By Therese Fitzgerald, PhD, MMS director of health care research, analytics, and insight
When Lauren Bloomstein, a neonatal intensive care nurse, gave birth to a healthy baby girl, her husband Larry, a physician, never dreamed he’d be leaving the hospital a single father. But just 20 hours after giving birth, Lauren was dead. A 2017 report by ProPublica and NPR describes in agonizing detail what led to Lauren’s death.
Lauren is one of more than 450 expectant and new mothers in the US who have died since 2011. The US ranks a dismal 47th in the world for maternal mortality rates, and is the only developed country in which maternal mortality is rising. Women of color and low-income women are disproportionately at risk.
Most Maternal Mortality Is Preventable
Maternal mortality is a key indicator of the quality of health care, both in the US and internationally. Public health experts have been sounding the alarm. According to a 2018 report involving nine state maternal mortality review committees — “Building US Capacity to Review and Prevent Maternal Deaths” — 60 percent of pregnancy-associated deaths (maternal deaths during pregnancy or within one year of pregnancy ending) are preventable. That statistic highlights the importance of identifying data trends as a key preventive step. Timely, granular data is not so easy to come by.
Behavioral Health as a Risk Factor
In Massachusetts — where maternal mortality is relatively low by US standards — physicians and public health experts are grappling with data limitations and inadequate resources. The opioid epidemic has made that challenge more acute. According to the Massachusetts Department of Public Health (MDPH), nearly half of all pregnancy-associated deaths are now related to substance use. The risk of maternal overdose is greatest at 6 to 12 months postpartum — a finding from an innovative database developed under Chapter 55, a state law that authorized the MDPH to link 20 data sources relevant to the opioid epidemic.
The state’s Maternal Mortality and Morbidity Review Committee (MMMRC), which reviews each case of maternal mortality and makes recommendations aimed at improving outcomes, lags several years behind. “Right now, we’re looking at 2014–15 deaths. We’re so far behind that we couldn’t pick up the uptick in narcotics-related deaths earlier. That would have been helpful,” says Glenn Markenson, MD, professor of obstetrics and gynecology at Boston University School of Medicine, who sits on the committee.
The gap is in resources, not political will. Dr. Rebecca Lundquist, a psychiatrist and associate professor at the University of Massachusetts Medical School, who also sits on the committee, welcomes the Commonwealth’s attention to the intersection between behavioral health and maternal mortality: “I am proud to be in a state [where] there is a high degree of awareness at the legislative and executive branches regarding behavioral health and its impact on morbidity and mortality in pregnant and postpartum women.”
