DiversityNursing Blog

Maternal mortality remains one of the most critical public health challenges worldwide, with millions of women still facing life-threatening complications during pregnancy and childbirth. In the United States, maternal mortality rates are alarmingly high compared to other developed countries, and these numbers are disproportionately worse among Black, Indigenous, and Hispanic women. The factors contributing to maternal deaths include limited access to healthcare, inadequate prenatal care, underlying health conditions, and systemic inequities within healthcare systems. However, Nurse Midwives are emerging as key players in addressing this crisis.

Nurse Midwives are uniquely positioned to improve maternal outcomes. Their focus on providing holistic, patient-centered care is critical in preventing and managing complications, particularly for underserved communities. Here’s how they can help reduce maternal mortality rates:

Providing Comprehensive, Personalized Care

Nurse Midwives provide personalized, compassionate care that focuses on the entire woman—physically, emotionally, and socially. They take the time to build trusting relationships with patients, promoting open communication. This is particularly important for women in marginalized communities, who often face biases and discrimination in healthcare settings. By fostering trust, Midwives help ensure patients feel comfortable seeking care early and frequently during pregnancy, which is essential for identifying and managing complications.

Addressing Disparities in Healthcare Access

One of the leading contributors to maternal mortality is a lack of access to quality prenatal and postpartum care. Nurse Midwives often serve in underserved areas, such as rural communities or inner cities, where healthcare facilities may be scarce. Their ability to work in various settings—hospitals, birthing centers, and patients' homes—makes them accessible to a wider population. Furthermore, they can provide cost-effective care, which is critical for uninsured or underinsured women, ensuring financial barriers don’t prevent them from receiving life-saving interventions.

Expertise in Preventive Care and Early Intervention

Nurse Midwives emphasize preventive care and early intervention, both of which are key to reducing maternal deaths. They monitor women throughout pregnancy, helping to identify risk factors such as preeclampsia, gestational diabetes, or infections that could lead to severe complications if untreated. With their expertise, they can intervene early and either manage these conditions themselves or collaborate with Obstetricians and other specialists when necessary.

Promoting Safer Birth Practices

Nurse Midwives are strong advocates for evidence-based, low-intervention birth practices, which can significantly reduce the risk of complications during childbirth. For example, they support natural birthing methods and focus on minimizing unnecessary cesarean sections, which carry higher risks for infection, hemorrhage, and complications in future pregnancies. Their expertise allows them to balance safety with the mother’s birthing preferences, creating a safer and more empowering experience for women.

Providing Critical Postpartum Care

Postpartum care is often overlooked, yet it is a crucial period for preventing maternal deaths. Midwives are trained to provide extensive postpartum care, addressing both physical recovery and mental health. This includes monitoring for conditions like postpartum hemorrhage or infections and supporting mothers in managing the emotional challenges of the postpartum period. By continuing to provide care well beyond childbirth, Midwives can help identify and treat complications before they become life-threatening.

Advocating for Systemic Change

Beyond their clinical work, Nurse Midwives are strong advocates for healthcare reform. They are pushing for policies that improve maternal care across the board, including expanding Medicaid coverage for postpartum care, increasing access to Midwifery services, and addressing racial and socioeconomic disparities in healthcare. Their voices are essential in driving systemic change to reduce maternal mortality on a larger scale.

Nurse Midwives are crucial in the fight against maternal mortality. Their holistic, patient-centered approach to care, combined with their advocacy for systemic change, makes them invaluable in improving maternal outcomes. As we continue to seek solutions to this public health crisis, investing in and expanding access to Nurse Midwifery care is one of the most effective strategies we can employ. By empowering Nurse Midwives and supporting their efforts, we can save lives and create healthier futures for women and their families.

Women of color in the United States suffer unacceptably poor maternal health outcomes, including high rates of death related to pregnancy or childbirth.

The Pregnancy Mortality Surveillance System started in 1987 and since then, the number of reported pregnancy-related deaths in the United States increased from 7.2 deaths per 100,000 live births to 17.2 deaths per 100,000 live births in 2015.

Considerable racial/ethnic disparities in pregnancy-related mortality exist. During 2011–2015, the pregnancy-related mortality ratios were—

• 42.8 deaths per 100,000 live births for black non-Hispanic women.
• 32.5 deaths per 100,000 live births for American Indian/Alaskan Native non-Hispanic women.
• 14.2 deaths per 100,000 live births for Asian/Pacific Islander non-Hispanic women.
• 13.0 deaths per 100,000 live births for white non-Hispanic women.
• 11.4 deaths per 100,000 live births for Hispanic women.

Variability in the risk of death by race/ethnicity indicates that more can be done to understand and reduce pregnancy-related deaths.

According to a report from the Centers for Disease Control and Prevention, African American mothers die at a rate that's 3.3 times greater than whites, and Native American or Alaskan Native women die at a rate 2.5 times greater than whites.

Pregnancy-related mortality rates are also high among certain subgroups of Hispanic women. A Science Direct article says, pregnancy-induced hypertension was the leading cause of pregnancy-related death for Hispanic women.

The CDC report also shows roughly 3 in 5 pregnancy-related deaths are preventable. But, the health care system fails to listen to diverse population's health concerns and so the maternal mortality rate keeps rising.

According to the Healthy People Final Review, Approximately 25% of all U.S. women do not receive the recommended number of prenatal visits.  This number rises to 32% among African Americans and to 41% among American Indian or Alaska Native women.

An article from the Center for American Progress believes there is little research on what social factors contribute to poor delivery and birth outcomes for American Indian and Alaska Native women because of the small population size and racial misclassifications. But they do know these women face many barriers when it comes to getting healthcare.

The National Partnership for Women & Families explains African American women experience more maternal health complications. 

• African American women are three times more likely to have fibroids than white women. Fibroids are benign tumors that grow in the uterus and can cause postpartum hemorrhaging. Also the fibroids occur at younger ages and grow more quickly for African American women.
• African American women display signs of preeclampsia earlier in pregnancy than white women. Preeclampsia involves high blood pressure during pregnancy and can lead to severe complications including death if not properly treated.
• African American women experience physical “weathering,” meaning their bodies age faster than white women’s due to exposure to chronic stress linked to socioeconomic disadvantage and discrimination over the life course, this makes pregnancy riskier at an earlier age.

The CDC report also shows that more than a third of pregnancy-related deaths were due to cardiovascular conditions. Cardiovascular disease is more common among black women and can occur at earlier ages than in white women.

It is very clear that health disparities have a lot to do with racism. Until it is addressed and programs are put in place to combat racism in healthcare, mortality rates will continue to rise.

NPR and ProPublica launched an investigation on America's rising maternal mortality rates. More American women are dying of pregnancy-related complications than any other developed country. 

The United States saw a 26.6% increase in maternal deaths from 2000 to 2014, according to a recent study published in Obstetrics & Gynecology.

Racial disparities make these trends even more distressing. According to the Centers for Disease Control and Prevention, African-American women are almost four times more likely to die of pregnancy complications. Maternal mortality is also more common for low-income women and women living in rural areas.

Only about 6 percent of the nation’s Ob–Gyns work in rural areas, according to the latest survey numbers from the American Congress of Obstetricians and Gynecologists (ACOG). Yet 15 percent of the country’s population, or 46 million people, live in rural America. As a result, fewer than half of rural women live within a 30-minute drive of the nearest hospital offering obstetric services. Only about 88 percent of women in rural towns live within a 60-minute drive, and in the most isolated areas that number is 79 percent.

The ProPublica investigation shows, America has not published official maternal mortality statistics in more than a decade. So we are forced to rely on incomplete estimates because the data needed to determine exactly how many women are dying, and from what causes, go uncollected.

Many states have created Maternal Mortality Review Committees (MMRCs). Maternal and public health experts analyze maternal deaths and propose ways to prevent similar deaths. The data from these MMRCs have revealed that more than half of maternal deaths are preventable. 

California created its MMRC in 2006 and reduced its maternal mortality rate by more than 55% to 4.5 per 100,000 live births, far lower than the national average. It was accomplished by using its data to design safety resources and tool kits aimed at the most common causes of maternal death in the state. For example, excessive bleeding and complications of high blood pressure, such as preeclampsia are common causes. Many states have not set up MMRCs due to lack of funding.

There are multiple reasons for a rising maternal mortality rate in the U.S. New mothers are older than they used to be, with more complex medical histories. Half of pregnancies in the U.S. are unplanned, so many women don't address chronic health issues beforehand. Greater prevalence of C-sections leads to more life-threatening complications. The fragmented health system makes it harder for new mothers, especially those without good insurance, to get the care they need. Confusion about how to recognize worrisome symptoms and treat obstetric emergencies makes caregivers more prone to error.

While most developed countries are making strides in preventing maternal-related deaths, the United States is falling behind. Addressing the causes of maternal mortality as well as contributing factors and underlying problems is a national concern. Health care professionals are the first line of defense for reversing this lethal trend.

Do you have any experiences or thoughts you’d like to share on this topic? Perhaps something you practice that would be helpful to other Nurses in a critical delivery situation?