Maternal Deaths Rose During the First Year of the Pandemic
The number of women in the US who died while pregnant during the first year of the pandemic, the coronavirus, increased dramatically shortly after childbirth, according to a new study. This increase is partly attributed by health officials to Covid and pandemic-related disruptions. A new report from the National Center for Health Statistics says the number of maternal deaths rose 14 percent to 861 in 2020 from 754 in 2019.
The United States already has a much higher maternal mortality than in other developed countries. Rising mortality increases the maternal mortality rate in the country to 23.8 deaths per 100,000 live births in 2020 from 20.1 deaths in 2019. Maternal mortality rates in developed countries have fluctuated in recent years from less than two deaths per 100,000 live births. Births in Norway and New Zealand to just under nine deaths per 100,000 live births in France and Canada.
Black women in America experienced the most deaths, with a third of the pregnant women and new mothers who died in 2020 being black, even though black Americans make up just over 13 percent of the population. Their mortality rate was nearly three times that of white women.
Hispanic women’s mortality rate, which has historically been lower than that of white women, has also increased significantly in 2020 and is now nearly equal to that of white women. Mortality rates increased among all pregnant women over 24, but especially among pregnant women aged 40 and over, whose mortality rate was nearly eight times that of women under 25.
“We have the highest maternal morbidity and mortality in the developed world, and this trend continues despite our awareness of it, despite our maternal mortality review committees, despite the media attention,” said Kara Zivin, a professor of psychiatry obstetrics and a gynecologist at the University of Michigan who studies access to care during and after pregnancy. “Whatever we do, it is clearly not enough to solve the problem of either the overall indicator or inequality.”
Although the new report is sparse in detail – data on maternal deaths were not provided for American Indian/Alaska Natives, who have higher pregnancy-related deaths than White, Hispanic, and Asian/Pacific Islander women – experts say some of the deaths were the most likely due to the coronavirus pandemic. Pregnancy puts women at risk of more severe illness if they are infected with the SARS-CoV-2 virus that causes Covid and, vaccines for them were not available in 2020.
” In fact, when the lockdown began, we said we expected an increase in maternal mortality due to both Covid and the response to Covid,” said Dr. Denise Jamison, an obstetrician at Emory University in Atlanta and a member of the expert panel on Covid to the American College of Obstetricians and Gynecologists, adding that she was not surprised by the increase.
In addition to the higher risks that pregnant women with Covid face, she said, “We haven’t figured out how to deliver obstetric care safely in 2020,” she said.
“Our healthcare systems were not yet set up to manage telehealth,” she said, “and there were other roadblocks: kids were home from school and parents couldn’t leave for doctor appointments.”
Many doctors stopped seeing patients in person, hospitals were often overwhelmed, and patients avoided emergency rooms filled with Covid patients.
Pregnant women who develop Covid face a higher risk of requiring intensive care or mechanical ventilation. And despite the relative youth of pregnant women, they face a higher risk of death, research has shown. Health experts urge them to get vaccinated, but their vaccination rates remain low.
Black Americans as a whole have been disproportionately affected by the pandemic, with higher rates of hospitalizations and deaths than their white counterparts, but racial disparities in maternal deaths predate and post-Covid and stem from structural health inequalities that have complex underlying causes.
According to Dr. Mary D’Alton, director of obstetrics and gynecology at Columbia University Irving Medical Center, cases of stress, mental health problems, and substance abuse have increased during the pandemic, which may also have contributed to worse outcomes.
New programs that provide enhanced patient services, such as doulas that can support and protect patients, are positive developments, she said.
“We also need to educate our providers on how to listen to patients,” said Dr. D’Alton. “My dad was a primary care physician and he used to say, ‘Mary, if you want to know what’s wrong with a patient, ask them and they’ll tell you. But above all, you must listen to them.”
“Complaints from pregnant women are often ignored, and this is probably much more important for black and brown women,” she added.
Generally speaking, the leading causes of pregnancy-related death are cardiovascular disease, other diseases, and infections. Studies have shown that cardiomyopathy, a disease of the heart muscle; blood clots in the lungs; and hypertensive disorders of pregnancy contribute to a higher proportion of pregnancy-related deaths among black women than among white women.
One of the young mothers who died in 2020, whose story was widely reported, was Dr. Chanice Wallace, a black doctor who was the chief pediatrician at the Indiana University School of Medicine in Indianapolis.
Dr. Wallace developed a pregnancy complication called preeclampsia, and in October 2020, her baby girl was born prematurely by cesarean section. But Dr. Wallace developed additional complications and died just days after giving birth.