August 24, 2023
Shock, sepsis and other serious pregnancy complications have been increasing in Pennsylvania over the past seven years, according to research released this week.
Severe maternal morbidities, or SMMs, increased by 40% statewide between 2016 and 2022, according to a report by the Pennsylvania Health Care Cost Containment Council, an independent state agency. Severe maternal morbidities are defined as unexpected outcomes of labor and delivery that result in significant short- and long-term health consequences.
Philadelphia County had the fourth-worst rate in the state, at 171.9 SMMs per 10,000 deliveries. Only Lehigh, Carbon and Pike counties fared worse. Chester County's rate, 58.7, was among the lowest in the state. Bucks (91.8), Delaware (103) and Montgomery (86.7) counties fell in the middle of the pack.
"When our research team identifies a data trend such as this, we know we need to make our stakeholders aware," said Dr. Jane Keck, director of health policy research at PHC4. "We know this reporting provides valuable insights, we hope it can help improve future outcomes too."
The agency studied women ages of 12 to 55 who were admitted for delivery in Pennsylvania hospitals. Black women were the most adversely impacted, mirroring nationwide trends in maternal mortality rates. Their SMM rate jumped by 51% over the seven-year study period.
Middle-aged mothers and those from poorer neighborhoods also fared worse. SMM rates rose by 46% among patients ages 40 to 55, and by 61% for patients from zip codes with the highest poverty rates. Expectant mothers on Medicaid also saw a 50% increase in SMMs.
The types of complications observed in the study varied, but the most common was acute renal failure. Disseminated intravascular coagulation, which causes abnormal blood clotting, also was prevalent, as was adult respiratory distress syndrome, a condition wherein fluid builds up in the lungs. The vast majority of women in the study who died in the hospital during delivery also had an SMM.
Experiencing these complications is not only dangerous, but expensive. Delivery hospitalizations that included an SMM resulted in an average $101,335 bill compared to an average $27,925 charge for all other deliveries.
Maternal health care has become an area of increasing concern in recent years, as mortality and morbidity rates have continued to climb. The United States has the highest rate of maternal deaths among wealthy nations, and the COVID-19 pandemic may have made the problem worse.
Earlier this year, the U.S. Centers for Disease Control and Prevention reported nation's highest maternal death rate since 1965 – at 32.9 deaths per 1000,000 live births – based on data collected from 2021. Some studies have attributed the longstanding problem to a lack of adequate medical care providers, or guaranteed parental leave.
The maternal care American women receive is often unsatisfactory, according to mothers. In a recent CDC survey, 1 in 5 said they were mistreated by health care providers during pregnancy or childbirth.
Under legislation signed into law this summer, the Pennsylvania Department of Health will be required to publish data on SMMs each year and make recommendations on how to reduce complications and prevent deaths.
Earlier this year, Philadelphia became the first American city to require hospitals to provide detailed information about pregnancy, delivery and the parent's health for patients that experience serious childbirth complications.
Maternal deaths in Philadelphia rose 28% between 2011 and 2014 – the most recent data available. That was faster than maternal deaths rose nationally.
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