Data about maternal mortality can improve health outcomes

A few weeks ago, the U.S. Centers for Disease Control and Prevention released the National Vital Statistics Report on Maternal Mortality for 2018. Until fairly recently, gathering information about maternal mortality has been difficult and inconsistent, so making progress towards standardization of data collection is a welcome step toward improving outcomes for women.

Having said that, the numbers are grim: the CDC reports that 658 women, either pregnant or within 42 days of having given birth, died in 2018. 

Causes of death were most commonly due to preventable conditions like heart disease, infection, or hemorrhage around the time of birth. Yet, as if that statistic were not alarming enough already, an accurate count of maternal mortality is incomplete without another important data set: deaths in, or shortly after a pregnancy, that occurred as a result of suicide or homicide. 

Mental health is a monumental issue in this country, and not any less so for women during and after pregnancy. Perinatal mental health conditions like postpartum depression and anxiety are the cause of a significant number of maternal deaths annually. 

They can lead women to the brink of suicide or, worse yet, motivate them to take that fatal step. And while many may assume that the highest risk for women with either of these disorders is in the first few weeks after giving birth, studies have shown that the greatest risk window for women to commit suicide is 9 to 12 months after giving birth. 

While up to 80 percent of women may experience baby blues — sadness, occasional crying, feeling anxious over the maternal role — in the first few days and weeks after giving birth, postpartum depression is different and more severe. 

Postpartum depression affects at least 15 percent of women. Affected women may feel very anxious and sad, overwhelmed, and frustrated. They often have difficulty sleeping or eating, as well as just carrying out their daily activities. Hopelessness is often pervasive. Further, postpartum depression is severely underreported, as women tend to suffer in silence rather than tell even those closest to them. 

Another crucial mental health issue for pregnant and recently delivered women is postpartum anxiety. Postpartum anxiety has been reported to affect at least 10 percent of women, though recent studies purport the rate of anxiety among new mothers may actually be higher than that of postpartum depression. 

Often the woman with postpartum anxiety imagines the worst things that could happen to her baby, which can lead to obsessive behaviors. For example, she may experience obsessive thoughts about a baby dying of sudden infant death syndrome. 

These pervasive thoughts can then lead her to literally stand by her sleeping baby all night long to watch the baby’s breathing. The anxiety and obsessive thoughts can be crippling, yet are sometimes not taken as seriously by health care providers because providers may not be as familiar with postpartum anxiety as they are depression. 

Additionally, some pregnant and newly delivered women — especially women of color — are simply not safe. The CDC previously found that homicide is one of the leading causes of death for women under 44 years old; it is also one of the top causes of death in pregnancy, a factor not counted in the recent statistics. 

A spouse or partner is five times more likely to be a woman’s murderer than is a stranger. Ironically, the person who should be protecting the pregnant woman from harm is very often the person to cause her the ultimate harm. 

There is an old adage that says “the hand that rocks the cradle rules the world.” When a society invests the appropriate resources — health care, paid family leave, social support, mental health care — the health of mothers, and thus families, thrive. 

As this latest report notes, women do die during pregnancy and childbirth from common physical causes, no question. Yet it is also unquestionable that there are also mental health causes of maternal death, and any data collected for the purposes of getting to the root of maternal mortality must include mental health indicators — otherwise, we are missing a huge part of the bigger picture. 

Michelle Collins Ph.D. is a practicing certified nurse-midwife and an associate dean of Academic Affairs at Rush University College of Nursing. Aside from practice and administration, she also conducts research and teaches.