For several weeks a year, the work of nurse-midwife Karen Sheffield-Abdullah is really detective work. She and a team of other medical investigators with the North Carolina public health department scour the hospital records and coroner reports of new moms who died after giving birth.<\/p>\n

These maternal mortality review committees<\/a> look for clues about what contributed to the deaths \u2014 unfilled prescriptions, missed postnatal appointments, signs of trouble that doctors overlooked \u2014 to figure out how many of them could have been prevented.<\/p>\n

The committees are at work in 36 states, and in the latest and largest compilation of such data<\/a>, released in September by the Centers for Disease Control and Prevention, a staggering 84% of pregnancy-related deaths were deemed preventable.<\/p>\n

Even more striking to nurse-detectives like Sheffield-Abdullah<\/a> is that 53% of the deaths occurred well after women left the hospital, between seven days and a year after delivery.<\/p>\n

\u201cWe are so baby-focused,\u201d she said. \u201cOnce the baby is here, it\u2019s almost like the mother is discarded. Like a Reese\u2019s Peanut Butter Cup. The mom is the wrapper, and the baby is the candy. Once you remove the wrapper, you just discard the wrapper. And what we really need to be thinking about is that fourth trimester, that time after the baby is born.\u201d<\/p>\n

Mental health conditions were the leading underlying cause of maternal deaths between 2017 and 2019, with white and Hispanic women most likely to die from suicide or drug overdose, while cardiac problems were the leading cause of death for non-Hispanic Black women, according to the CDC report.<\/p>\n

The data highlights multiple weaknesses in the system of care for new mothers<\/a>, from obstetricians who are not trained (or paid) to look for signs of mental trouble or addiction, to policies that strip women of health insurance coverage shortly after they give birth.<\/p>\n

The No. 1 problem, as Sheffield-Abdullah sees it, is that the typical six-week postnatal checkup is way too late. In the North Carolina data, new moms who later died often missed this appointment, she said, usually because they had to go back to work or they had other young children.<\/p>\n

\u201cWe really need to stay connected while they\u2019re in the hospital,\u201d Sheffield-Abdullah said, then make sure patients are referred for the appropriate follow-up care \u201cwithin one to two weeks after delivery.\u201d<\/p>\n

Increased screening for postpartum depression and anxiety, starting at the first prenatal visit and continuing throughout the year after birth, is another CDC recommendation, as is better coordination of care between medical and social services, said David Goodman, who leads the maternal health team at the CDC\u2019s Division of Reproductive Health<\/a>, which issued the report.<\/p>\n

A common crisis point in the months after childbirth is when a parent\u2019s substance use problem gets so bad that child protective services takes the baby away, precipitating a mother\u2019s accidental or intentional overdose. Having access to treatment and making sure child visitations happen regularly could be key to preventing such deaths, Goodman said.<\/p>\n

The most important policy change underscored by the data, he said, has been the expansion of free health coverage through Medicaid. Until recently, pregnancy-related Medicaid coverage typically expired two months after delivery, forcing mothers to stop taking medications or seeing a therapist or doctor because they couldn\u2019t afford the cost without health insurance.<\/p>\n

Now, 36 states have either extended or plan to extend<\/a> Medicaid coverage to a full year postpartum, partly in response to the early work of maternal mortality review committees. For years, the data showed about a third of pregnancy-related deaths occurred one year after delivery, but in this report, they jumped to more than half, Goodman said, putting more urgency on the importance of longer-term Medicaid coverage.<\/p>\n