Life-threatening complications during childbirth are on the rise in the United States, up almost 200 percent from the early 1990s to 2014. And a striking investigation published in the journal Obstetrics and Gynecology this week reveals who is most at risk.
Looking at national hospital data, researchers found that the rate of severe childbirth complications was significantly higher for women who identify as black, Hispanic, Asian, Pacific Islander, Native American or Alaska native than for white women.
This remained true even if women of color were otherwise healthy going into childbirth.
The disparity was particularly pronounced for black women, who had a 66 percent higher rate of major birth complications than white women. Severe complications occurred in 231 per 100,000 deliveries among black women, compared with 139 per 100,000 deliveries among white women.
Researchers have looked extensively at the disparities in maternal death in this country, where black women die at a rate nearly four times that of white women during pregnancy or in the year after giving birth. Increasingly, public health experts are attempting to track serious complications as well — and the new study is among the first to look at how race and chronic underlying conditions contribute to who is most at risk.
The researchers looked at 10 kinds of life-threatening situations that arose during childbirth, including the need for a blood transfusion, the need for a hysterectomy and the development of sepsis.
“Across all of the conditions we examined, every single one occurred in a higher frequency among non-Hispanic black women,” study researcher Lindsay Admon, an obstetrician at Michigan Medicine’s Von Voigtlander Women’s Hospital and a member of the University of Michigan Institute for Healthcare Policy and Innovation, told HuffPost.
“Among other racial and ethnic minorities, it was maybe a handful of them,” she said.
Admon and her team pulled from national data on hospital stays from 2012 to 2015, during which time nearly 41,000 women had an emergency procedure or were diagnosed with a life-threatening condition during childbirth.
Blood transfusions — which are generally required when women hemorrhage during birth — were the most common major complication.
Yet again, the difference in outcomes for women of color and white women was stark. If blood transfusions for women of color occurred at the same rate as for white women, the number of blood transfusions for the former group would drop by roughly 40 percent.
And obstetric hemorrhage is often preventable, having much to do with the quality of care where a woman delivers.
“Focusing on [improving care in] hospitals where racial and ethnic women deliver will be a really important strategy,” Admon said.
Previous research has shown that black women tend to deliver in a concentrated set of hospitals that often have higher rates of severe birth complications, suggesting that focusing effort on improving care in those hospitals could have a significant impact on black women’s outcomes nationwide.
In addition to looking at how race and ethnicity are linked to birth outcomes, the researchers also looked at how certain chronic health conditions contribute to life-threatening complications.
They found that women who had a chronic condition before giving birth — such as asthma, diabetes or depression — had a higher risk of severe problems after giving birth.
There were, however, notable differences among racial groups in who was most affected, suggesting again that white women tend to benefit from better care. For example, white women had higher rates of depression and substance abuse issues compared with other women in the study, and yet their risk of developing life-threatening complications during childbirth remained lower than for black mothers with a history of depression or substance abuse.
“We really hope these data will force the maternal health community to consider ways in which we can support the health of racial and ethnic minorities,” Admon said.
“To improve the health of women during pregnancy,” she added, “we have to also look beyond the pregnancy itself.”