Of the more than 1,000 maternal deaths in the United States between 2017 and 2019, 30% occurred from six weeks to one year postpartum-a time that has not previously been a focus of research on maternal morbidity and mortality. The most common underlying causes of pregnancy-related deaths were mental health conditions, followed by infection, embolism, and cardiomyopathy, according to a report from the Centers for Disease Control and Prevention (http://www.cdc.gov/reproductivehealth/maternal-mortality/docs/pdf/Pregnancy-Rela), which relied on data obtained from the Maternal Mortality Review Committees of 36 states. More than 80% of these deaths were determined to be preventable.
Among high-income nations, the United States has the highest rate of maternal deaths from avoidable causes. Women in the United States are also more likely to skip or delay reproductive care because of costs and difficulties in accessing health care services. Women of color and those living in rural areas bear the brunt of these access problems. The COVID-19 pandemic only worsened the situation for disadvantaged populations.
Medicaid, which pays for pre- and postnatal care for low-income women, until recently covered only up to 60 days postpartum. States can now opt to extend Medicaid postpartum care to 12 months under the American Rescue Plan Act of 2021 and the current omnibus spending bill. Thirty-five states and the District of Columbia have opted for 12-month coverage thus far, and more are planning to do so. The spending bill also supports training programs to address and prevent racial bias and improve obstetric care in rural areas.
To address these issues, nursing care must be an ongoing process specific to each mother's needs and risk factors.
Nurses and nurse midwives can provide key interventions during discharge planning to ensure follow-up visits are in place (the American College of Obstetricians and Gynecologists recommend women have contact with their obstetric care providers within the first three weeks postpartum, rather than six weeks). Assessing a new mother's access to care, transportation needs, and level of knowledge regarding the physical signs and symptoms of complications are crucial. And providing access to resources like the National Maternal Mental Health Hotline (1-833-852-6262) may save a new mother's life.-Gail M. Pfeifer, MA, RN