"Compared with their own mothers, American women today are 50% more likely to die in childbirth," Harvard Medical School obstetrics, gynecology and reproductive biology professor Neel Shah wrote in the Harvard Health Blog. "And the risk is consistently three to four times higher for black women than white women, irrespective of income or education."
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For every death, he said, worrisome pregnancy-related conditions such as high blood pressure or blood clotting can result in up to 100 severe injuries. Factor in inadequately treated physical or mental illnesses, the lack of paid parental leave policies or lack of social support and tens of thousands more women are at risk.
Overall, “very few deaths counted in maternal mortality statistics occur during childbirth,” Shah wrote. “Rather, four out of five of these deaths happen in the weeks and months before or after birth.”
"The association between mental illness and mortality is complicated because mental illness does not directly kill women, but rather serves as an underlying factor resulting in injury in the form of suicide, accidental deaths, and deaths due to homicide," according to the Maternal Mortality Review Committee, which uses CDC data for its annual reports.
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Specifically, perinatal mood and anxiety disorders (depression, anxiety, and affective disorders with psychotic episodes) all greatly impact women’s mental health during pregnancy and up to one year after delivery. The metabolic changes associated with pregnancy may also result in adjusted pharmacological treatment dosage as providers are often hesitant to treat depression or anxiety in pregnant women using antidepressants.
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These deaths reflect a myriad of failures in addition to unsafe medical care, including “eroding social support necessary for women to recognize medical warning signs... rapidly accelerated responsibilities, extreme sleep deprivation, and relentless pressure to return to work.”
The transition from pregnancy recover to parenthood is another of “life’s greatest physiological endurance tests,” according to Shah.
A significant responsibility to address the well-being of mothers “lies with the rest of us,” he added. Providers and medical institutions can do more to inform their patients; policymakers can keep track of maternal mortality and associated failures and we as a society need to step up: “birth partners, grandparents, friends, neighbors, professional colleagues — all of us.”
Read Shah's full blog post at health.harvard.edu.
This story has been updated for clarification.