Maternal death disparities have widened in Ohio. Eighty-eight percent of pregnancy-related deaths in 2021 could have been prevented. This compared to 66 percent in 2020, according to The Department of Children and Youth (DCY) report on pregnancy-related deaths in Ohio for 2021.
Eighty-eight percent of pregnancy-related deaths in 2021 could have been prevented.
As explained in our previous article on 2020 data, the Pregnancy Associated Mortality Review (PAMR) Committee examines the records of maternal deaths and their factors and leading causes. Alarmingly, about one-third of pregnancy-associated deaths were pregnancy-related. Hence, more women died from pregnancy-related causes (48 individuals) in 2021 compared to those in 2020 (35 individuals).
Racial disparities in pregnancy-associated deaths
Additional findings from the current report reveal that maternal death statistics have gotten worse, and the racial disparity gap has increased. From 2008 to 2020, non-Hispanic Black (NHB) women faced nearly two times the risk of pregnancy-related death compared to non-Hispanic white (NHW) women. By 2021, NHB women were at more than three times the risk. This disparity persisted regardless of whether COVID-19 was accounted for.
Most patients who died from pregnancy-related events were covered by Medicaid.
Specifically, 63 percent of deaths occurred among women with Medicaid coverage, 23 percent with private insurance, 10 percent were either uninsured or self-pay, and 4 percent was other/unknown. Most pregnancy-related deaths happened during the postpartum period (between one day to one year after giving birth), a sensitive time where a birthing parent needs to heal while taking care of their baby or babies. The highest concentration of maternal deaths, and the most dangerous time in postpartum, is within the first six weeks.
Leading causes of pregnancy-related deaths
Infection was the leading cause of pregnancy-related deaths in Ohio for 2021,at 35 percent. This includes COVID-19 and sepsis. Almost nine out of every 10 pregnancy-related deaths from COVID-19 were preventable. More leading causes of death are:
- Other | 23 percent. Includes hemorrhage, renal diseases, hypertensive disorders of pregnancy, pulmonary conditions, hematologic conditions, injury, cancer, renal diseases, cerebrovascular accidents, and metabolic/endocrine disorders.
- Mental health conditions | 17 percent. Includes mental health conditions and overdoses related to depressive disorders, psychotic disorders, and substance use disorders.
- Thrombotic embolism | 15 percent
- Cardiovascular conditions | 10 percent
The following table presents the leading causes of pregnancy-related deaths in Ohio based on race and ethnicity.
Contributing factors leading to pregnancy-related deaths
Members of the PAMR Committee identified contributing factors to pregnancy-related deaths. Many of the contributing factors are related to the healthcare system itself, and the quality of care provided. If these factors were addressed, preventable pregnancy-related deaths could have been avoided. Committee members identified 185 contributing factors to pregnancy-related deaths; half of them were categories within the following five categories:
- Non-adherence to medical recommendations. The most identified contributing factor to pregnancy-related deaths was non-adherence to medical recommendations. In other words, providers or patients failed to follow established procedures and protocols. Specifically, this included not consistently implementing mental health guidelines, not offering COVID-19 vaccine counseling or supporting vaccine uptake during prenatal visits, and failing to educate patients about urgent warning signs of maternal health problems after childbirth.
- Clinical skill/quality of care. Some healthcare providers were not well trained to handle certain situations and did not fully think through best practices. Many did not follow proper care guidelines for pregnant and postpartum people with substance use disorders or other serious health conditions.
- Lack of care coordination/continuity of care. Continuity of care means that doctors, nurses, and other support providers (e.g., non-clinical providers like social workers) work together and communicate well during pregnancy and after birth. Patients affected by lack of care coordination or continuity of care were those who didn’t receive enough prenatal and postnatal care, suffered from a mental health or substance use issues, or were facing higher risks during pregnancy and after delivery.
- Failure to screen/inadequate assessment of risk. Providers failed to screen patients for mental health conditions (like postpartum depression), substance use disorder, intimate partner violence, and human trafficking. In addition, providers failed to diligently assess the risk of other leading causes of pregnancy-related deaths (e.g. hemorrhage and hypertensive disorders).
- Delay. This contributing factor occurs when a provider or patient delays in referring to or accessing care, treatment, or follow-up tasks. There were delays in transferring patients to higher levels of care and the timely execution in treating patients with high-risk symptoms.
How do we address contributing factors in maternal death?
The PAMR committee developed recommendations on how to handle contributing factors that could prevent future maternal death outcomes. They identified solutions based on what systems of care, facilities, providers, and communities should do. For example, in order to address non-adherence to medical recommendations, providers should educate their patients about the risk and physiological impacts of COVID-19 during pregnancy and offer the vaccinations.
To address skill and quality care, hospital licensure should mandate training in sepsis for healthcare centers. Furthermore, PAMR suggested that delays should be handled at the community level such as national, state, and local health departments regularly advertise the Urgent Maternal Signs (e.g., preterm labor, preeclampsia systems, and fetal movement).
Local health care engagement and community attention is essential
Due to the worsening trends in maternal deaths in Ohio, local healthcare systems must apply the recommendations from the PAMR committee and incorporate them when serving patients. Doing so will save the lives of birthing parents and make Ohio a great place for families to live and thrive. Communities and other institutions throughout Ohio play an essential role in preventing maternal deaths as suggested by the PAMR committee. In a future article, we will discuss the efforts local and state entities are conducting to reduce maternal deaths and to ensure that birthing parents are able to take care of their babies.
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