MMRC ) critically reviews the cause of all maternal deaths that occur during or within a year following a pregnancy in the state of Kentucky . The most recent year for which we have complete data is 2018 . 5 Of the 76 deaths that were reviewed that year , 92 % were deemed preventable , and 52 % were linked to substance-use . 5 Although this is a shocking statistic , the fact that these deaths are preventable means that we have the power to change and improve the system .
The national and state maternal mortality rates also show large racial disparities . In 2020 , the national rate for non-Hispanic Black individuals was 55.3 deaths per 100,000 live births , almost three times the rate of non-Hispanic white individuals at 19.1 deaths per 100,000 live births . 1 The rate for Hispanic individuals was 18.2 . 1 In 2018 , pregnancy-related deaths for non-Hispanic Black mothers in Kentucky were 40.2 deaths per 100,000 and 13.1 for non-Hispanic white moms . The raw numbers for this statistic are two Black pregnancy related deaths and six white pregnancy related deaths in Kentucky in 2018 . 5 Kentucky ’ s population is 87.5 % white / Caucasian , 8.5 % Black / African American , and 3.9 % Hispanic ( U . S . Census Bureau ). The majority of both non-Hispanic Black women and non-Hispanic white women live in metropolitan areas close to the high-tech , academic medical centers full of specialists . Despite the fact that both groups have access to the same providers and hospitals , there are obvious disparities between their maternal mortality rates . Racism and poverty compound the issue , with many women less likely to have time , money and transport - or enough trust in the system - for prevention and treatment . And the intersection of sexism and racism can mean women of color are not listened to or respected by health care personnel , contributing to preventable morbidity and mortality due to delayed diagnosis or care . Prioritizing the health care of mothers , discovering the causes of disparities and eliminating such disparities should be the number one priority of the state of Kentucky and of the U . S . as a whole .
This problem does not stop at maternal mortality . The rate of severe maternal morbidity ( SMM ) is also increasing . SMM includes unexpected outcomes or complications of labor and delivery that result in significant short-term and / or long-term consequences to a woman ’ s health . 8 This can include hemorrhage , sepsis , embolism , cardiovascular disorders , eclampsia and renal failure . From the physician ’ s point of view , these are the near misses . A postpartum hemorrhage that required eight units of blood and a stay in the ICU could have been a mortality statistic , instead it is a near miss . For every pregnancy-related death , there are 70 SMM or near misses . 8 The danger of an SMM persists after discharge and extends into the first-year postpartum . 8 Currently , there is not a mechanism in Kentucky to track SMM . Future work in this area will need to start with developing a method to identify and document SMM statewide .
There are racial disparities as well as differences in treatments that affect a woman ’ s likelihood of experiencing SMM . The chance of developing SMM is 1.7 times more likely for non-Hispanic Black women than for non-Hispanic white women . Furthermore , women who have Caesarean sections ( C-section ) are more likely to experience an SMM . A recent look at our own Kentucky Medicaid data revealed that women insured by Kentucky Medicaid who experience an SMM were 20.5 times more likely to die within the year following the birth than moms who did not ( unpublished Kentucky Medicaid data ). To further exacerbate this problem , C-section deliveries have increased over the last two decades . 9 In 2020 , 31.8 % of births nation-wide and 34.3 % of births in Kentucky were delivered by C-section . 9 Partnering with hospital systems and providers to find ways to safely decrease C-sections can go a long way to decrease SMM .
Maternal health has also been impacted by the recent pandemic . Pregnant women with a SARS CoV-2 ( COVID-19 ) infection are at an increased risk of preterm delivery , stillbirth and other pregnancy complications . They are also at a higher risk of developing a more severe COVID-19 infection leading to an ICU admission , the need for mechanical ventilation or placement on ECMO . 10 , 11 The safest thing expecting moms can do to avoid serious illness is to stay up to date with their COVID-19 vaccines , including getting an updated booster shot . 12
Among pregnancy-related deaths with information on timing , 22 % of deaths occurred during pregnancy , 25 % occurred on the day of delivery or within seven days after and 53 % occurred between seven days to one year after delivery . 13 The overwhelming majority of pregnancy-related deaths are preventable with cardiovascular issues being the primary cause of death for new mothers . However , instances of suicide and homicide are also increasing ; 8.4 % of deaths reviewed by the Maternal Mortality Review Committees ( MMRC ) in 2017-2019 were caused by suicide and 2.9 % were caused by homicide . 14 In the last seven years , 6.2 % of Kentucky ’ s maternal deaths have been deemed a suicide . 5 I believe this number is likely much higher because in Kentucky , suicide deaths require clear evidence of intent such as a history of suicidal ideation documented in a note . 5 Many deaths are determined to be accidental , especially drug overdose deaths , that may in fact be suicides .
The most recent Kentucky Maternal Mortality Report found that substance-use was a contributing factor in 53 % of the accidental maternal deaths in 2018 and may have been a contributing factor in an additional 14 % of these deaths . Whether the death is caused by overdose or suicide , the behavioral health crisis in Kentucky has expanded into the maternal health population . One thing we can do is screen patients for depression and substance-use disorders . If the screen is positive , providers can connect the patient to the appropriate resources . One in three new moms receiving Kentucky Medicaid benefits visits the emergency department within the year following delivery ( unpublished Kentucky Medicaid data ). In 2018 and 2019 , the number one reason for readmission to the hospital within 90 days of delivery was suicidal ideation ( unpublished Kentucky ( continued on page 22 )
January 2023 21