Report: Majority of pregnancy-related deaths in Iowa could have been prevented

A newly released report found that 95% of pregnancy-related deaths in Iowa were preventable, and those deaths disproportionately affected women who are Hispanic and Black and on Medicaid.

Imagine your sister being a healthy woman in her mid-20s who, 18 days after giving birth to a healthy baby, experiences chest pains and shortness of breath. And then imagine having to take care of her newborn because she passed away after going into cardiac arrest while waiting almost 20 minutes for an ambulance.

While that isn’t exactly the scenario that happened to a woman in Iowa, it does contain key elements from actual maternal deaths in the state. A report found that 95% of those pregnancy-related deaths were preventable.

The Iowa Maternal Mortality Review Committee recently released its first report in nearly four years. The authors reviewed  20 pregnancy-related deaths in the state that occurred from 2019 to 2021 (either during pregnancy or up to a year postpartum). Of those 20, 19 were preventable.

“It really feels like a really disheartening statistic,” Stephanie Radke, the chair of the committee and an OB/GYN at University of Iowa Health Care, told IPR. “What’s important for people to understand is that when we evaluate a death, and we are having a conversation about preventability, it gets boiled down to a yes [or] no, but it’s really more on a scale of like, ‘Was this possibly preventable? Was this likely preventable? Was this most certainly preventable?’”

Of the 20 pregnancy-related deaths in the report,

• 6 deaths were due to infection
• 4 deaths were due to hemorrhage
• 4 deaths were due to an embolism
• 6 deaths were from conditions such as cancer, hypertensive disorders, and mental health conditions  

The deaths disproportionately affected women who are Hispanic and Black, and on Medicaid.

What can be done?

Iowa, like many states, has faced challenges related to maternal health. Factors such as access to quality prenatal care, rural healthcare shortages, and socioeconomic disparities contribute to maternal health outcomes. 

In the report, the Maternal Mortality Review Committee recommends that healthcare providers and medical facilities expand mental health screening, improve emergency care readiness, and ensure women have access to the full range of family planning services. 

“We want to think about, are all of our facilities prepared to manage a catastrophic hemorrhage, an eclamptic seizure?” Radke said. “And then in all facilities, are we really identifying risk factors?”

The report also recommended that the state address gaps in maternity care, especially in rural areas. In Iowa, 57% of counties lack obstetric facilities. To combat this, the University of Iowa Health Care’s department of obstetrics and gynecology, in partnership with the state, is focusing on training healthcare professionals and supporting existing birthing centers.

More can also be done on the state level, the report said. At the beginning of the year, Iowa extended Medicaid coverage for postpartum women from 60 days to 12 months. However, the new law, approved by the Republican-majority legislature, also lowered the income eligibility threshold, which resulted in about 1,300 mothers and 400 infants losing coverage each month.

Iowa’s Department of Health and Human Services is also implementing community-driven strategies. The state participates in the Alliance for Innovation on Maternal Health Program, a national initiative focused on implementing best practices to enhance maternal health outcomes.