80% of pregnant-related deaths in Missouri were preventable, report finds

Missouri (KHQA) — “We hope that individuals look at the recommendations and they can see themselves in some of those and try to work within their respective communities to put these actions into place because one death is too many,” said Ashlie Otto, a registered nurse for the Missouri Department of Health and Senior Services (DHSS).

The Missouri DHSS released their 2018-2022 Pregnancy-Associated Mortality Review. They recorded any death of a pregnant Missouri resident, from the pregnancy to a year postpartum. They categorize them into pregnancy-associated (where the death had nothing to do with the pregnancy, like a car accident) and pregnancy-related (when the death was the direct result of or caused by chain of events from the pregnancy).

These pregnancy-related deaths are decreasing, but the leading causes are still a cautionary tale for soon-to-be mothers.

From 2018 to 2022, there was an average of 70 deaths per year; from 2020 to 2022, 83% of pregnancy-related deaths were preventable.

This means that if at least one piece of effort or intervention had been applied in the specific situation, the pregnant woman would still be alive.

Otto hopes that these reports lead to further studies and increase public education on the issues women face during and after pregnancy, which will prevent more deaths in the future.

Black women are 2.5 times more likely to die than white women.

Otto said this is likely due to a number of factors, such as distrust in medical care, systemic issues, and environmental/community factors.

Black women are also more likely to be victims of homicide during or after pregnancy—six of the deaths in the report were black women that were murdered directly because of their pregnancy.

This is also why, in the report, the DHSS urges local and state governments to invest in urban infrastructure and violence intervention programs: to “increase avenues for fostering healthy interpersonal and family relationships with a goal of reducing violence and improving maternal health,” according to the report. Creating a safer community for pregnant women, and, in turn, everyone else.

“Looking at the health of moms and babies, that directly correlates with the health of your community and state,” said Otto.

Most of the deaths occur after the pregnancy, between 43 days and a year postpartum.

The leading cause of pregnancy-related death is mental health issues.

“Statewide we see a lack of mental health resources,” said Otto.

51% is due to postpartum depression and anxiety, while 41% is due to a substance use disorder.

“There’s a large focus on moms when they’re pregnant, you know, they’re going to the doctor often. People tend to, for lack of better words, dote on them more…Once that baby is born, it’s like ‘eh, you know, moms got this,'” said Otto.

But mom maybe doesn’t ‘got this,’ and that’s okay.

“We know that maternal mental health is stigmatized and that the more we talk about it, the more we normalize that if you’re feeling this way, it’s okay to speak up, it’s okay to get help. It doesn’t mean you’re less of a mother,” said Otto.

Otto also encourages healthcare providers, family, friends, and basically anyone that comes in contact with someone who has just given birth, to check in with them.

“Talk to them, just have a brief conversation with them about how their feeling. And sometimes mom don’t necessarily say ‘I’m struggling.’ So sometimes what you can do is ask: ‘How are you sleeping? Are you able to get at least two nutritional meals a day and some snacks in between? Do you feel overwhelmed?’ Sometimes they’ll be more comfortable answering questions like that, that can really help you figure out if that individual might need extra attention,” said Otto.

Basically, while moms are looking after the baby, someone needs to be looking out for the moms.

Other leading causes include cardiovascular disease, infections, amniotic fluid embolisms

The second leading cause of pregnancy-related deaths in cardiovascular disease.

“A lot of people think that women during their child-bearing years, you’re fairly young, it tends to be the healthiest time in your life. And most people don’t stop to think about high blood pressure during your pregnancy, or even if you have slightly higher blood pressure before you get pregnant, how that can negatively impact your health,” said Otto.

She also said that if you experience high blood pressure for the first time while pregnant, to work with your health care provider on how to manage that during the pregnancy, but also afterwards— to make sure it is going back down to normal at a healthy pace.

The third leading cause was infection from COVID-19, sepsis, pneumonia.

And then there’s the rare and life-threatening amniotic fluid embolism: a condition where amniotic fluid enters the bloodstream. Otto said that while there was an increase, they don’t have enough data yet to understand why its increasing, or if it even is a trend that will continue to increase.

Understanding the report

The 15-page report is more user friendly than the past years, so that the everyday person can learn from it and make “sure we’re educating mom and the family unit,” said Otto.

There’s also a dashboard with interactive graphs.

The end of the report lists several recommendations for local communities, healthcare facilities, insurance companies, and state governments to further protect the life of a pregnant mother.

Medicaid for mothers

The report recommends for Missouri to continue extending Medicaid coverage to one year postpartum for all conditions.

But Medicaid cuts are looming as the US Senate passed the “One, Big, Beautiful Bill” and is now on the House of Representatives floor for debate. This could mean more health risks for pregnant women, and possibly more deaths.

“We see that we have higher rates of maternal mortality in states that have not expanded Medicaid…Medicaid and Medicaid expansion often are a primary source of care of women who are of reproductive age,” said Sophia Tripoli, the Senior Director of Policy at Families USA, a non-profit that pushes to protect Medicaid.

There’s still a bit of ways to go, but overall, the report is supposed to help educate the public, push for better support for pregnant women, and give women a place to start when learning how and what to ask for help for.

“I hope that they are able to take this and talk to their providers…about their health before and during the pregnancy and things they can do to help lower their risk of having a complication,” said Otto.