With federal data showing a surge in deaths among pregnant women during the pandemic, California supporters say it strengthens their resolve to continue trying to prevent as many of these deaths as possible.
The National Center for Health Statistics said on Thursday that 1,205 pregnant women died in the United States in 2021, up 40% from 861 deaths in 2020. In 2019, there were 754.
Pregnant black women continued to be at the highest risk of death, according to the report. In 2021, the maternal mortality rate for black women was 69.9 deaths per 100,000 live births, 2.6 times that of white women (26.6 deaths). Among Hispanic women, there were 28 deaths per 100,000 live births, according to the report.
The report did not list causes of death or provide data by state, but a federal government accountability office report released in October showed that a quarter of maternal deaths in 2020 and 2021 were attributable to COVID-19.
“We were afraid to see the real numbers,” the doctor said. Elliott Maine, medical director of the California Maternal Health Quality Assurance Alliance, which brings together government agencies, hospitals and health care provider associations to find ways to prevent pregnancy complications and death.
“It kind of overwhelms all the other work that we did to deal with hypertension deaths, bleeding deaths and blood clotting deaths,” Maine said. “All of them are now overwhelmed or minimized by the pandemic.”
In recent years, California has become a national leader in reducing maternal mortality. Speed maternal mortality in California in 2006 it was 16.9 per 100,000 live births, according to the California Collaboration for Quality Maternity. By 2016, the indicator had decreased by 65%.
Was 18.6 maternal mortality per 100,000 live births in 2020 in California, up from 12.8 in 2019, according to the state Department of Public Health.
Among pregnant women in California, cardiovascular disease was the leading cause of death between 2018 and 2020, followed by hemorrhage, sepsis, thrombotic pulmonary embolism, and amniotic fluid embolism. More than a quarter of deaths occurred on the day of birth.
According to Sonia Young Adam, executive director of the California Black Women’s Health Project, a non-profit organization based in Inglewood, few people know how high maternal mortality is.
She said it’s “amazing and hard” to hear stories all the time from black people who reminisce about failed births that happened to them, or family members with complications, or doctors who didn’t listen to them. Too often, she said, these stories involve the person feeling something is wrong before, during, or after childbirth.
But even in the absence of awareness, Adam said she and other advocates are trying to walk a fine line, educating black communities about maternal deaths and pregnancy complications without causing fear to the point that people refuse to get pregnant.
“It informs our community that they do have a voice and helps build advocacy capacity around it so people don’t walk away from the situation wondering, ‘What did I do?’ “” said Adam. “[It’s so] they come armed and ready to demand joyful childbirth, which they should be able to enjoy in any health care system in the state. We now know that this is not possible.”
The new report comes as families, health advocates and healthcare providers are raising alarm over the number of deaths and pregnant women who have not received the physical, emotional and social support they needed during the pandemic. Pregnant women often had to be isolated in hospitals to prevent potential exposure to COVID-19, limiting possible support in hospital wards.
Parent support groups and communities have moved from in-person calls to Zoom calls for the sake of social distancing. Some pregnant women were unable to maintain social distancing because they were essential workers and exposed to COVID-19. In addition, public health leaders at the federal, state, and county levels throughout the pandemic have struggled with the spread of messages to encourage more pregnant people to get vaccines for COVID-19.
Maine said that women who give birth today are “much more difficult patients than we were giving birth 20, 30, 50 years ago” because many of them are 35 years old and older and come with high blood pressure, diabetes or other problems, which can complicate pregnancy.
According to a federal report, there are 20.4 deaths per 100,000 live births in women under 25, 31.3 in women aged 25 to 39, and 138.5 in women aged 40 and over.
When it comes to narrowing the massive death gap between black and white mothers, Maine said part of it comes down to differences in rates of high blood pressure, diabetes and obesity. He also mentioned the “weathering impact” on black health from years of constant exposure to racism. But implementing protocols that all healthcare professionals must follow for every patient can help reduce complications.
“When you start to enter[to] subjective decision-making that is… biased,” Maine said. “The more we can reduce some of the subjective decision making, the better we can reduce inequality.”
Part of the work of the California Maternal Quality Care Collaborative included helping develop the bleeding carts now available in every hospital in the state so that health care workers can quickly help if a mother is bleeding rapidly. The collaboration also worked with health care providers to develop protocols for helping mothers experiencing high blood pressure after childbirth, known as preeclampsia.
In recent years, California has also extended Medi-Cal benefits for new parents to 12 months after birth and now allows doulas to become qualified Medi-Cal providers.
Doulas are considered a key part of providing emotional and physical support and advocacy for mothers before, during, and after childbirth, especially for black women. The State has also established a fund for midwifery education programs that prioritize the admission of underrepresented groups.
The California Black Women’s Health Project has launched training for black midwives and created a set of business tools to help them get started and have support circles for midwives across the state. The organization is also developing training to help midwives apply to become a Medi-Cal provider.
The organization has also been a financial sponsor to help women in childbirth receive funding from the Los Angeles County Department of Public Health. Despite the progress made, more “shameless investment” in black-focused community efforts is needed, Adam said.
“There are many, many, many, many of us who may even die from this Earth before this problem is really solved,” Adam said. “It’s going to take time, but no matter how we save someone along the way, that’s what we’re trying to do to reduce these stories – to arm our sisters with someone who will be there for them and a support team around them.”