Life Threatening or Life Giving?

Authored by Anwesa Brahmachary

Art by Sabrina Chen

Bringing life into the world is one of the most incredible human abilities. However, with time, this remarkable event has become increasingly dangerous. According to the National Center for Health Statistics, the U.S. maternal mortality rate was 32.9 per 100,000 live births in 2021 and most of those deaths were preventable [1]. From unnecessary procedures to prejudice and lack of knowledge about caring for certain races, the United States’ maternal mortality rates continue to rise faster than other high-income countries [2]. 

As medical technology has advanced in the United States and provided us with numerous benefits and increased intervention opportunities, specific technologies have become overused. For example, Electronic Fetal Monitoring or EMF’s initial intention was to manage high-risk pregnancies. However, it is now used more frequently, even for low-risk patients. Although increased technology accessibility is usually beneficial, using Electronic Fetal Monitoring unnecessarily can lead to factors such as fetal heart rate tracings being read too much and more risks being detected with less accurate predictive quality [3]. Due to these risks being detected, more cesarean deliveries occur. Cesarean sections can lead to increased infections, blood clots, and more risks for future pregnancies such as uterine rupture [4]. With this rise in unnecessary procedures and interventions, more risks are created for women than needed, a factor that contributes to the rising United States maternal mortality rate. 

Other than medical technological and procedural risks, social factors also impact rising maternal mortality rates. Prejudice against women in healthcare, especially women of color, persists. According to the National Library of Medicine, when women speak about their health symptoms to providers, their concerns are likely to be ignored. Lack of education and knowledge can cause many women to not know about prenatal care, diet changes, and other actions they can take to make their pregnancies safer [5]. According to the National Library of Medicine, of pregnant women surveyed from 2011-2013, 15.8% did not have a high school diploma or a GED and 29.6% did not have a Bachelor’s degree, showing that they might not know about ways to make their pregnancy safer [6]. However, medical providers often even ignore women who are educated with the excuse that these women are ignorant and uneducated about their health. Prejudice leads to women not being believed when describing their own sensations and feelings when growing a life. Negligence has cost many lives in childbirth [5]. Furthermore, due to racism in healthcare, including the negligence described above, racial factors such as being an African American woman have been shown to create increased pressure and elevate stress hormones. This can then lead to increased premature deliveries and other adverse effects when giving birth [5]. The maternal mortality rate was 69.9 deaths per 100,000 live births for non-Hispanic black women in 2021, compared to the 32.2 overall maternal mortality rate [7]. This shows the role that race plays in the rising maternal mortality rates and how even the stress of being a Black woman can lead to increased pregnancy risks. 

Furthermore, most current medical knowledge is oriented towards non-Hispanic white women.  Historically, childbirth illustrations taught to providers were based on European women’s anatomy, which can be different from that of other races [8]. These disparities in race-based medical knowledge extend to the care of women when giving birth. In a study by the American Public Health Association, data from death files from the National Center for Health Statistics showed that the leading causes of maternal deaths include eclampsia/preeclampsia, obstetric embolism, and postpartum cardiomyopathy [9]. Additionally, the data showed that Black women with postpartum cardiomyopathy tend to have more intense symptoms than White women with cardiomyopathy and are more likely to die from the complication. Additionally, the results from this study showed that non-Hispanic Black mortality from one of these complications, obstetric embolism and hemorrhage, was 2.3-2.6 times more than for non-Hispanic White women [9]. Increased education about comorbidities and maternal mortality associated with certain races can help prevent the disparities shown in maternal mortality for women of color [10]. Thus, a crucial way to reduce these rising mortality rates is to provide further education for physicians on how to treat and diagnose women of color, accounting for their underlying risks and anatomy, as well as for all women with underlying causes.

Maternal mortality rates continue to rise in the United States despite the increased discussion of racial prejudice and growing interventions through technology and research. Giving birth and bringing new life into the world, despite the painful process, is one of the most joyous occasions for a family. Having to fret the risk of death is something that can be eliminated from one’s worries when they already have so much to worry about during pregnancy. New policies like the Momnibus Act, which seeks to look more into the social determinants of maternal medical outcomes, can help counter this crucial cause [11]. Increased emphasis on maternal care in general, as well as based on race, is becoming more crucial than ever. 

Works Cited

1.  Hoyert, D. L. (2023, March 16). Maternal mortality rates in the United States, 2021. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm 

2. Delbanco, S., Lehan, M., Montalvo, T., & Levin-Scherz, J. (2019, June 28). The rising U.S. maternal mortality rate demands action from employers. Harvard Business Review. https://hbr.org/2019/06/the-rising-u-s-maternal-mortality-rate-demands-action-from-employers 

3. Sachs, B. P. (1989). Is the rising rage of cesarean sections a result of more defensive ... National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK218656/ 

4. Mayo Foundation for Medical Education and Research. (2022, June 16). C-section. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655 

5. Njoku, A., Evans, M., Nimo-Sefah, L., & Bailey, J. (2023, February 3). Listen to the whispers before they become screams: Addressing black maternal morbidity and mortality in the United States. Healthcare (Basel, Switzerland). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9914526 

6. Branum, A. M., & Ahrens, K. A. (2017, April). Trends in timing of pregnancy awareness among US women. Maternal and child health journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5269518/ 

7. Hoyert, Donna L. (2023, March 16). Maternal mortality rates in the United States, 2021. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm 

8. Baumgaertner, E., & Fassihi, F. (2023, July 12). Racism and sexism underlie higher maternal death rates for black women, U.N. says. The New York Times. https://www.nytimes.com/2023/07/12/health/maternal-deaths-americas-un.html 

9. MacDorman, M. F., Thoma, M., Declcerq, E., & Howell, E. A. (2021). Racial and ethnic disparities in maternal mortality in the United States using Enhanced Vital Records, 2016‒2017. American Journal of Public Health, 111(9), 1673–1681. https://doi.org/10.2105/ajph.2021.306375 

10. Lister, R. L., Drake, W., Scott, B. H., & Graves, C. (2019). Black maternal mortality-the elephant in the room. World journal of gynecology & womens health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384760/ 

11. Passing the Momnibus in end-of-year package is Americans’ number one priority, poll reveals. Representative Lauren Underwood. (2022, December 5). https://underwood.house.gov/media/press-releases/passing-momnibus-end-year-package-americans-number-one-priority-poll-reveals