How Can Maternal Mortality Be Prevented?

ACOG's and Obstetric Intelligence Perspective

Despite advances in medical care, the United States continues to face a maternal mortality crisis, with about 700 pregnancy-related deaths each year. The American College of Obstetricians and Gynecologists (ACOG) stresses that the majority of these deaths are preventable. Their recommendations focus on clinical excellence, system improvements, and addressing inequities.

1. Standardized Clinical Care: ACOG regularly updates evidence-based guidelines for managing leading causes of maternal death, such as hemorrhage, hypertension, heart disease, thromboembolism, and sepsis. Consistent application of these guidelines helps providers recognize and treat complications early.

2. Maternal Safety Bundles: Hospitals are urged to adopt “safety bundles”-sets of best practices for obstetric emergencies. These bundles ensure teams are prepared, protocols are clear, and responses are rapid.

3. Simulation & Team Training: Regular simulation drills and team-based training are key. Practicing emergency scenarios improves coordination and saves precious minutes during real events.

4. Maternal Mortality Review Committees (MMRCs): State-based MMRCs review every maternal death to identify root causes and recommend system-wide changes. These reviews are critical for learning and prevention, not punishment.

5. Addressing Disparities: Black and Indigenous women face two to three times the risk of maternal death compared to white women. ACOG calls for targeted quality improvement, anti-bias training, and community engagement to close this gap.

6. Enhanced Postpartum Care: Many deaths happen after delivery. ACOG recommends early and ongoing postpartum follow-up, especially for those with chronic conditions or complications.

7. Education and Advocacy: Patients should be empowered to recognize warning signs and advocate for themselves. ACOG also supports policies that expand healthcare coverage, fund MMRCs, and improve data

Obstetric Intelligence: Insights from Clinical Practice - Systemic Gaps Undermine ACOG’s Maternal Mortality Strategies

While ACOG’s recommendations represent clinically sound steps to reduce maternal mortality, they risk becoming performative gestures without addressing the foundational flaw in the U.S. healthcare system: the lack of universal coverage. Over 80% of maternal deaths are preventable, yet systemic barriers-rooted in fragmented insurance access-persistently sabotage progress. The U.S. spends more per capita on healthcare than any high-income nation but maintains the highest maternal mortality rate, disproportionately impacting Black and rural populations106.

Universal healthcare would directly resolve the inequities ACOG’s strategies aim to mitigate. All European countries with over 75% less maternal mortality have universal healthcare. For example, Medicaid expansion-a partial step toward universal coverage-reduced maternal mortality by 7.01 deaths per 100,000 live births, with Black women benefiting most. This underscores how insurance access is a prerequisite for effective care. Without it, safety protocols and guidelines remain theoretical for uninsured or underinsured patients, particularly in states refusing Medicaid expansion17.

How Universal Healthcare Addresses ACOG’s Eight Strategies

Strategy

Universal Healthcare’s Impact

Clinical guidelines: Ensures all providers follow standardized care, regardless of a patient’s insurance status. In many hospitals so called “private doctors” are allowed to flaunt guidelines.

Safety bundles & protocols: Funds implementation in underserved hospitals, closing rural-urban resource gaps. Have uniform hospitals, not those for “poor” and “affluent” patients.

Simulation & team training: Allocates resources for training in safety-net hospitals, where staffing shortages are acute.

MMRCs: Eliminates data gaps caused by uninsured deaths, enabling accurate, nationwide reviews

Addressing disparities: Reduces racial inequities by removing cost barriers, critical for Black women’s survival

Enhanced postpartum care: Extends coverage beyond 60 days, vital for addressing 33% of deaths occurring 7–365 days postpartum. In Europe nurses visit postpartum women at home.

Education: Guarantees access to prenatal/postpartum visits where education occurs. Ensure that all patients understand educational maternal that should be written in 8th grade or below language.

Advocacy & legislation: Makes ACOG’s policy goals (e.g., Advocate for Universal Healthcare) redundant by solving coverage gaps entirely.

In short, ACOG’s framework-while valuable-cannot transcend a system where 8.6% of women of reproductive age lack insurance. Universal healthcare isn’t just complementary; it’s the keystone without which other interventions falter.