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Maternal Mortality and Post-Delivery Warning Signs

Unlike women in the rest of the developed world, women in the United States remain at greater risk of dying from pregnancy or childbirth-related complications, according to the Centers for Disease Control and Prevention (CDC). Based on 2021 data from the National Vital Statistics System, 1,205 women died in the United States due to a pregnancy or childbirth-related complication, an increase from 861 women in 2020 and 754 in 2019. Black women continue to lose their lives at substantially higher rates than White and Hispanic women. The maternal mortality rate for Non-Hispanic Black women was 69.9 per 100,000 live births compared to non-Hispanic White women at 26.6 and Hispanic women at 28.0.

The most common causes of pregnancy-related deaths include other cardiovascular conditions, sepsis/infection, cardiomyopathy, hemorrhage, embolism, and other non-cardiovascular medical conditions. Substance use disorder overdose-related poisoning is a mental health condition associated with maternal mortality that typically occurs late (43 – 365) days postpartum. Age is another factor in maternal mortality. In 2021, the rate for women under 25 was 20.4 deaths per 100,000 live births. For women aged 25–39, rates were 31.3. For women over the age of 40, the rate increased to 138.5.

Post-delivery is an important time to make sure mom and baby are healthy. Education is vital to successfully reduce and prevent maternal mortality and morbidity. Through education, Arkansas women and their family members are empowered to recognize and report potentially life-threatening complications.

New mothers should be encouraged to trust their instincts about their bodies. Moms must be aware of the many changes their body goes through during pregnancy and delivery. While there will be discomfort, soreness, and fatigue, moms must be aware of the conditions that need immediate medical attention.

There are numerous efforts to improve maternal health and reduce maternal mortality in Arkansas. Hospitals throughout the state are implementing Maternal Safety Bundles, which require action measures to prevent maternal mortality and morbidity. The Maternal Safety Bundles include obstetrical hemorrhage, severe hypertension/preeclampsia, venous thromboembolism, reduction of low-risk primary cesarean births, reduction of peripartum racial disparities, and postpartum care access and standards.

Arkansas is now an AIM state! In 2022, Arkansas became the 48th state to join the Alliance for Innovation on Maternal Health (AIM). A quality improvement initiative to support best practices that make birth safer, improve maternal health outcomes, and save lives. AIM develops multidisciplinary, clinical-condition-specific patient safety bundles to support best practices.

In 2023, Arkansas will launch its first state Perinatal Quality Collaborative (PQC). PQCs are state networks of hospital teams working to improve maternal outcomes. State PQCs partner with hospitals, providers, patients, public health, and other stakeholders to provide opportunities for education, information, data sharing, and quality improvement support to achieve systems-level change. The first PQC initiative will focus on reducing primary cesarean delivery rates.

The Arkansas Maternal Mortality Review Committee (AMMRC), formed in 2020, helps to ensure the collection and accurate interpretation of maternal deaths in Arkansas. The committee performs comprehensive reviews of maternal deaths that occur during pregnancy or within one year of the end of a pregnancy. The AMMRC is tasked with developing clinical recommendations to improve maternal outcomes. AMMRC reports can be found on the Arkansas Department of Health website.

The CDC’s HEAR HER campaign was developed to prevent pregnancy-related deaths that may occur during or after a pregnancy. Women understand their own bodies and often know when there is something wrong. HEAR HER is a campaign encouraging everyone, including family, friends, and health care providers, to listen when a pregnant or postpartum woman expresses that something does not feel right. Quick action can save her life.

Educational materials regarding post-delivery warning signs are provided by AFMC and Arkansas Medicaid. If you are interested in these materials, please contact This email address is being protected from spambots. You need JavaScript enabled to view it.. Together, we can make a difference and decrease the number of families tragically affected by maternal mortality.

Kamilah's Story

Web Resources

Alliance for Innovation of Maternal Health
https://saferbirth.org/

America's Health Rankings: Health of WOmen and Children Report, 2022
https://www.americashealthrankings.org/learn/reports/2022-health-of-women-and-children-report

America’s Health Rankings: Maternity Practices Score in Arkansas, 2021
https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/mPINC_a/state/AR?edition-year=2021

Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)
http://www.awhonn.org/
https://awhonn.org/education/hospital-products/post-birth-warning-signs-education-program/

Arkansas Department of Health Maternal Mortality Review Committee
https://www.healthy.arkansas.gov/programs-services/topics/arkansas-maternal-mortality-review-committee

California Maternal Quality Care Collaborative (CMQCC)
https://www.cmqcc.org/

The American College of Obstetricians and Gynecologists Women’s Health Physicians (ACOG)

(ACOG website works best on current web browsers Firefox, Chrome, and Edge)

Maternal Mortality
https://www.acog.org/search#q=maternal%20mortality&sort=relevancy&f:topic=[Maternal%20mortality]

Maternal Mortality in the United States
Recent Trends, Current Status, and Future Considerations
https://journals.lww.com/greenjournal/Fulltext/2021/05000/Maternal_Mortality_in_the_United_States__Recent.3.aspx

Centers for Disease Control (CDC)

Association of Mental Health Conditions, Recent Stressful Life Events, and Adverse Childhood Experiences with Postpartum Substance Use — Seven States, 2019–2020 Weekly/April 21, 2023 / 72(16);416–420 https://www.cdc.gov/mmwr/volumes/72/wr/mm7216a1.htm?s_cid=mm7216a1_e&ACSTrackingID=USCDC_921-DM103802&ACSTrackingLabel=This%20Week%20in%20MMWR%20-%20Vol.%2072%2C%20April%2021%2C%202023&deliveryName=USCDC_921-DM103802

Hear Her Campaign
https://www.cdc.gov/hearher/index.html

Maternal Mortality Rates in the United States, 2021 
https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm

Pregnancy Mortality Surveillance System
https://www.cdc.gov/prams/index.htm

Institute for Perinatal Quality Improvement (PQI)

https://www.perinatalqi.org/

https://www.perinatalqi.org/page/PPDischargeEdu

March of Dimes

https://www.marchofdimes.org/ResponseCDC2021MaternalMortalityReport

https://www.stoptheclot.org/spreadtheword/hospitalization/

MERCK For Mothers

http://merckformothers.com/

National Public Radio (NPR)

‘Near Miss’ Mothers: The Risk of Childbirth in America │ NPR
https://www.youtube.com/watch?v=I5Dsn4obCa4&feature=youtu.be

Review to Action

Working Together to Prevent Maternal Mortality
http://reviewtoaction.org/

University of Arkansas for Medical Sciences (UAMS) Institute for Digital Health & Innovation (IDHI) High-Risk Pregnancy Program

Patient Education
https://patientslearn.uams.edu/featured-topics/pregnancy-childbirth/

Post-delivery warning signs interactive video
http://learntelehealth.org/modules/Post%20Delivery%20Warning%20Signs/story_html5.html?lms=1

Provider Education, Programs, and Services
https://idhi.uams.edu/high-risk-pregnancy-program/healthcare-providers/community-outreach-education/

Revised May 2023 

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