Authors
- Simpson, Kathleen Rice PhD, RNC, CNS-BC, FAAN
Article Content
During 2020 and 2021, much attention was devoted to caring for childbearing women in the context of the COVID-19 pandemic. Concerns about minimizing transmission in the inpatient setting during the birth hospitalization, short-staffing, changes in protocols for maternity patients and for support persons and in lengths of stay, and increased stress among the health care team were predominant (George et al., 2021; Iobst et al., 2023). Women who had COVID-19 had worse outcomes compared to women who had not and maternal deaths in the United States due to COVID-19 and other complications were significantly higher than prepandemic rates (Thoma & Declercq, 2022). It is estimated that 102 maternal deaths in 2020 and 401 maternal deaths in 2021 were related to COVID. The overall US maternal mortality rate for 2021 was 32.2 deaths per 100,000 live births compared with a rate of 23.8 in 2020, 20.1 in 2019, and 17.4 in 2018 (United States Government Accountability Office, 2022). Unavailability of vaccines in 2020 followed by vaccine misinformation and mistrust of health care providers and government agencies encouraging vaccines in 2021 likely contributed to less-than-ideal vaccination rates among maternity patients, increasing their risk of adverse outcomes.
Birth data for those 2 years are available for analysis; highlights are included in the table (Osterman et al., 2022, 2023). There was a slight increase in the number of births from 2020 to 2021. Obstetric interventions were increased, with rates of cesarean births and induction of labor the highest as these data were recorded from certificates of birth. For example, since 1965, when the cesarean birth rate was 4.5%, the rate has increased over 600% to 32.1% in 2021. Since 1989 (the first year induction data were included in US certificates of live birth), when the rate of induction of labor was 9% (Simpson, 2020), the rate has risen to 32.1% in 2021, a ~257% increase. Compared to 2020, in 2021 there were more preterm births and low birthweight babies. Rates of gestational diabetes and gestational hypertension were higher. Overall, the prevalence of severe maternal morbidity (SMM) has risen substantially in the United States. Between the beginning of 2008 and the end of 2021, SMM increased from 146.8 to 179.8 per 10,000 discharges after birth hospitalizations (Fink et al., 2023). Cesarean birth, also increasing, was found to be one of the risk factors for SMM (Fink et al., 2023). There were more births attended by nurse midwives and more out of hospital births, although physician birth attendants and hospital births remain the vast majority. Positive trends included an increase in the VBAC rate, and a decrease in births to teen mothers. As a supplement to the published data are internet tables that offer much more detail. Become familiar with these types of resources to be aware of national trends and how your practice setting compares.
References
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