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Complications from pregnancy and delivery estimated at $32B for babies born in 2019

A mother holds her baby to her chest
Commonwealth Fund

Health complications that result from pregnancy and delivery are known as maternal morbidity. A woman can develop hypertension or diabetes during pregnancy. She may have to deliver prematurely or by cesarean. And these complications can impact the lives of mom and child into the future.

A new report from the Commonwealth Fund, a private foundation that supports health care research, added upthe financial cost of these complications to be more than $32 billion for all babies conceived in 2019 through their fifth birthday — and many of those costs were preventable. WBFO's Marian Hetherly talked about the findings and policy implications of this research with one of its authors, New York OB/GYN Dr. Laurie Zephyrin.

This tells us our maternal health care crisis is bigger than we think it is, it's everybody's problem.

Dr. Laurie Zephyrin
Commonwealth Fund
New York OB/GYN Dr. Laurie Zephyrin is an author of the research.

Laurie Zephyrin: So, I'm an OB/GYN by training and I've seen many patients that have had the experience of a traumatic birth. I had a patient once who was so traumatized by what had happened when she gave birth, she didn't step foot into a doctor's office for 10 years. It really had me thinking about just how many times is this happening over and over again. We're just not understanding the impacts of a broken health care system. And so we did this report because it's essential to better understand.

If we're able to ensure every pregnant person and birthing person was able to have a healthy birth, we would certainly be much better off as a society. An ideal birthing experience would be a birthing experience that integrates an entire perinatal health care team — a midwife or a doula and a health care coordinator — have the option to deliver at a birthing center or in a hospital, and be able to go through the birthing process in a very seamless way. A holistic, coordinated model of care where we can have and promote better outcomes.

Marian Hetherly: It was kind of scary that, with all the medical advancements and education we have available, your report talks about how maternal morbidity has doubled over the past few decades and in the U.S. is twice that of most other developed countries.

LZ: It's always very shocking. And, you know, to add to that, many of these cases are preventable. If we think about New York State, we know that the inequities are significant, with Black women about eight times more likely than white women to die from a pregnancy-related condition and also more likely to experience severe maternal morbidity.

MH: Perhaps you could start with a summary of the research findings.

LZ: When we think about maternal morbidity, about 60,000 mothers in the U.S. experience an unexpected complication from pregnancy or delivery that have serious impacts. Many don't fully recover and have to live with pain and reduced ability or trauma or fear. And so, as we think about the human cost, there are also serious financial costs. This study that we conducted was really looking to estimate the monetary costs of maternal morbidity. And it's estimated to be at least $32 billion for every child born between 2019 through age five.

This model accounts for medical and non-medical impacts to mother and child. About two-thirds of the costs are related to children's health and the highest maternal health outcome was around loss productivity — about $6 billion. As astonishing as this estimate may seem, it could fall short of the actual estimate, because of just the paucity of comprehensive data. We could very well be talking about much, much more. This tells us that our maternal health crisis is bigger than we think it is.

We have long known that the U.S. ranks last on maternal mortality, which is horrible enough, and shouldn't be happening. But now I think we're better understanding the devastating impacts of pregnancy and birth and complications on thousands and thousands of people's lives, their ability to work and raise their children and feel safe in their health care system. If we're going to make pregnancy and childbirth safer, we need to better measure these complications and work with communities and health systems to find solutions and make these needed fixes to prevent them.

If we're going to make pregnancy and childbirth safer, we need to better measure these complications and work with communities and health systems to find solutions and make these needed fixes to prevent them.

MH: And that's really what this is about, making childbirth safer, right?

LZ: Right.

MH: So what are we doing wrong?

LZ: That's a great question. We looked at, for example, other developed nations that are doing a lot better than the United States around maternal maternal health care. What we found is that, one, there's a broader investment in health and health care. So access to universal health care coverage, coverage that doesn't wane or vary when you're pregnant or not, are not based on what job you have or not. So that is really important: ensuring that everyone is covered. When we think about our perinatal health care teams, we have a lack of investment overall in our maternal health care workforce. And we also need to invest more in the midwifery model of care and support building out that capacity.

The other piece which I think is really important, are considerations around equity. We also have significant disparities in our maternal health outcomes. And so we need to be able to address and understand why we have these disparities. What are the roots of these disparities? What's the impact of structural racism and bias on maternal health outcomes. And we need to invest in a diverse maternal healthcare workforce and diversity in terms of the types of providers, so that there's culturally safe maternity care as well. And I think the last piece, which the study also highlights is, we definitely need to improve better data collection on maternal morbidity. It's definitely important for us to capture and understand why we see the deaths, but we also need to better understand what the near misses look like and how to be able to not only capture that, but also have targeted interventions to have people have a better birthing experience.

MH: Am I right in saying that I saw the largest portion of costs was for mental health?

LZ: Mental health is definitely something that requires additional attention. We know the heavy financial toll and personal toll of untreated mental health conditions. And so it's really important to think about anxiety disorders or postpartum depression. It means the number one complication of pregnancy and childbirth and about half of people that have a diagnosis of depression don't get the treatment they need.

MH: Some may disagree with counting the numbers to a child's fifth birthday as part as maternal morbidity, as you guys did in this report. The report says nearly two-thirds of costs are child outcomes. So maybe you could explain why you chose that time period?

LZ: From a policy perspective, we have to have a short-term view and a long-term view. It's also important to look at where there are data available and try to integrate that as well. Because ultimately, what we're trying to do is think about how to support birthing people and their families and their children. And so it's really important to be able to project out to understand what are the implications.

I do think it's important for people understand that most childbearing people have safe and healthy births. Having said that, maternal morbidity is all too common. We really need to put voices to those experiences.

MH: What kind of policy implications are we talking?

LZ: There are a range of policy implications around that. Being able to develop more aligned policy initiatives across the federal government is really important. Build Back Better, for example, would expand and extend Medicaid coverage for about a year after giving birth, including for mental illness, which is a major contributor to maternal morbidity. The Black Maternal Health Omnibus Act of 2021 would invest in and expand the maternal health care system to address social factors like housing and nutrition and transportation. That has significant implications on outcomes and developing models to address root causes and social drivers.

The second thing, which I think is really important in terms of policy implications, we definitely need a more diverse maternal health workforce, whether we're talking about the types of providers, but also in terms of the representation, so that our providers can represent the people being served. And then the third policy implication is around data. We need to improve data collection on maternal morbidity so that we can have better solutions.

MH: You mentioned that your research probably underestimated the costs. To that, I think it's important to mention that the cost that you guys calculated came from only nine common maternal morbidity conditions. And, of course, there's a lot more that can happen during that nine months of pregnancy plus the next five years.

LZ: That's correct. There's also a range of other conditions that we couldn't look at because there wasn't enough data to include in the model.

MH: So where do we go from here? We're already having problems getting folks on board with this kind of thing, as evident by our high rate of maternal morbidity.

LZ: Well, I do think it's important for people understand that most childbearing people have safe and healthy births. And so I don't want birthing people to go into pregnancy and birthing scared and fearful for their lives. Having said that, maternal morbidity is all too common and we really have to take these near misses very seriously. They can impact people for a lifetime. And most of those impacted, we really need to put voices to those experiences. So the goal of this work is to really raise awareness, help promote policy change and also promote delivery system change, so that people can have better and safer birthing experiences.

MH: You also mentioned that the majority of this is preventable.

LZ: The majority of this is preventable, yes. We can do something about it. And what's exciting about this time is that there seems to be a lot of momentum to make change. I think we're on the precipice of really having significant impacts, positive impacts, on our maternal health care system. And we need to continue with the urgency of this as a society so that we can bring about change.