Maternal Mortality in Tennessee

Tennessee

The World Health Organization (WHO) defines maternal mortality as “female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.” The maternal mortality rate in the United States has risen steadily since 1990, and the U.S. consistently has the highest rate among high-income countries. Moreover, there has been a substantial increase in maternal deaths since the beginning of the COVID-19 pandemic. Substantial disparities in maternal mortality persist by race and ethnicity. 

The Centers for Disease Control and Prevention (CDC) monitors pregnancy-related mortality at the national level. Their surveillance expands the follow-up period to within one year of the end of pregnancy and conducts thorough reviews of each death. The leading causes of pregnancy-related deaths in the U.S. are cardiovascular diseases, infection or sepsis, hemorrhage (bleeding), hypertensive disorders (high blood pressure) and other non-cardiovascular medical conditions, including mental health conditions. According to the CDC, cardiovascular conditions account for more than one-third of perinatal mortality. Complications with cesarean deliveries also play a role in maternal mortality. A recent study broke down the most common causes of maternal mortality by race and ethnicity, which were:

• Cardiovascular and coronary conditions among non-Hispanic Black mothers.
• Mental health conditions among non-Hispanic white and Hispanic mothers.
• Hemorrhage among non-Hispanic Asian mothers.
• Mental health conditions and hemorrhage among American Indian/Alaska Native mothers.

The maternal mortality rate is higher among: 

• Black and American Indian/Alaska Native women compared with Asian/Pacific Islander, Hispanic and white women.
• Women without any college education. However, racial and ethnic disparities eclipse differences in education level, with college-educated Black women still experiencing far higher maternal mortality rates than white and Hispanic women without a high school education.
• Women ages 40 and older, who have a maternal mortality rate nearly 16 times that of mothers under 40.
• Women who live in rural areas compared with those who live in urban areas. Hospital closures in rural areas have decreased access to services such as obstetrics, further contributing to difficulties in maternal care. 

According to the WHO, the majority of maternal deaths resulting from pregnancy-related complications are preventable. Most pregnancy-related deaths could be prevented by improving the quality of medical care. Approaches to reducing and preventing maternal mortality include:

• Preconception health: A healthy pregnancy begins before conception. Improving women’s health by preventing and treating chronic disease may result in healthier pregnancies with fewer complications.
• Collaboration with midwives and doulas: A study found that incorporating midwives as part of the care team during pregnancy, labor, delivery and postpartum recovery is associated with better maternal health outcomes. Areas without nearby hospital services in particular may benefit from midwifery care. 
• Medical care improvement: Improvements to hospital protocol and patient safety tools have been effective strategies to reduce maternal mortality. In one study, a collaborative hospital quality improvement program reduced severe maternal morbidity from hemorrhage. Systems to detect early warning signs during prenatal visits may prevent delays in diagnosing and treating conditions that lead to maternal death. The Alliance for Innovation in Maternal Health program offers quality improvement toolkits, maternal early warning system trainings and other resources to support and guide quality improvement efforts in health care facilities. 
• Maternal Mortality Review Committees (MMRCs): These committees are made up of various medical professionals tasked with identifying and investigating maternal deaths. They attempt to determine the preventability of maternal deaths and recommend focused approaches to prevent future deaths and reduce disparities in maternal mortality. Nearly all U.S. states have MMRCs, and many have established legislation requiring a review of maternal deaths. 

Many factors are likely associated with the increased risk of death among women of color. Efforts to improve access to high-quality care, reduce the prevalence of chronic conditions and address structural racism and implicit bias in health care may help reduce racial and ethnic disparities. The CDC provides actionable steps that individuals, health care providers, health systems, communities and states can take to reduce racial disparities in maternal mortality.

Reducing the maternal mortality rate is a Healthy People 2030 leading health indicator.

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