It’s supposed to be the happiest time for new moms. Pregnancy and childbirth are over, and their much-anticipated “bundle of joy” has finally arrived. But amid all the excitement that a new baby brings, most new moms or their partners don’t consider the possibility that deadly pregnancy-related complications can occur long after they leave the hospital or birthing center.
They should. Too many women are dying postpartum — indeed, up to one year after delivery — from conditions that could have been prevented with proper medical intervention and better access to care, according a new report by the Centers for Disease Control and Prevention (CDC).
According to the CDC, 700 women die each year from pregnancy-related complications in the U.S. For 2011 through 2015, the agency reports that about one-third of those deaths — approximately 233 — happened one week to one year postpartum. Also noted in the report is that one-third of the women studied died during pregnancy, while another third died during delivery or in the week thereafter.
In fact, maternal mortality is rising in the U.S., even as it declines elsewhere, according to an investigative report by National Public Radio. The report notes that per 100,000 live births in the U.S. there are 26.4 maternal deaths. By way of comparison, here are the rates of maternal deaths per 100,000 live births in other countries:
- UK (9.2)
- Portugal (9)
- German (9)
- France (7.8)
- Canada (7.3)
- Netherlands (6.7)
- Spain (5.6)
- Australia (5.5)
- Ireland (4.7)
- Sweden (4.4)
- Italy (4.2)
- Denmark (4.2)
- Finland (3.8)
When Is a Pregnancy-Related Death Most Likely to Occur?
Of the women studied, the CDC found:
- 31.3 percent died during pregnancy
- 16.9 percent died on the day of delivery
- 18.6 percent died one to six days postpartum
- 21.4 percent died seven to 42 days postpartum
- 11.7 percent died 43–365 days postpartum
What Are the Leading Causes of Pregnancy-Related Deaths?
The CDC identified the leading causes of pregnancy-related deaths as follows:
- Heart disease and stroke cause the most deaths overall
- Obstetric emergencies, like severe bleeding and amniotic fluid embolism (when amniotic fluid enters a mother’s bloodstream), cause the most deaths at delivery
- In the week after delivery, severe bleeding, high blood pressure and infection are most common
- Cardiomyopathy (weakened heart muscle) is the leading cause of deaths one week to one year after delivery
How Many Pregnancy-Related Deaths Are Preventable?
The CDC reports that 60 percent of pregnancy-related deaths — that’s about three out of every five —could have been prevented.
How Can a Woman Reduce Her Risk of Dying During Her First Year after Childbirth?
In 2018, the American College of Obstetricians and Gynecologists (ACOG) revised its recommendations on postpartum care given the urgent need to reduce severe maternal morbidity and mortality.
The ACOG now recommends that postpartum care be an ongoing process, essentially a “fourth trimester,” rather than a single encounter and that all women have contact with their ob-gyns or other obstetric care providers within the first three weeks postpartum. Previously, the ACOG recommended that a comprehensive postpartum visit take place within the first six weeks after birth.
The medical follow-up, which should be a transition to ongoing well-woman care, should include a full assessment of the following:
- Mood and emotional well-being
- Infant care and feeding
- Sexuality contraception and birth spacing
- Sleep and fatigue
- Physical recovery from birth
- Chronic disease management
- Health maintenance
Up to 40 percent of women who have given birth do not attend a postpartum visit with a healthcare provider, according to the ACOG.
The ACOG also recommends special care prior to pregnancy, during pregnancy and postpartum for women with known heart disease.