Maternal death and pregnancy-related death

The death of a parent is tragic, with devastating effects on families. In this country, more and more parents are dying from complications related to pregnancy and childbirth. This is especially true for pregnant and parenting people who are exposed to racism. The maternal death rate for pregnant Black and American Indian/Alaska Native people is about 3 times higher than it is for white people who are pregnant. These disparities increase by age. The maternal death rate of Black and American Indian/Alaska Native pregnant people who are 30 years old or older is about 4 to 5 times higher than it is for white people who are pregnant. This is not acceptable.

Watch March of Dimes President Stacey Stewart speak to Congress about the maternal and child health crisis happening in our country. Learn about March of Dimes’ efforts to combat the epidemic of health disparities in pregnancy-related deaths. Join our advocacy network to take action today and help us lead the fight for the health of all moms and babies.

Help Save Moms’ Lives

What are maternal death and pregnancy-related death?

You may have heard these terms in the news lately. They mean similar things, but they’re not exactly the same. Here’s what they mean:

• Maternal death is when a pregnant or birthing person dies during pregnancy or up to 42 days after the end of pregnancy from health problems related to pregnancy. Maternal death and maternal mortality mean the same thing.
• Pregnancy-related death is when a pregnant or birthing person dies during pregnancy or within 1 year after the end of their pregnancy from health problems related to pregnancy. 

These deaths may be caused by:

• A health condition (such as heart disease) that someone had before pregnancy that gets worse because of pregnancy
• A pregnancy complication, such as preeclampsia (a serious blood pressure condition that can happen after the 20th week of pregnancy or after giving birth) 
• Treatment provided during pregnancy

The differences between pregnancy-related death and maternal death are important to health care providers and researchers who study this topic to help us understand more about why moms die from conditions related to pregnancy. The statistics and information in this article focus on pregnancy-related death. 

Who is at risk for pregnancy-related death?

About 700 moms die each year in the United States from complications during or after pregnancy.

Race and pregnancy-related death

In the United States, Black pregnant people are 3 to 4 times more likely to die from pregnancy-related causes than white pregnant people are. American Indian/Alaska Native pregnant people are 2 to 3 times more likely to die from pregnancy-related causes

We call this a health disparity (difference). To understand why these groups are at a higher risk of pregnancy-related death, we need to look at the social factors affecting them. These are known as “social determinants of health.” These are the conditions in which you are born, grow, work, live and age. These conditions affect your health throughout your life. In many cases, social determinants of health and health disparities are related to racism.

Racism refers to the false belief that certain groups of people are born with qualities that make them better than other groups of people.

Racism isn’t limited to personal attacks such as ethnic slurs, bullying, or physical assault. In a racist culture, one group of people has more power than other groups. People in the dominant racial or ethnic group make important decisions that affects everyone’s lives. For example, they have a lot of control over the way that schools, health care, housing, laws and law enforcement work. This control means that people in the dominant group are more likely to:

• Have better education and job opportunities
• Live in safer environmental conditions
• Be shown in a positive light by media, such as television shows, movies, and news programs.
• Be treated with respect by law enforcement
• Have better access to health care

In contrast, people from racial or ethnic minority groups who live in a racist culture are more likely to:

• Experience chronic stress
• Live in an unsafe neighborhood
• Live in areas that have higher amounts of environmental toxins, such as air, water, and soil pollution
• Go to a low-performing school
• Have limited access to healthy foods
• Have little or no access to health insurance and quality medical care
• Have less access to well-paying jobs

Being a person of color is not a cause for pregnancy-related death. However, communities of color are disproportionately affected by racism. Racism and unequal living conditions affect their health and well-being. This puts them at higher risk of pregnancy complications, such as pregnancy-related death.

March of Dimes recognizes that racism and its effects are factors in the health disparities in pregnancy outcomes and babies’ health. We must work together to bring fair, just and full access to health care for all moms and babies.

Age, health and pregnancy-related death

The risk of pregnancy-related death also increases with age. In the United States, pregnant and birthing people age 35 to 39 are about twice as likely to die from pregnancy-related causes than are pregnant and parenting people age 20 to 24. The risk for pregnant and birthing people who are 40 and older is even higher.

The rate of pregnancy-related death in the U.S. has increased over the last 30 years and continues to rise. This increase may be because more pregnant people have health conditions such as high blood pressure and diabetes that may increase the risk of complications during pregnancy. High blood pressure is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy. Diabetes is a medical condition in which there’s too much sugar (called glucose) in the blood. This can damage organs, including blood vessels, nerves, eyes and kidneys. 

What can you do to reduce your risk of pregnancy-related death?

Getting regular health care before, during and after pregnancy can help you and your provider identify conditions that can cause serious health problems. Learning the signs and symptoms of these conditions may help you spot them early so you can get treatment right away. Signs of a condition are things someone else can see or know about you, such as having a rash or coughing. Symptoms are things you feel yourself that others can’t see, such as having a sore throat or feeling dizzy. 

Trust your instincts! If you’re worried about your health or your pregnancy or you have signs or symptoms of conditions that can cause problems during pregnancy, call your provider or go to the hospital. If you know someone who’s pregnant or is a new parent, encourage them to go to their checkups and to tell their provider if they think something’s wrong. Sharing the word about how to prevent maternal death can help save lives.

If you’re planning pregnancy

• Get a preconception checkup. This is a checkup you get before pregnancy to help make sure you’re healthy when you get pregnant. Pregnancy-related death can be caused by health conditions you have before pregnancy. Finding out about them and getting treatment before you get pregnant can help prevent death. 
• Tell your provider about any medicines you take. Make sure any health care provider who prescribes you medicine knows you’re trying to get pregnant. You may need to change to a medicine that’s safer for you and your baby during pregnancy.
• Protect yourself from infections. For example, talk with your provider about vaccinations (such as the flu shot) that can help protect you from certain diseases. Wash your hands with soap and water after using the bathroom or blowing your nose. Stay away from people who have infections. Don’t eat raw meat, fish or eggs. Use a condom to protect yourself from sexually transmitted infections (also called STIs). If you have a cat, ask someone else to change the litter box.
• Get to a healthy weight. Eat healthy foods and do something active every day. 
• Don’t smoke, or use harmful drugs. Tell your provider if you need help to quit.   

During pregnancy

• Go for your first prenatal care visit as soon as you think you’re pregnant.
• Go to all your prenatal care checkups, even if you’re feeling fine. This can help your health care provider spot and treat any health problems that may affect your pregnancy. 
• Tell your provider about any medicines you take. Make sure any provider who prescribes you medicine knows that you’re pregnant. 
• If you’re at risk for preeclampsia, talk to your provider about taking low-dose aspirin to help reduce your risk. Preeclampsia is a serious condition that condition that can cause pregnancy-related death. 
• Protect yourself from infections. For example, talk to your provider about vaccinations (like the flu shot) that can help protect you from certain diseases. Wash your hands with soap and water after using the bathroom or blowing your nose. Stay away from people who have infections. Don’t eat raw meat, fish or eggs. Use a condom to protect yourself from STIs. And if you have a cat, ask someone else to change the litter box.
• Eat healthy foods and do something active every day.
• Don’t smoke, drink alcohol or use harmful drugs. Tell your provider if you need help to quit. 
• If you are not receiving the care you deserve, find a new provider. If you feel you are being exposed to racism, file a report with your provider’s office and find a new provider.

After pregnancy

• Tell your provider right away if you have you have any of the following signs or symptoms:
• Chest pain
• Dizziness
• Fever and chills (temperature of 100.5 or higher)
• Headache
• Nausea and/or vomiting
• Trouble breathing,
• Severe abdominal pain
• Swelling, pain, or redness in the legs, hands, or face
• Visual changes
• If you’re worried about anything or something doesn’t seem right, call your provider. 
• If you’re having a medical emergency, call 911. 

What causes pregnancy-related death? 

We know most of the causes of pregnancy-related death. The leading causes can be different depending on timing:

• During and after pregnancy: Heart conditions and stroke cause more than 1 in 3 pregnancy-related deaths.
• During birth: Emergencies, such as heavy bleeding and amniotic fluid embolism, cause the most deaths during birth. Amniotic fluid embolism is when some of your baby’s cells or amniotic fluid (fluid that surrounds the baby in the womb) gets into the bloodstream.
• The week after giving birth: Heavy bleeding, high blood pressure and infection cause the most deaths in the week after giving birth.
• One week after birth to 1 year after birth: Cardiomyopathy (weakened heart muscle) causes the most deaths during this time. 

Getting early treatment for conditions that can cause complications during and after pregnancy may help prevent death. If you have signs or symptoms of any of the following health conditions, tell your health care provider right away.

Heart and blood vessel conditions

Cardiomyopathy. This condition affects the heart muscle. It can make the heart larger, thicker or more rigid (stiffer) than normal, so it’s harder for the heart to pump blood. Signs and symptoms of cardiomyopathy include:

• Swelling in your legs 
• Fatigue (being really tired)
• Chest pressure or having a pounding, fast or fluttering heartbeat
• Fainting or feeling out of breath, dizzy or lightheaded

Heart disease (also called cardiovascular disease). Heart disease includes conditions that affect the heart and blood vessels. They often affect the heart muscle or involve narrowed or blocked blood vessels that can lead to a heart attack or stroke. Common signs and symptoms of heart disease include:

• Chest pain, discomfort or tightness
• Dizziness or fainting
• Extreme tiredness 
• Nausea (feeling sick to your stomach)
• Really fast or really slow heartbeat
• Shortness of breath
• Swelling in the legs, ankles or feet

Preeclampsia and eclampsia. Preeclampsia is a serious blood pressure condition that can happen after the 20th week of pregnancy or after giving birth (called postpartum preeclampsia). It’s when a pregnant or birthing person has high blood pressure and signs that some of their organs, like the kidneys and liver, may not be working normally. Eclampsia is a very serious complication of preeclampsia, when a person has seizures. These seizures can result in a coma, brain damage, or even death to mom and baby. Tell your provider right away if you have signs or symptoms of preeclampsia, such as:

• Changes in vision
• Headache that doesn’t go away
• Nausea, vomiting or dizziness
• Pain in the upper right belly area or shoulder
• Sudden weight gain (2 to 5 pounds in a week)
• Swelling in the legs, hands or face
• Trouble breathing 

Stroke. A stroke is when blood supply to the brain is interrupted or reduced. Stroke can happen when a blood clot blocks a blood vessel that brings blood to the brain, or when a blood vessel in the brain bursts open. The risk of stroke increases during pregnancy. Signs and symptoms of a stroke come on suddenly and can include: 

• Numbness or weakness in your face, arms or legs
• Feeling confused
• Having trouble talking and understanding what other people are saying
• Having trouble seeing or walking
• Feeling dizzy
• Having a severe headache

Thrombotic pulmonary embolism. This is the sudden blockage of an artery in the lung. It usually happens when a blood clot in the leg travels to the lungs and blocks the flow of blood to the lungs. When a blood clot forms in a deep vein in your leg or somewhere else in your body, it’s called deep vein thrombosis (also called DVT). You’re at increased risk for thrombotic pulmonary embolism during pregnancy. Tell your provider if you have any of the following signs or symptoms: 

• Shortness of breath, chest pain and cough
• Having a fever
• Feeling dizzy or lightheaded
• Leg pain or swelling
• Having a fast heart rate
• Sweating or having clammy skin or skin that has a bluish color

Hemorrhage (also called heavy bleeding)

Causes of hemorrhage that can lead to pregnancy-related death include:

• Problems with the placenta, including placental abruption, placenta previa and placenta accreta, increta and percreta. The placenta grows in the uterus and supplies the baby with food and oxygen through the umbilical cord. Placental abruption is when the placenta separates from the uterus before birth. Placenta previa is when the placenta lies low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta accreta, increta, and percreta happen when the placenta grows too deeply into the wall or muscles of the uterus, or grows through the uterus. If you have bleeding during pregnancy, tell your health care provider right away. If the bleeding is severe, go to the hospital. 
• Uterine rupture. This is when the uterus tears during labor. Signs and symptoms of a rupture include pain, bleeding, long labor and problems with the baby (called fetal distress), like having a slow heart rate during labor.  
• Ruptured ectopic pregnancy. This is when an ectopic pregnancy breaks open. An ectopic pregnancy happens when a fertilized egg implants itself outside the uterus and begins to grow. An ectopic pregnancy always ends in pregnancy loss. It can cause serious problems. Most of the time, ectopic pregnancies are removed by surgery. Signs and symptoms of ectopic pregnancy include:
  • vaginal bleeding;
  • pain in the shoulder, lower back or pelvic area (the part of the body between the stomach and legs); and
  • feeling dizzy or faint.
• Retained products of conception. This is tissue from the placenta or from the baby that stays in the uterus after a pregnancy ends. Signs and symptoms include fever, bleeding, pelvic pain and tenderness of the uterus. 
• Uterine atony. This is when the uterus doesn’t contract (tighten) as strongly as it should after the placenta is delivered after the baby is born. Normally, contractions help stop the bleeding after the placenta separates from the uterus. But when these contractions aren’t strong enough, hemorrhage can happen. Signs and symptoms of uterine atony include heavy bleeding and not having contractions after giving birth.
• Tears in the cervix, vagina or a blood vessel in the uterus

Infection

When you’re pregnant, your immune system isn’t as quick to respond to infections (illnesses caused by bad germs), so you’re more likely to get infections that can cause problems for you and your baby. Infections that can cause pregnancy-related death include:

• Chorioamnionitis. This is an infection of the amniotic fluid and tissue that surround a baby in the womb. Signs and symptoms of this infection include fever, fast heart rate in you or your baby, a uterus that’s tender to the touch and discharge from the vagina that smells bad. 
• Flu (also called influenza). The flu is a serious disease that can cause fever, chills, cough, sore throat and body aches. It’s safe to get the flu shot during pregnancy. It protects you and your baby from serious health problems during and after pregnancy.
• Genital tract infections. The genital tract includes reproductive organs, like the vulva, vagina, uterus, fallopian tubes and ovaries. Signs and symptoms of genital tract infections may include fever, chills and pain in the lower belly.
• Sepsis. Sepsis is the body’s extreme response to an infection. It can be life-threatening. Signs and symptoms of sepsis include fever, fast heart rate and fast breathing.

Non-cardiovascular medical conditions

These are medical conditions, such as diabetes, kidney disease and pneumonia, that aren’t directly associated with the heart and blood vessels. You may have had the condition before you got pregnant. 

Amniotic fluid embolism

This is a rare condition that can happen during or right after birth. Tell your provider if you have signs or symptoms of amniotic fluid embolism, including: 

• Shortness of breath
• Feeling anxious (worried) 
• Chills or a fast heart rate
• Seizures
• Bleeding from the vagina, from an incision (cut) from surgery, or from an IV site (when you get fluid or medicine through a needle into a vein) 

How are mental health conditions involved in pregnancy-related death?

Mental health conditions affect your emotions, feelings, and behaviors. They’re medical conditions that need treatment to get better. They can happen for the first time during pregnancy and the postpartum period (the time right after you give birth), and they can reoccur or happen again (called a relapse) during these times. Mental health conditions that affect pregnancy include:  

• Depression (also called major depression). Depression is a medical condition that causes strong feelings of sadness, anxiety (worry), tiredness, and a loss of interest in things you like to do. It can affect how you think, feel, and act. It can last for a long time and can interfere with daily life. 
• Postpartum depression (also called PPD). PPD is a kind of depression some women get after having a baby. PPD can make it hard for you to take care of yourself and your baby.

Mental health conditions can lead to pregnancy-related death. Having an untreated mental health condition can make it hard for you to take care of yourself and your baby. 

If you think you have a mental health condition, tell your health care provider. You can get treatment to make you feel better. If you’re being treated for a mental health condition before, during or after pregnancy, talk to your provider about any medicine you take. You and your provider can work together to decide about treatment options. It’s best to talk to your prenatal care and mental health providers about a treatment plan before you get pregnant.

What is a “near-miss”?

A near-miss is when a birthing parent has unexpected and severe complications from labor and childbirth. These complications are also known as “severe maternal morbidity,” or SMM. In the United States, it’s more common to experience a near-miss than it is to die, and SMM isn’t uncommon. Between 2006 and 2015, the rate of SMM increased 45 percent.

If you’ve had a near-miss, you may have lots of different feelings. You may feel like you should be happy or grateful. Or you may have trouble dealing with what happened. You may feel sad, upset, worried, scared or angry. 

Some parents who’ve had a near-miss have a condition called post-traumatic stress disorder (also called PTSD). This is a severe form of anxiety (strong feelings of worry or fear). PTSD may happen when you go through something shocking, scary or dangerous. If you have PTSD, you may feel stressed or scared even when you’re not in a dangerous situation. 

Signs and symptoms of PTSD include:

• Serious anxiety
• Flashbacks of the event. A flashback is when you relive a traumatic (scary or troubling) event so that it feels like the event is happening again. 
• Nightmares
• Physical responses (like sweating or a racing heartbeat) when you’re reminded of the event

If you think you have PTSD:

• Tell your health care provider.
• See a mental health professional. This is a person with training and education to help people with emotional or mental health conditions like PTSD. Mental health providers include social workers, therapists, counselors, psychologists, psychiatrists and psychiatric nurse practitioners. Ask your health care provider to help you find a mental health professional. 
• Talk with family and friends about how you’re feeling.
• Connect with other parents and families who have had experiences like yours at Share Your Story, the March of Dimes online community. 

Last reviewed: May, 2021

See also: March of Dimes Action Center, Your checkup before pregnancy, Your first prenatal care checkup, Warning signs after birth