Maternal mortality and morbidity are key indicators of maternal health and health care quality in Wisconsin. Every maternal death represents not just the loss of a woman’s life, but the impact of that loss on her family and community. Instances of severe maternal morbidity can be traumatizing for women and families, have lasting health consequences, and result in avoidable medical expenses. Though maternal health in the United States has improved greatly during the past century, recent increases in pregnancy-related deaths and significant racial disparities in maternal health demonstrate the need for systematic improvements in the care of pregnant women and mothers.
One measure of maternal mortality is the pregnancy-related mortality ratio (PRMR) or the ratio of pregnancy-related deaths to live births. “Pregnancy-related death” refers to the death of a woman while pregnant or within one year of pregnancy termination (i.e., birth, miscarriage, or elective abortion) - regardless of the duration and site of the pregnancy - from any cause related to or aggravated by the pregnancy or its management. Deaths from accidental or incidental causes are not considered pregnancy-related.
During 2006-2010, the PRMR in Wisconsin was 5.9 deaths per 100,000 live births, compared to the U.S. ratio of 16.0. Though Wisconsin routinely reports a lower PRMR than the nation, the disparity between Black and White women in Wisconsin is greater. During 2006-2010, the PRMR among non-Hispanic Black women was 5.0 times the PRMR among non-Hispanic White women in Wisconsin. During the same period, the PRMR among non-Hispanic Black women in the U.S. was 3.2 times that among non-Hispanic White women.
Maternal deaths constitute only a small fraction of the serious health issues that women experience during the perinatal period. Severe maternal morbidities (SMMs) or so-called “near misses” make up a much larger proportion of adverse maternal outcomes. SMMs include complications resulting from or exacerbated by pregnancy, such as renal failure, eclampsia, and sepsis. National data suggest that the burden of SMM is increasing, possibly due to demographic factors and pre-pregnancy health conditions.
In Wisconsin, hundreds of women experience one or more severe maternal morbidities during a delivery hospitalization each year. During 2009-2013, at least 1 out of every 100 delivery hospitalizations resulted in at least one SMM. SMM rates were highest for women younger than 20 years of age, women 35 years of age and older, and non-Hispanic Black women. The most common types of SMM in Wisconsin were blood transfusions, disseminated intravascular coagulation, heart failure during surgery, operations on the heart, hysterectomy, and eclampsia.
Addressing Maternal Mortality and Morbidity
Given the substantial burden of maternal morbidity and mortality and the persistence of racial disparities, the Wisconsin Department of Health Services supports the in-depth investigation of maternal death incidents through the Wisconsin Maternal Mortality Review Team (MMRT). The MMRT is part of Wisconsin’s broader effort to use comprehensive fatality reviews, such as Child Death Review (CDR) and Fetal and Infant Mortality Review (FIMR), to inform public health prevention.
Wisconsin also investigates perinatal health issues by participating in the Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS is an ongoing survey of new mothers conducted in partnership with the Centers for Disease Control and Prevention. PRAMS examines the attitudes and experiences of women before, during, and shortly after pregnancy.
Findings from these investigations and other research suggest that quality in maternal health care can be maintained through regionalized systems of perinatal care. Regionalization ensures that the highest-risk pregnant women and infants receive care in facilities well-equipped to manage them. The Wisconsin Association for Perinatal Care (WAPC) leads a self-assessment process to help hospitals identify their level of perinatal care and makes these designations available to the public.
In 2015, a statewide Perinatal Quality Collaborative was established to advance evidence-based practices and quality improvement initiatives related to the care of pregnant women and mothers. The Wisconsin Perinatal Quality Collaborative provides a platform for perinatal care providers and public health professionals to coordinate efforts to address critical maternal health issues
Reports and Presentations
The following publications provide more information on maternal mortality and morbidity in Wisconsin:
- Report: Wisconsin Maternal Mortality Review Recommendations Report, April 2018
- Article: Severe Maternal Morbidity During Delivery Hospitalizations
- Report: Severe Maternal Morbidity among Wisconsin Residents, 2010-2014 (PDF)
- Article: A Review of Pregnancy-Related Maternal Mortality in Wisconsin, 2006-2010 (PDF)
- Report: Maternal Mortality in Wisconsin 1998-2005 (PDF)
- Poster: Investigating All Causes of Pregnancy-Associated Death in Wisconsin through Maternal Mortality Review (PDF)