Older Age, High Blood Pressure, Diabetes Contribute to Growing U.S. Maternal Death Rate

CHICAGO – Many people would be surprised to learn that among developed countries, the United States not only has the highest rate of maternal mortality (death during pregnancy or within one year of birth), but that it increased 56% between 1990 and 2015. Older age and conditions such as diabetes, high blood pressure and obesity increase the risk, which is why the American Society of Anesthesiologists (ASA) says expectant mothers should talk with their obstetrician and physician anesthesiologist to develop a plan that ensures the safest pregnancy, childbirth and recovery.

“Thanks to the miracles of modern medicine more women are giving birth in their late 30s and 40s, but this does not come without some risk,” said ASA President Linda J. Mason, M.D., FASA. “Expectant mothers know they shouldn’t drink or smoke while pregnant, but many aren’t fully aware how important it is to focus on their overall health, for their safety as well as their baby’s. Older mothers, certain health conditions and multiple cesarean deliveries are some reasons the maternal death rate has risen. Physician anesthesiologists not only are experts in managing pain during and after childbirth, they work closely with obstetricians to combat the growing mortality trend.”

To ensure the safest care for you and your baby, ASA recommends the following:

• Take care of yourself: If you are older, overweight or have diabetes or high blood pressure, work closely with your physicians to address your condition prior to labor and delivery to ensure you understand all possible complications and have a plan. About halfway through your pregnancy meet with your physician anesthesiologist, who will provide information to help you feel safe by developing an optimal labor, delivery and recovery plan.
• Express your concerns: If you have had a bad experience with anesthesia or have any fears about childbirth let your physicians know. Never brush off your concerns – if something doesn’t feel right, tell your obstetrician and physician anesthesiologist. Be sure to ask about other issues, such as if you can have an epidural if you have a slipped disk or lower back tattoo.
• Ask about an emergency plan. Your physicians will always prioritize your safety as well as your baby’s. But it’s important to know your hospital has an emergency plan in place. Physician anesthesiologists have extensive critical care training and are experts in treating emergencies such as postpartum hemorrhage (bleeding) and preeclampsia (high blood pressure).
• Know experts are working to improve care. Physician anesthesiologists are leading the way to develop protocols that improve safety during and after childbirth. Efforts include:
  • “Safety bundles” and best practices for managing common causes of maternal death, including postpartum hemorrhage and high blood pressure that can lead to preeclampsia and, if not treated, seizures, coma, brain damage, blood clots and death.
  • “Early warning systems” that trigger an immediate evaluation if a mother’s health declines rapidly.
  • Refining labor and delivery pain management techniques, including epidurals and spinal anesthesia, which have led to significant reductions in maternal deaths.
  • Multi-disciplinary review committees at the state level to examine maternal deaths and identify the causes, determine preventability and implement prevention efforts.
• Plan your pain management: Untreated post-delivery pain (after vaginal as well as C-section birth) can lead to post traumatic stress disorder (PTSD) in some women, so don’t downplay your pain. Ask your obstetrician to reach out to your physician anesthesiologist if you have questions regarding how to manage pain after birth and if opioids are an option or should be avoided.

“The maternal death rate is 26 deaths in 100,000 births, but even one death is too many. The rising rate in the United States is a wakeup call for this country,” said Dr. Mason. “With more awareness and proactive management, it can be decreased. Women at increased risk should work closely with their obstetrician and physician anesthesiologist to ensure the safest care possible.”

To learn more about the critical role physician anesthesiologists play in managing emergency care, including during labor and delivery, visit www.asahq.org/WhenSecondsCount. For more information about pain management during labor and delivery and the importance of seeing a physician anesthesiologist, including a downloadable birth plan, visit asahq.org/birth. 

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 53,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/WhenSecondsCount. Like ASA on Facebook; follow ASALifeline on Twitter.

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