Earlier this year, the Centers for Disease Control released its official maternal mortality rate, and it was grim: 17.4 deaths per 100,000 births in 2018, with 658 maternal deaths total. This places us as the worst among wealthy nations, and 55th among all countries globally.

It’s still hard to comprehend the fact that, despite having some of the most advanced care in the world, we also have some of the highest maternal complications and death rates. Studies have shown that pregnant women in the U.S. today have 40% higher rates of chronic medical conditions such as high blood pressure, Type 2 diabetes, heart disease and obesity than they did in the past—a much higher rate than those in other industrialized nations. As a result, they’re more likely to develop complications such as pre-eclampsia and blood clots during pregnancy, both of which are leading causes of maternal death.

Another reason for maternal death may lie within our health insurance system. About 11% of women still lack health insurance, and we know that women without it are up to four times more likely to die of pregnancy-related complications than their insured counterparts. But even those who do have insurance often don’t get the access they need; for example, we have a real lack of integration between maternity care and primary care. As a result, many women go into pregnancy with poorly controlled underlying health conditions.

But the most significant issue to address is racial disparity. According to the Centers for Disease Control (CDC), African American women are two and a half to three times more likely to die from childbirth than non-Hispanic white women—even when other factors are controlled, such as socioeconomic status and education level. We’ve also seen this in the recent COVID-19 pandemic, which has disproportionately affected Black Americans. These social injustices must absolutely be addressed.

High rates of cesarean sections (C-sections) in the U.S. also need to be dealt with. About a third of all pregnancies in the United States result in C-sections, compared to only a little over a quarter in Western Europe, according to a 2018 Lancet study. But these procedures raise the risk of bleeding, blood clots and other complications, which increase the potential for major health issues and even death.

Our national obstetrical organizations are well aware of this and have worked tirelessly to address many of these causes. Much work has been accomplished to standardize clinical care, but we need to do much more to address both racial disparities and the management of medical comorbidities, or pre-existing conditions, during pregnancy.

Here at Northwell, we’re introducing the Northwell Maternity Outcomes and Morbidity Collaborative (MOMS), an integrated system that draws on the expertise of patients, community-based organizations, public health experts and clinicians from multiple specialties in an effort to lower maternal morbidity and mortality. Key components include:

• Ongoing engagement with patients during their pregnancy. We do this through routine contact via chat bots, telephone calls and telehealth. The chats are designed to promote education and ask questions that will help identify comorbidities that can be addressed early on, before they require extensive intervention.
• Enhanced birth preparedness. We’re working with outpatient practices and community-based organizations—especially those that serve at-risk populations—to create classes that promote preparedness throughout pregnancy, birth and parenting.
• Training in implicit bias. We know that social factors and racism play a big role in adverse outcomes. One way to address this is to train OB/GYN staff in implicit bias—unconscious bias that impacts the way we interact with patients who are “different” from us.
• Promoting practices that can positively impact pregnancy outcomes. For example, research has shown that taking low-dose aspirin at the end of the first trimester can help reduce a woman’s risk for pre-eclampsia, which African American women are disproportionately prone to. Strategies to promote vaginal delivery—including induction of labor in the 39th week of pregnancy—may help drive down the C-section rate, which leads to fewer potential complications.
• Staying in touch post-delivery. We’re looking at ways to use technology to follow up with patients in the months to years after they have given birth. Women who experience complications during pregnancy are more likely to have underlying health conditions that crop up again during subsequent pregnancies, so if we’re proactive, we’ll improve their chances of a better pregnancy in the future.

We’re committed to working in collaboration with our clinical, public health and community-based partners to improve the health and wellness of the women and families we care for. It’s a daunting task, but if we all work together to reduce health care disparities, we can help ensure that all women—including those at higher risk—get the care they need for a healthy pregnancy and a safe labor and delivery. Our community deserves no less.