Ericka Gibson, MD
Obstetrician-Gynecologist, The Southeast Permanente Medical Group in Atlanta, Georgia
The well-documented maternal mortality rate in the U.S. is heartbreaking, and the situation has gotten worse. Data released by the Centers for Disease Control and Prevention in March 2023 highlighted significant increases in maternal mortality rates during the COVID-19 pandemic. In 2021, over 1,000 pregnant women in the United States died of pregnancy-related causes, a 40% increase in maternal mortality since 2020 and a 60% increase over 2019. Pandemic-related deaths accounted for much of the increase. And the news gets even worse: there are large gaps in these outcomes by race. Black women are 3 to 4 times more likely to die during pregnancy or during the postpartum period compared to non-Hispanic, white women.
The dangers of childbirth
As a physician program director for perinatal safety and quality, I have first-hand experience caring for maternity patients and grappling with this crisis. The data goes on to tell an even worse story: mothers in this country die at higher rates than those in other developed countries, and more than 80% of maternal deaths are preventable. The U.S. also has higher rates of chronic medical disease that can increase the risks from pregnancy. For every maternal death, there are almost 70 cases of severe hemorrhage, infection, or other serious complication from pregnancy or delivery.
Despite our understanding of the drivers for maternal mortality, the racial inequities that lead to poor health outcomes, and the enormous amount of public attention paid to this issue, the maternal health crisis has worsened rather than improved. How do we turn the tide?
Addressing racial disparities and improving maternal care experiences
A bright spot in this crisis is that journalists, researchers, and health care leaders have renewed their energy and focus on maternal health. At Kaiser Permanente, we are committed to improving maternity care for every patient, as well as understanding, addressing, and eliminating racial inequities in maternal outcomes. For example, by establishing a Black, Indigenous, and People of Color Women’s Advisory Council to inform our maternal care, we have created a space where underrepresented individuals can share their experiences and shape the care we provide. Through this work, the potential impact of racial bias is being incorporated as a part of maternal mortality reviews, and we continue to focus on efforts to acknowledge and address implicit bias.
There is also important and impactful work being done within my organization aimed at improving maternal health and maternity care experience. Kaiser Permanente has committed to the goal of eliminating preventable maternal deaths from hypertension and hemorrhage.
In Georgia, where I practice, we utilize a promising approach called the Cocoon Pregnancy Care Model (Cocoon Care). Cocoon Care places the pregnant person at the center of care and fully integrates maternal health providers including nurses, behavioral health clinicians, social workers, and case managers. This care model focuses on 3 factors that affect a pregnant woman’s health: social determinants of health (such as stable housing, healthy food access, and reliable transportation), access to care, and quality of care.
Since diabetes and hypertension are known risk-factors for maternal mortality and complications, we offer patients with these conditions remote monitoring during their pregnancy. This type of support, coupled with telehealth and psychosocial services, has led to improvements in key quality and safety metrics that are especially impactful for Black mothers. As this work continues, my goal is to ensure that the mother’s voice is heard throughout her journey – she must feel empowered, supported, and protected.
A path forward
How do we address our current maternal health crisis and make our country one where it is safe for all women to have healthy babies? We must keep the maternal health crisis in the spotlight, understand and address racial disparities, and support those who serve mothers. We must continue to focus on safety and quality metrics so that we can provide the best care possible. We must listen to women and elevate their voices – especially Black women and underrepresented populations.