Panel works to understand, reduce maternal deaths in Washington

Women more likely to die from pregnancy in U.S. than in most developed nations

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Women in the United States are more likely to die from pregnancy-related complications than in nearly any other developed country in the world.

According to the Centers for Disease Control and Prevention, the national maternal mortality rate has more than doubled over the past three decades, from about seven deaths per 100,000 live births in 1989 to about 17 in 2013. This puts women in the United States in the company of women in Libya, Iran and Turkey with respect to maternal mortality.

In Washington state, women fare somewhat better than in other parts of the country: Maternal mortality rates have remained steady since the 1990s, averaging about nine pregnancy-related deaths per 100,000 births each year. But funding for tracking and analyzing pregnancy-related deaths ended during the Great Recession.

To understand maternal mortality in Washington and gain insight on why maternal deaths have remained the same over the past 30 years, stakeholders supported and state legislators passed Senate Bill 6534 in June 2016. The bill directed the state Department of Health to convene a Maternal Mortality Review Panel to review all maternal deaths in Washington. Similar panels have been adopted by many other states also hoping to better understand why the United States is such an outlier.

“The goal of the panel is to understand the nature of maternal mortality, to identify factors and issues surrounding these deaths, and make recommendations to prevent these deaths and improve women’s health care services,” said Alexis Bates, maternal mortality review coordinator with the Department of Health.

The results of the review were released today.

The Washington State Department of Health’s Maternal Mortality Review Panel have issued a report after studying the deaths of 69 Washington women who died in 2014 or 2015 while pregnant or during the year following their pregnancies. (official Governor’s Office photo)

The MMRP reviewed the 69 maternal deaths that occurred in Washington in 2014 and 2015. A maternal death is defined as the death of a woman during pregnancy, or within the first year following the pregnancy, from any cause.

Some of the MMRP’s findings are:

  • Sixteen of the maternal deaths were pregnancy-related. A maternal death is considered pregnancy-related if it is due to conditions initiated or exacerbated by the pregnancy.
  • The most frequent causes of pregnancy-related death were hemorrhage, which can lead to excessive blood loss, and serious conditions related to high blood pressure during pregnancy or after childbirth. Obesity, mental health issues, and inadequate follow-up care during and after pregnancy all seem to be contributing factors.
  • Early analyses suggest that some groups of women were more likely to die from pregnancy-related complications, including women from low-income backgrounds and women from certain racial or ethnic groups. However, more data collection and interpretation are needed to understand why.
  • Of the 53 maternal deaths that were not pregnancy-related, most were due to motor vehicle accidents, drug overdoses, homicide or suicide. The nonpregnancy-related death rate for American Indian or Alaska Native women was eight times higher than for Hispanic and white women.

The challenge ahead is to determine how to help more women have a healthy and safe pregnancy, delivery and recovery.

To this end, the MMRP developed eight recommendations to prevent pregnancy-related deaths and improve women’s health care services:

  • Improve care for pregnant women who have a high body mass index.
  • Standardize treatment for women with ectopic pregnancies, which are pregnancies that occur outside the uterus. Deaths due to ectopic pregnancy should be preventable if identified early, treated promptly and given adequate follow-up.
  • Expand access to and continuity of health care coverage for all women and children.
  • Improve access to substance use treatment and mental health services for pregnant and postpartum women.
  • Improve and expand efforts to provide effective follow-up care for women during all points of pregnancy and through the first year postpartum.
  • Improve health equity and reduce racial and ethnic, socioeconomic and geographic disparities in maternal mortality.
  • Improve maternal death investigations.
  • Coordinate efforts with other state and nongovernmental agencies that share a focus on preventing maternal deaths and improving maternal health.

“The findings of the MMRP emphasize the complexity surrounding maternal deaths in our state,” Bates said. “If we want to get to the root cause of maternal deaths and save lives, we have to first understand all the factors involved. We want all women to have access to the care they need so they can stay healthy and safe throughout their pregnancy and after they deliver their babies.”

For more information about the maternal mortality review process, the MMRP at the Department of Health and to read the report, please visit: www.doh.wa.gov/maternalmortality.

Gov. Jay Inslee with supporters of Senate Bill 6534 on April 1, 2016, after he signed the bill creating a state Maternal Mortality Review Panel. The panel studies the deaths of pregnant women and women who died during the year following their pregnancy. (Legislative Support Services photo)