnancy (Creanga et al., 2014, 2015; Hirshberg & Srinivas, 2017).

What are the racial and ethnic disparities in maternal morbidity?

Importantly, Black women are 3–4 times more likely to have a pregnancy-related death or complications than women of any other demographic, including Hispanic women who are also overrepresented in low-income tax brackets in the US (Hirshberg & Srinivas, 2017). In fact, Black women are 7 times more likely to suffer from pregnancy related death when compared to Chinese women or White women with a college degree (Singh, 2020). On top of that, while 1/3 of these deaths were potentially preventable for all women, nearly half of the deaths of Black women were likely preventable (Berg et al., 2005).

Why do these disparities exist?

It isn’t completely clear why Black women suffer a higher likelihood of maternal death and morbidity. What is certain is that Black women are more likely than White women to lack important resources like stable housing, transportation, and even clean air and water. Black women are also more likely to live in neighborhoods that lack amenities like healthy grocery stores and parks, which are important predictors of health-related behaviors, preconception health, and a healthy pregnancy/childbirth (Hailu et al., 2022). Black women tend to suffer from higher rates of preexisting medical conditions and lower insurance coverage than White women (Creanga et al., 2015). As a result, they are at higher risk for preterm labor, preeclampsia and other hypertensive disorders, placenta previa and placental abruption, and infection (Creanga et al., 2014). But income-related issues alone don’t tell the whole story.

Many researchers have suggested that historical exposure to racial trauma, discrimination, and marginalization play a major role in increasing risk for pregnancy-related complications (Fink et al., 2023). Along with the stress of living in less resourced neighborhoods, trauma from discrimination also increases stress in pregnant women, and chronic exposure to such stress across the lifespan triggers a cascade of maladaptive stress responses, which lead to dysregulated physiology, and even premature biological aging (Hailu et al., 2022). This emotional stress thus affects the body in ways that can increase a pregnant mother’s risk of experiencing complications during pregnancy and childbirth.

Another related factor that might drive inequities in maternal health is distrust of the health system as a result of this discrimination. When pregnant mothers don’t trust their doctors, they are less likely to seek prenatal care or follow doctor-prescribed treatment plans (Hailu et al., 2022). Historically, researchers have assumed that this lack of trust among Black women is related to historical events, like the infamous Tuskegee Syphilis Study (1930s-1970s) where hundreds of impoverished Black men with syphilis were studied without proper treatment. However, recent research suggests that Black Americans are not only still experiencing medical distrust, but it also has nothing to do with knowledge about historical events like Tuskegee; instead it stems from more recent first-hand experience feeling less cared for by their personal doctors (Martin et al., 2023). Indeed, in a recent analysis of more than 2,000 mothers, 24% (consisting of mostly Black and Hispanic women) reported perceived discrimination during birth hospitalization (Collier et al. 2019).

What can we do about it?

So what do we do? Most researchers agree that better access to quality medical care is the most important factor in preventing these deaths (Berg et al., 2005). One group of researchers estimate that differences in hospital access may account for almost half of the Black-White disparity in patient-clinician communication gaps, lack of care coordination, and disrespect in maternity care, which have all been shown to relate to perinatal disparities (Glazer& Howell, 2021). In fact, in a comparative study assessing the effect of delivery site on health disparities, the researchers determined that if Black women gave birth in the same hospitals as White women, maternal death in Black women would be significantly reduced (Creanga et al., 2014b)

Fortunately, the Affordable Care Act’s Medicaid expansion led to significant reductions in Black–White disparities in adverse birth outcomes shortly after the policy went into effect, and a 50% reduction in infant mortality, with the greatest declines among Black/African American infants (Crear-Perry et al., 2021). Further, delivery-related mortality in US hospitals decreased for all racial and ethnic groups for the first time in decades from 2008 to 2021, likely demonstrating the impact of national strategies focused on improving maternal quality of care (Fink et al., 2023). So there is a light at the end of the tunnel. But the fight isn’t over; in order to keep up with this progress we need to keep advocating for mothers, especially Black mothers, to receive high quality care.

On this January 23, consider taking action to advocate for maternal health in your community! Use your voice or your vote to fight for better health care for women or donate blood at your local Red Cross. Every little effort counts.

Photo by PickPik/royalty-free photos

References

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