Rising Maternal Mortality: When the Hand We Reach for Isn’t There
Steps to protect US mothers’ health are urgently needed when the baby comes.
Childbirth is a most miraculous and life-changing experience for a family, but the risks of a mother’s dying are going up, not down, in the United States. Shockingly, women’s rates of pregnancy-related mortality were more than 27% higher in 2022 than they had been in 2018, Journal of the American Medical Association (JAMA) just published in April 2025. Because of this urgent public health crisis, after far too many births, the hand a new baby reaches for will not be there. We must do better. Now is not the time for cuts to US maternal healthcare resources and research.
Rising maternal health risks reflect local conditions and biases.
During pregnancy and childbirth, US women are losing their lives at rates that are triple those of other high-income countries, according to the most recent World Health Organization (WHO) data. And even within the US, mothers’ health risks are much higher in some states than in others.
Tragically, many mothers’ pregnancy-related deaths were preventable but their care systems failed. Over the four years of study, as many as 2,679 lives could have been saved if only maternal death rates across the country had been reduced to the rate of the state that was lowest. The US Centers for Disease Control and Prevention (CDC) has also reported that the vast majority of maternal deaths, 84%, were preventable in their newest data release. Disparities show a potent effect of persistent biases of racism in healthcare: mothers who were Indigenous, Alaska Native or Black died at far higher rates than the average.
“All women have the right to dignified, respectful health care throughout pregnancy and childbirth as well as freedom from violence and discrimination. A growing body of evidence, however, shows that women are being mistreated during childbirth in health facilities across the world.” – WHO
Human rights during childbirth are not the same as legal rights.
How can this happen, that so many women lose their lives in pregnancy and childbirth here? A look at lived experiences points to clues of violated rights. Only one in four women give a high rating to their healthcare system’s performance in the US, according to research surveys by The Commonwealth Fund. I was not one of those mothers.
I didn’t know much about my risks or rights when having my two daughters in New York hospitals. Not about the human right for respectful care, nor the legal right to consent or refuse a medical intervention. When my pain during natural childbirth reached astounding levels, health workers had given me a drug to induce stronger contractions, setting up IV’s taped to my hands, but providing no pain relief medication. I had refused the induction drug (a synthetic oxytocin hormone) during both deliveries, but health workers were not deterred. Induction happened anyway. I didn’t know then that this causes more intense, more painful contractions that place significant stress on both mom and baby. For some, this intervention can be dangerous. For others, even life-threatening. Hospital staff didn’t say anything to me about risks. By rights, that disclosure should have happened. Then I could have made a choice.
After oxytocin, the usual protocol is to closely monitor mom’s pain and give medical pain relief, as needed. An epidural – an injection containing fentanyl or sufentanil opioids, with obvious risks – most often is the choice in the US. That didn’t happen. Clinicians also usually monitor the baby inside more closely after oxytocin. And so they threaded a cord up through my cervix to attach a fetal scalp electrode to my baby. That intervention seems dangerous for a baby, I thought, and it is – but again, no one mentioned the risks to me.
Flat on my back both deliveries, I had no ability to move around. I yelled, screamed and begged to change my body’s position and for pain relief. No pain medication of any kind came my way. Then, when the baby was finally emerging after a 24-hour labour, there was the unwanted episiotomy. Without anesthesia.
It all should have been easier for my second baby, but it wasn’t. As hospital workers came and went, I asked every one of them for pain medication again and again but got no reply. Eventually, I begged. That didn’t work. And then I was screaming. Someone finally announced they were injecting me with an antipsychotic because of the screaming. This type of drug generally treats hallucinations and delusions – not pain during childbirth – but does sedate a person. Categorized as being mentally ill.
Through it all, I bled so much with both deliveries that I was sure I would die right then and there. I survived. Still, somehow, it seemed my life had become invisible; multiple layers of risk, ignored. Maybe with a patient advocate or doula by my side, things would have gone differently.
Medical abuse during childbirth is far from rare.
I was not alone in what I’d felt. The CDC published a scathing report of self-reported experiences revealing additional clues to risks in Morbidity and Mortality Weekly Reports. Their surveys showed 20% overall and 30% of women who were Black, Latina or multiracial had suffered actual mistreatment by the people who provided their hospital childbirth care. Some of the highest rates of abuses, 28%, were of women who had no health insurance – like I had been at the time I gave birth.
Women reported healthcare providers ignored them during childbirth, refusing their requests for help or not responding. Shouting at or scolding them. Violating their physical privacy. Threatening to withhold treatment. Forcing them to accept treatment they explicitly said they did not want. Among the mistreatments were clinicians using aggressive physical contact. Refusing to provide women with anesthesia for an episiotomy – which I also endured.
Errors like these could lead to clinical staff overlooking, ignoring or mistreating a woman’s potentially fatal complications. The underlying causes of maternal deaths that records most often show are heart-related like severe bleeding, embolism or hypertension, and also often mood-related including suicide, overdose or poisoning or substance use disorder. Rarely if ever mentioned are the possible effects of medical abuse, bias and racism in health care.
Demanding rights for safer births has become ever more urgent.
While public health advocates call again and again for urgent reform of US health care to better protect life during childbirth, healthcare systems and policies can surely restore basic humanity. And families can demand it. Even if not legally mandated, our human rights require this. If not now, when?
Here are a few steps expectant mothers can take to protect their health when the baby is coming.
Be sure to have a doula or advocate you trust in the room with you. Having someone there who will respect your rights, has experience, and knows your care preferences can help you be heard and protect your safety.
Share your birth plan. You can write out what you want and expect for pain management, for birth position and movement, for eating or not, for who you would like there with you, whether you want or don’t want vaginal exams and medical interventions, and your preferences for staying with your newborn – and more.
State your acceptance or refusal of any medical intervention. You have the right to know all potential risks of a medication or procedure, and you have the right to refuse it or accept it. You can say no, and no means no. Interventions you can refuse or accept are things like labor induction (oxytocin), electronic fetal monitoring, C-section, epidural, episiotomy. Be as clear and direct as you can if you say no. Repeat yourself. Even record your demands and responses.
Demand your care providers acknowledge and respect your human rights. These include giving care that maintains your dignity, privacy and confidentiality, allowing for your informed choice, providing you support all through the labour and birth, and of course protecting you from any mistreatment – to say the very least. And maybe most importantly of all – listening to how you feel. Your very life may depend on it.
References for this post along with more resources:
Chen Y, Shiels MS, Uribe-Leitz T, et al. “Pregnancy-Related Deaths in the US, 2018-2022.” JAMA Netw Open. 2025;8(4):e254325. doi:10.1001/jamanetworkopen.2025.4325.
Centers for Disease Control and Prevention (CDC). “Pregnancy-Related Deaths: Data From Maternal Mortality Review Committees in 38 U.S. States, 2020.” May 20, 2024. Available at: https://www.cdc.gov/maternal-mortality/php/data-research/index.html
The Commonwealth Fund. “Health and Health Care for Women of Reproductive Age: How the United States Compares with Other High-Income Countries.” 2022. Available at: commonwealthfund.org.
Mohamoud, YA et al. “Vital Signs: Maternity Care Experiences — United States, April 2023.” Morbidity and Mortality Weekly Reports (MMWR) 2023;72:961–967 doi: 10.15585/mmwr.mm7235e1.
World Health Organization (WHO) “New WHO evidence on mistreatment of women during childbirth.” October 9, 2019. Available at: https://www.who.int/news/item/09-10-2019-mistreatment-of-women-during-childbirth
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And they say they want more babies. Putting your life at risk to have one is not something many would want to do. Not to mention the chaotic world we live in....food quality, a poisonous environment, unaffordable housing. No thanks.