The proportion of women who experience severe and potentially deadly complications while giving birth in U.S. hospitals has risen dramatically over the past decade, according to a government report released last week by the Agency for Healthcare Research and Quality (AHRQ).
The rate of severe complications, including kidney failure, blood clots, sepsis and blood transfusions (an indicator of hemorrhaging), increased 45 percent between 2006 and 2015, the report found. In 2006, the rate was 101 medical complications per 10,000 hospital deliveries. By 2015, it had jumped to 147 per 10,000.
Some of the severe conditions result in medical procedures. For example, during the year 2015, blood transfusions were given to women in more than half of deliveries in which the women were in shock, had an amniotic fluid embolism, were experiencing a sickle cell disease crisis or developed blood clots. And among the women who went into shock, a third had a hysterectomy.The highest rates of complications were among mothers who were poor, uninsured or on Medicaid, living in large urban areas, or over the age of 40. The report also identified significant racial and ethnic disparities. Childbirth-related complications were 110 percent more likely among black women and 40 percent more likely among Hispanic women than among white women.
The report notes that although the rate of childbirth-related deaths decreased for women of all races and ethnicities during the 10 years of the study, black women were three times more likely than white women to die as a result of delivering a baby in 2015.
Women in the United States die during pregnancy and childbirth at a higher rate than in any other country in the developed world, other reports have noted. An American woman is three times more likely to die during childbirth than a woman in Canada, for example, and six times more likely than a woman in Sweden.
And for every woman who dies from childbirth in the U.S, at least 70 nearly die of complications.
The findings in the AHRQ report did not surprise Katy Kozhimannil, an associate professor at the University of Minnesota who has done extensive research on health policies that affect pregnancy and childbirth outcomes.
“It’s very consistent with other data that we’ve seen,” she told MinnPost. “But at the same time, it’s remarkable to me that moms are doing worse and worse over time, and so much worse than in other countries.”
“I can’t believe that this is where we are,” she added.
The AHRQ report doesn’t identify reasons for the steady rise in childbirth complications. Other reports, however, have cited as leading causes such patient-related factors as women giving birth at older ages and the higher number of pregnant women with pre-existing conditions, such as obesity, diabetes and high blood pressure.
Access to quality care — during pregnancy, during childbirth and in the postpartum period — is also a major factor, however.
Low-income women, even those who have insurance through Medicaid, are confronted with many barriers to accessing quality care, Kozhimannil stressed.
“Some of the barriers to care for people during pregnancy are transportation,” she pointed out. “Can you get from where you live to where you have to go to receive care? And can you take off from work? Do you have flexible work arrangements that allow you to go?”
Kozhimannil also noted that states vary in the amount they will pay through their Medicaid programs for medical care during pregnancy and childbirth.
“That affects whether or not a woman is able to find a provider who is willing to take her health insurance,” she said.
So, although individual patient factors, such as age and health-related behaviors, explain part of the recent rise in childbirth-related complications, they do not fully explain this troubling trend.
A systemwide failure
“The solution is not that women shouldn’t have a baby if they’re over a certain age or if they’re obese,” said Kozhimannil. “The solution has to be getting patients and systems to work together to ensure the healthiest possible pregnancies.”
“Generally, the data show that the system is failing the people rather than the people are failing the system,” she added.
The importance — and effectiveness — of changing systemic factors can be seen in California, which has cut its rate of childbirth-related deaths in half since 2006 through a systemwide overhaul of how women are treated throughout pregnancy and childbirth.
California was able to implement those life-saving changes by collecting and studying detailed data on pregnancy- and childbirth-related complications and death.
Minnesota is not yet doing that data collection, said Kozhimannil. “I wish we were,” she said.
Minnesotans like to think of their state as being progressive on health matters, but it’s not always true, she added.
“In Minnesota, our racial disparities are pretty regularly alarming given our overall good rates of health,” Kozhimannil said. “I don’t think it’s very Minnesotan to accept, for example, that black and American Indian babies are twice as likely to die in their first year of life as white babies.”
“Yet, that’s what our own data from the Minnesota Department of Health have shown,” she added.
FMI: You can read the AHRQ report on that agency’s website.