Maternal Mortality Increasing, Especially Among Black Women

According to a recent story in Forbes Health, a report from the National Vital Statistics System and the U.S. Centers for Disease Control and Prevention (CDC) shows that in 2021, there was a significant rise in maternal mortality in the U.S. Of even greater concern, the study also found that, regardless of education, social background and income level, Black women are dying in pregnancy at more than two times the rate of non-Hispanic white women.

Maternal deaths are defined by the World Health Organization (WHO) as deaths that take place during pregnancy or in the 42 days after delivery, the story notes. “In 2021, 1,205 women died of maternal causes in the U.S. This is a pronounced increase from 861 deaths in 2020 and 754 in 2019. Historically, compared to other high-income countries including France, Canada, Australia, New Zealand and others, the U.S. has the worst maternal mortality rates.”

Resource editors spoke with Theresa Ann Buckson M.D., medical director for Baptist Health South Miami Hospital’s OB Hospitalist Group. Dr. Buckson offered her perspective on what’s behind the rise in maternal mortality in the U.S., and why Black women are more at risk for developing serious complications during pregnancy.

Theresa Ann Buckson, M.D., medical director for Baptist Health South Miami Hospital’s OB Hospitalist Group

Resource: What do you think is the reason for the increase in maternal mortality and the disparity in mortality rates among Black and white women?

Dr. Buckson: There are multiple factors that led to this increase but I believe the primary cause is the systemic racism and implicit bias against women of color that has always existed in the health care system and which continues to exist today. Also, minorities typically have many barriers to accessing timely and quality healthcare in the U.S. Some of the socioeconomic inequities that contribute to high rates of maternal mortality in Black women include differences in health insurance coverage; challenges in accessing prenatal and postnatal care; higher chances of preterm birth; higher teen birth rates among Black women, which is associated with higher risk of complications; economic instability; food insecurity; lack of social support and less community engagement.

Resource: What role has COVID-19 played in this increase?

Dr. Buckson: With the introduction of an illness such as COVID-19 into an already overburdened health care system to which many minorities already lack adequate access, it exponentially exacerbated these underlying problems and thus likely led to this significant rise in maternal mortality, particularly among Black women. We must also note that, even before the pandemic, Black women were already two to three times more likely to die from a pregnancy-related cause than white women.

Resource: Can you identify some of the common risks for women during pregnancy?

Dr. Buckson: Pregnant women should always be evaluated for high blood pressure, gestational diabetes, preeclampsia, preterm labor, depression and infections such as pneumonia, COVID-19 and urinary tract infections (UTIs).

Resource: What symptoms might women experience when pregnancy is endangering their health? 

Dr. Buckson: Some of the symptoms that women should be on the watch for during pregnancy include headache; frequent or painful urination; calf pain; shortness of breath; dizziness; blurred vision or vision changes; vaginal bleeding; chest pain or heart palpitations; fever; decreased fetal movement; thoughts of harming themselves; swelling in face and/or hands; significant itching; and nausea or vomiting other than early morning sickness. Any of these could be an indication of a serious underlying condition.

Resource: Are there any steps women can take to maintain their health during pregnancy?

Dr. Buckson: Maintaining your health during pregnancy begins with optimizing your health prior to pregnancy. Medical problems such as high blood pressure, diabetes, anemia or obesity need to be managed in preparation for pregnancy. For example, certain medications cannot be taken during pregnancy and must be stopped prior to conception in order to prepare for pregnancy. Or if you have diabetes, your blood sugar needs to be very well controlled prior to conception or your baby will be at increased risk for birth defects. Patients must be tested for certain health conditions prior to pregnancy and some may need to get vaccines at that time. 

Seeking prenatal care as early as possible is also very important. Certain prenatal testing can only be performed during the first trimester. Keeping scheduled doctor visits is extremely important. As your pregnancy progresses, appointments become more frequent because medical problems very quickly become medical emergencies the further along you get. Take prenatal vitamins, eat a healthy diet, exercise and keep track of your weight gain. Drinks lots of water. Do not smoke or drink alcohol or use recreational drugs. Be honest with your doctor about your medical history and also about any symptoms that may develop during your prenatal course.

Resource: What advice would you give to women who are planning to become pregnant or already are?

Dr. Buckson: Optimize your health and address any medical problems you have before becoming pregnant. Make sure you have a doctor who you’re comfortable with and see your doctor for preconception counseling. It’s important to be your own advocate and also to have a family member come along for visits to help advocate for you.

Resource: What about medications, vitamins and supplements?

Dr. Buckson: Start taking prenatal vitamins at least one month before trying to become pregnant. Find out early if any of the medications you’re taking are unsafe during pregnancy so that you can be switched to a different medication that is safe but still effective for your condition. This includes vitamins and herbs and over the counter (OTC) medications. Try to get to a healthy weight before you become pregnant. Stop smoking, alcohol use and use of any recreational drugs, and limit caffeine. Exercise regularly and get plenty of rest and relaxation.

Resource: How is Baptist Health reaching out to at-risk women to increase awareness of the importance of maternal health during pregnancy?

Dr. Buckson: Baptist Health has a variety of helpful resources and classes for moms and their partners at every step of the way before, during and after their pregnancy. We offer classes on baby care, breastfeeding, baby CPR and other important things parents will need to know. Several of our hospitals have a patient care navigator who organizes pre- and post-delivery care for new moms.

For more information about maternity services, classes and support groups available from Baptist Health,

visit Maternity Services or Birthing Classes, Newborn Parenting Classes and Parent Support Groups.