Maternal Mortality Rate in the United States

Each state reports deaths of mothers that occur within 1 year of delivery to the Centers for Disease Control and Prevention as part of the ongoing Pregnancy Mortality Surveillance. In the U.S, the mortality rate for moms is the highest of all developed countries in the world and is the only one that continues to rise (MacDorman 2016). In 2015, a study by Harvard determined that women today are 50% more likely to die from complications surrounding childbirth than their own mothers were (Shah 2018), and there are huge racial disparities between Black mothers and non-Hispanic White mothers, at a three to four time difference in mortality (MacDorman 2016).

There are slightly under 4 million babies born in the U.S. every year, and in a homebirth setting, the maternal mortality rate is 15 in 100,000 women - in a hospital, 58 in 100,000 women (Jansen, et al 2017). While this seems small as a figure, that’s roughly 2,320 women dying from birth in a hospital setting every year; almost a four-fold increase from a planned homebirth setting. These complications include emergencies during delivery, certainly, but actually the problem lies in the development of infections postpartum. These stem from interventions such as unnecessary cervical checks, internal fetal monitoring, avoidable cesarean section practices, and a huge lack of postpartum care (Kooy, et al 2017). The number one cause of maternal mortality globally is hemorrhage (Kassenbaum 2017), but in the U.S. it is infection. Current hospital standard practice suggests a follow up appointment for mothers at 6 weeks postpartum, far beyond the timeframe that infection sets in, if it does. This appointment may or may not include a physical exam, which that is entirely dependent upon the provider. However, more often than not, it is little more than a 15 minute yes or no answer format to basic questions (Kassenbaum 2017).

How can mothers, and especially first time mothers, put themselves in the best and safest situation when it comes to birthing their babies? With a homebirth midwife, almost all of the abovementioned practices are left out entirely, and in the births that do require a little extra attention, the rates are still significantly lower than in a hospital setting. As an example, the cesarean rate in the U.S overall is at 31% or 1 in 3 women, and for planned homebirths, 5.2%. All of this added together leads to a vastly decreased infection rate. Midwives are also able to see red flags pertaining to hemorrhage, where doctors often can not because of drugs masking the signs. On top of that, standard postpartum protocol with a homebirth midwife includes two to three home visits following birth to check on both the baby and the mother, an office visit around two weeks postpartum, and finally another office visit at four-six weeks postpartum. The midwives assess the mother both mentally and physically, both of which are vital to catching any signs of an early infection, as well as any other problems such as postpartum depression.

While all this about the safety of mothers is both horrifying in regards to the fact that medical professionals have this information available to them the same as everyone else, but also enlightening for those mothers who do not know they have any other options, what about the babies? The reason this essay did not address the safety of the babies, is that there is no statistical difference in the neonatal outcome between hospital and planned home births. The babies born at home however, are more likely to be full-term at 40 weeks gestational age, weigh an average of eight pounds, and are also more likely to be breastfeeding at the six week postpartum visit.

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*Kassebaum, Nicholas J. “Global, Regional, and National Levels of Maternal Mortality, 1990–2015: a Systematic Analysis for the Global Burden of Disease Study 2015.” Maternal Mortality Collaborators, The Lancet, www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)31470-2.pdf.

*Kooy1, Jacoba van der, et al. “Planned Home Compared with Planned Hospital Births: Mode of Delivery and Perinatal Mortality Rates, an Observational Study.” BMC Pregnancy and Childbirth, BioMed Central, 8 June 2017, bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-017-1348-y.

*MacDorman, M., Declercq, E., Cabral, H., Morton, C., “Is the United States Maternal Mortality Rate Increasing? Disentangling trends from measurement issues: Short title: U.S. Maternal Mortality Trends.” Obstet Gynecol. 2016 Sep; 128(3):447-55. 

*Martin, Nina, and Renee Montagne. “U.S. Has The Worst Rate Of Maternal Deaths In The Developed World.” NPR, NPR, 12 May 2017, www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-maternal-deaths-in-the-developed-world.

*Shah, Neel. “A Soaring Maternal Mortality Rate: What Does It Mean for You?” Harvard Health Blog, 16 Oct. 2018, www.health.harvard.edu/blog/a-soaring-maternal-mortality-rate-what-does-it-mean-for-you-2018101614914.