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Maternal Mortality

Cassie McGrath

Healthcare Brew delivers the latest news and trends in healthcare.

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The One Big Beautiful Bill Act is set to have big implications for hospitals and 

. But experts say it could also impact patient care—specifically, maternal health.

 for maternal and infant mortality and morbidity, according to the 2024 March of Dimes Report Card. Now, the bill is cutting federal spending on Medicaid and the Children’s Health Insurance Program (CHIP) by $1 trillion, 

 beneficiaries potentially without coverage by 2034.

This is a challenge, as Medicaid is the largest single payer for pregnancy-related services, KFF reported in May, covering 41% of births across the country and nearly half of births in rural areas. States with the most rural hospitals are 

 to have reproductive rights restrictions. (For example, Alabama, Oklahoma, and Texas all have abortion bans and are experiencing a rural health crisis.)

“Medicaid is vital for moms and babies in this country,” Michael Warren, chief medical and health officer at nonprofit March of Dimes, told Healthcare Brew.

Additionally, there’s a growing fear Medicaid cuts will 

 of some rural maternal care units or entire facilities, experts previously told Healthcare Brew. When hospitals close services, 

This means not only are there healthcare workers leaving—or 

 to—these states but there’s also likely to be 

 in places where abortion isn’t allowed.

“We’re at a moment where we need to be doing all we can to think about increasing access and helping people get healthier before pregnancy and have a healthy pregnancy,” Warren said. “Anything we do that takes our foot off the gas is not moving us in the right direction.”

Planned Parenthood is one example of maternal health clinics that may be hit by cuts.

 of a preliminary injunction to stop Medicaid cuts from affecting Planned Parenthood, but the nonprofit organization is still on the chopping block for potential defunding.

Planned Parenthood has been reportedly “targeted” for 

, but the centers provide more than reproductive care, offering preventative and primary care, Monica Skoko Rodríguez, director of medical standards production at Planned Parenthood, told us. 

The organization also treats underserved populations, with 76% of 600 Planned Parenthood centers based in “rural or medically underserved areas,” according to a fact sheet.

If it were defunded, patients could lose access to care like cancer screenings and intimate partner violence screenings, she added, leaving them to turn to hospitals for care instead. Avoidable emergency department visits overall cost the healthcare system an estimated $32 billion each year, 

“They are not going to be able to access [these resources] until things really spiral out of control, and that’s where we see an overload in emergency care systems and hospital systems, when things would have been much better managed much earlier on and would have had much better outcomes for the patient and for the healthcare ecosystem at large,” Rodríguez said.

A black pregnant woman with a medical cross logo glowing behind her

Medicaid cuts could lessen access to maternal health

The US already received a D+ for maternal and infant mortality and morbidity from March of Dimes. 

 a “baby bonus,” i.e., cutting $5,000 checks to incentivize families to have more children in response to 

While still just an idea, it spurred concern among reproductive health experts. They told Healthcare Brew pregnant patients face many challenges, from 

For instance, it costs $18,865 to have babies in hospitals, including pregnancy, birth, and postpartum care, 

 of people who give birth are on Medicaid, and with Congress considering 

, patients may soon pay those costs out of pocket.

“$5,000…is probably a drop in the bucket in terms of raising a child. But is it maybe a step in the right direction? Yes,” Monica Cepak, CEO at women’s digital health company Wisp, said. “I think it should be part of a broader policy around reproductive health and childcare in our country.”

 First and foremost, the number of places to give birth in the US is on the decline.

March of Dimes, a nonprofit that works to support maternal and infant health, reported that in 2021 and 2022, about 1 in 25 obstetric units closed in the US and 70% of birthing units are located within 10 states. The organization also 

 35% of US counties don’t have a single birthing facility or obstetric clinician.

“To have wide swaths of this country without the presence of a maternity ward makes it seem more like a developing nation as opposed to one of the most industrialized nations with one of the best healthcare systems on the planet,” Melissa Simon, an ob-gyn at Northwestern Medicine in Chicago, said.

 was overturned in 2022, there’s been a rise in 

 in the US, meaning it’s more dangerous to have children now.

Research from nonprofit research organization the 

 found that in Texas, which has a strict six-week ban on abortion with no exceptions for rape or incest, maternal mortality rates rose by 56% between 2019 and 2022, compared to an 11% increase across the US overall.

Infant death rates have also risen, with 

 5.6 deaths for every 1,000 live births in 2022, up from 5.4 in 2021.

“Women who are in states where there’s restrictive reproductive healthcare laws…

Pregnant people living in states with “full support of reproductive healthcare,” like Illinois, New York, or California are also hesitant to travel to states with bans, she added. Some people from states with bans are choosing to stay in states with abortion access throughout their pregnancy, she said.

“It is unconscionable to think that the president or the government would give $5,000 to incentivize having a child while not taking care of the woman herself,” she said.

A woven basket filled with stacks of $100 bills and a sticky note with a baby stroller icon.

Birthing unit numbers are on the decline, and patients are facing greater risks 

With more labor and delivery departments closing and a decline in reproductive health access, it’s harder and more expensive to have children. 

illustrated headshot of caroline catherman, healthcare brew reporter

Caroline Catherman

Maternal mortality audio embed

The US is one of the deadliest high-income countries to give birth in—especially if you’re Black.

 from the Commonwealth Fund found the country had about 22.3 deaths during or shortly after pregnancy per 100,000 live births overall in 2022, but 49.5 deaths per 100,000 live births for Black patients. Compare this to Norway, which had zero per 100,000 in 2022, or Australia, which had 3.5 in 2021, according to OECD health statistics.

What’s more, the CDC reported in 2023 that 20% of 2,407 surveyed US mothers experienced mistreatment during maternity care—like being ignored or verbally abused—with rates climbing to 30% among those who were Black, Hispanic, or multiracial.

Tanay Lynn Harris, cofounder and director of Baltimore perinatal wellness center the Bloom Collective, told Healthcare Brew she’s heard many stories from Black mothers who say doctors dismissed their pain.

“There’s a lot of harm that is happening,” Harris said. “It has a ripple effect to the baby. It has a ripple effect to the female overall, to the community.”

Birth workers like Harris say the solution is diversifying the medical workforce and providing culturally competent community resources to empower Black patients.

A 2021 review from the Association of Black Cardiologists 

 the importance of community outreach programs and faith-based partnerships that educate Black patients about the common comorbidities and issues they may face, and how to manage the challenges.

The Bloom Collective is one of these community initiatives that coaches mothers, parents, and families to ask their provider why they’ve scheduled a C-section or are pushing formula over breastfeeding, for instance, or to speak up when they feel their pain is being dismissed, Harris said.

“That gives back the power to someone who feels disempowered,” Harris said.

Another tool in the toolbox: doulas. These are birth workers without any formal medical training who provide support during pregnancy, birth, and postpartum.

Though there aren’t a lot of studies on the impact of doula care, a

 in web-based medical journal Cureus found that doula care was associated with autonomy and confidence as well as decreased premature deliveries and C-sections.

“[Doulas are] particularly helpful for Black women who may not have this support,” Regina Davis Moss, president and CEO of advocacy coalition In Our Own Voice: National Black Women’s Reproductive Justice Agenda, told Healthcare Brew.

For instance, Black patients are more likely than white patients to experience complications like 

 looking at New Jersey childbirth hospitalizations between 2000 and 2015 found.

But many Black and low-income patients can’t afford doula care, which can 

 out of pocket and often isn’t covered by insurance, according to a May 2023 issue brief from the Women’s Bureau of the US Department of Labor.

Moss said the next step is providing Medicaid coverage for the service, an idea that is gaining momentum.As of November 2024, 27 states plus Washington, DC, had implemented or were in the process of implementing Medicaid coverage for doula care. 

 requiring private health plans to cover the service.

But doulas aren’t “the end-all be-all” for this issue, Harris said.

“We have to honor midwives. We have to honor lactation consultants, healthcare therapists, perinatal mental health therapists. It’s this full constellation of care,” she said.

Harris also serves as co-chair of the Maryland maternal health improvement task force, a group convened by the Maryland Department of Health to find solutions to gaps in care for pregnant and postpartum people. She said one of its most helpful tools—the Maryland Maternal Health 

—connects different professionals to each other.

Veronica Pimentel, a practicing maternal-fetal medicine specialist at Trinity Health of New England, agrees that collaboration is key.

She worked alongside doulas and midwives in her residency program and said she learned valuable insights from both. She said doulas were helpful “cultural interpreters” for doctors who were not part of the same community as the patient.

Pimentel said it is also important to address the other contributing factors to Black patients’ increased mortality and morbidity rates, including chronic conditions like high blood pressure that can put them at higher risk of birth complications or needing C-sections, per the CDC.

Black patients are also more likely to be on Medicaid, which provides lower reimbursement for pregnancy care and postpartum care than private insurance, and can make it harder to find providers, Pimentel said.

About two-thirds of Black births in 2022 were funded by Medicaid, compared to four in ten births overall, according to the CDC’s April 2024 National Vital Statistics Report.

Pimentel also pushed for diversifying the maternal health workforce in order to overcome harmful stereotypes and assumptions.

For instance, from 2006 to 2021, race and ethnicity were factors in a widely used algorithm used to predict the safety of vaginal birth after a C-section, known as the vaginal birth after cesarean (VBAC) calculator, Pimentel said.

 from Harvard and Brigham and Women’s Hospital researchers argued that the calculator’s inclusion of race-based correction factors is “historically rooted in deeply racist enterprises” that suggested Black and Hispanic patients’ pelvises were less equipped to birth children than white patients.

 from Stanford researchers published in Women’s Health Issues found that large language models can still perpetuate racist ideas by giving “older, biased, or inaccurate information since they do not assess research quality.”

Racism has long been a problem in maternal healthcare, Pimentel said, adding that Marion Sims, who was sometimes credited as “the father of modern gynecology,” conducted research on Black slaves without anesthesia.

“We did not get here today by accident,” Pimentel said.

Maternal mortality: Solutions to Black women’s health crisis

Black mothers face higher rates of mistreatment and mortality during childbirth, but advocates are working to transform the system.

Moving beyond maternal mortality: Weighing solutions to Black women’s health crisis

Birthing care at hospitals is dwindling in the US, as 530 hospitals have closed their obstetrics units between 2010 and 2022.

That’s according to a new study out of the University of Minnesota School of Public Health published in 

In 2010, 35.2% (1,679 out of 4,768) of all hospitals in the US didn’t have obstetrics, but by 2022, that shot up to 42.4% (1,966 out of 4,639), with the worst effects felt in rural communities, according to the study.

“Rural hospitals not only started with fewer obstetric services but also experienced more severe losses over time, leaving rural residents with fewer options and longer distances to travel—often at times when patients are in urgent need of timely care,” lead author Katy Kozhimannil said in a December 4 press release.

This research followed a September study from the nonprofit 

 that found 35% of US counties are considered maternal health deserts. Meanwhile, maternal morbidity has increased since 2018, 

, with Black patients dying at higher rates (49.5 deaths per 1,000 live births compared to 19 deaths per 1,000 live births for white patients in 2022).

The research team used an algorithm to analyze data between 2010 and 2022 from the American Hospital Association’s annual surveys and Centers Medicare and Medicaid Services Provider of Services file for obstetric services at nearly 5,000 hospitals around the US.

According to the study, research from 2010 reported that 29.7% (836 of 2,813) of urban hospitals and 43.1% (843 of 1,955) of rural hospitals didn’t have birthing care. 

While 138 more birthing units opened from 2010 to 2022—112 in urban and 26 in rural areas—the increase in closures canceled them out.

Over that same time period, 537 hospitals closed their birthing units—299 urban and 238 rural closures—resulting in 35.7% (977 of 2,779) of urban hospitals and 52.4% (957 of 1,860) of rural hospitals unable to serve birthing patients by 2022.

“Without targeted resources and policy interventions focused on equitable access to maternity care for all, including people of color and geographically-isolated folks, this public health crisis will only get worse,” Kozhimannil said in the release.

A newborn baby is presented while still in the intensive care unit.

Study: Over 500 hospitals have closed obstetrics units since 2010

Rural communities have the least access to birthing care, according to a new study from the University of Minnesota School of Public Health.

Maia Anderson

Women’s health tech company Materna Medical raised an additional $5.7 million in funding, the first close of a $20 million Series B2 funding round led by medtech investing firm InnovaHealth Partners.

The Mountain View, California-based company has developed two products to treat pelvic floor conditions and has raised a total of $57.6 million over seven funding rounds, according to Crunchbase.

"We’re thrilled to have completed the first close and excited about the investors still seeking to participate in the final close later this year,” Tracy MacNeal, Materna Medical’s president and CEO, told Healthcare Brew. “Given the unmet needs in maternal health, investors can see the tremendous opportunity for both social impact and a great return on investment."

Materna Medical’s flagship product, the Milli Vaginal Dilator, is designed to treat people with vaginismus, a disorder characterized by involuntary tensing of the muscles surrounding the vagina, according to Cleveland Clinic. The Milli device received FDA clearance in 2023 to be sold over the counter.

The company’s second product, called Materna Prep, was created to help reduce pelvic floor injuries that occur during childbirth. More than 300,000 people—or roughly 10% of people who give birth vaginally—require surgery after childbirth each year due to pelvic floor injuries, according to a 2024 

In a pilot study, the Materna Prep device led to a 60% reduction in pelvic floor injuries for first-time vaginal births, according to Materna Medical.

The company plans to use the new funding to “obtain FDA marketing authorization for Materna Prep and support the commercial launch of this transformative technology,” Ariella Golomb, Materna’s board chair and InnovaHealth Partners’s founder and partner, said in a statement.

—which encompasses technology focused on the health needs of cisgender women as well as transgender and nonbinary people—have risen in recent years.

The industry brought in more than $50 billion in global funding in 2021 and is expected to bring in $103 billion by 2030, according to Statista.

In the US, the femtech industry brought in $481 million in 2023, a 5% increase over 2022, as Healthcare Brew previously 

 But women’s health still makes up a small percentage (2% or $823 million) of overall US healthcare funding as of 2023.

“The women’s health and sexual health space is massively underserved. And it’s only recently with a new demographic of venture capitalists that we’re seeing investments go toward other areas besides fertility,” Carli Sapir, founding partner at Amboy Street Ventures, a venture fund dedicated to women’s health and sexual health startups, previously told Healthcare Brew.

Materna Medical closes additional financing round, bringing total funding to $57.6m

The company plans to use the funds to support its medical device designed to prevent pelvic floor injury. 

Will Peischel

Despite some hospitals considering childbirth a “

 their birthing centers as they lose money on the procedure, according to a recent study from the Center for Healthcare Quality and Payment Reform (CHQPR).

More than half (55%) of rural hospitals in the US no longer provide birthing services, and 600+ more are at risk of closing their birthing centers because they cannot afford to maintain them, CHQPR researchers found.

“It is not an exaggeration to say that rural maternity care is in a state of crisis, and a crisis demands immediate action,” according to the CHQRP report.

The financial challenges rural hospitals are facing

Rural hospitals face a number of financial barriers when it comes to providing birthing services.

 across the US, according to a 2023 study from nonprofit organization Brookings Institution.

This presents an acute budgetary challenge, experts say: Insurance reimbursement rates are typically tied to the number of births that take place at a hospital, and some rural hospitals don’t administer births frequently enough to cover the costs of keeping clinicians staffed, Harold Miller, president and CEO of CHQRP, told Healthcare Brew.

Hospitals that provide birthing services are required to have specialized clinicians, including nurses and ob-gyns, on staff 24/7, since a birth could happen at any time. With nationwide 

, the cost to keep clinicians on staff is going up, and “it’s particularly hard to find people with the kinds of specialized skills that you need in maternity care,” Miller said.

As those costs go up—and a decreasing number of births leads to lower reimbursements—rural hospitals may feel they have no other option than to shut down birthing services, Miller said.

Without nearby birthing services, most patients have to travel farther, which in turn increases the risk of complications and death for both the childbearing patient and the baby, according to Miller.

In urban areas, it takes less than 20 minutes on average to access a hospital with birthing services, according to CHQPR’s study. In rural areas, it takes at least 30 minutes on average; more often, it actually takes 40 minutes or longer, the researchers found.

And the consequences go beyond just childbirth, Miller noted. When hospitals eliminate birthing services, they often eliminate prenatal and postnatal care as well, he said.

That could have devastating consequences.

As the authors of the CHQPR study note, the US “has the highest rates of mortality for both infants and mothers among the world’s advanced economies […] Moreover, the problem is getting worse, not better; 

 rates in the US nearly doubled between 2018 and 2021.”

Last June, St. Peter’s Health Partners (SPHP), a health system serving upstate New York, 

 plans to shut Burdett Birth Center at Samaritan Hospital in Troy.

Kim Baker, SVP of Samaritan Hospital’s health operations, said the decision was driven by low Medicaid reimbursement rates, a high proportion of Medicaid enrollees, and declining birth rates, per a letter to state Health Commissioner James McDonald.

Further, a health impact equity assessment that the hospital submitted to the state said that “the losses incurred through operation of the maternity services unit at Samaritan Hospital, inclusive of providers, anesthesia, and fixed costs, totaled $2.3 million” in 2022.

“Burdett has not been immune to the critical healthcare challenges hitting hospitals and birthing centers across the country,” Robert Webster, an SPHP spokesperson, told Healthcare Brew in an emailed statement.

Community organizers who are against the closure said it would force them to look at alternative birthing services in the future—particularly the midwifery and doula support offered at the facility, which would move to St. Peter’s Hospital in Albany if Burdett closes.

“If we lose it, we have nothing in Rensselaer County,” Ashley Saupp, an organizer with the Save Burdett Birth Center Coalition, told Healthcare Brew. “Here in our little corner, there’s no place to deliver a baby in Rensselaer County, in Greene County, or Columbia County.” The average distance to a birthing center for residents in Greene County, for example, is located nearly 33 miles away, 

 to the March of Dimes, which tracks maternity ward closures.

One possible solution to alleviate some of the financial burden on rural hospitals is to create a reimbursement system that’s not tied to the number of births, Miller said, arguing that insurers should reimburse hospitals with what CHQPR calls an “annual standby capacity payment.”

In this model, an insurer would essentially pay hospitals a flat rate per year to have maternity services available, rather than pay based on a strictly 

“That [flat rate] would be paid by health insurance plans based on the number of women living in the community that they’re insuring, age 15 to 44,” Miller said. “The payment then better matches the way the hospital incurs the cost.”

To make a difference, every type of insurer—including private, employer-based, and government-run—would need to agree to this new payment method, according to Miller.

Miller said he’s not aware of any insurers that have tried such a reimbursement model.

“Every day that steps are not taken to implement the changes in workforce recruitment and payments described above increases the likelihood that more women and babies will die unnecessarily,” the CHQPR study authors noted.

Majority of rural hospitals can’t afford to keep birthing centers open, study finds

Between low reimbursement rates and rising costs, rural hospitals are struggling to afford birthing centers.

Most rural hospitals no longer offer birthing services, study finds 

A person with dark hair and a red plaid shirt

Quinn Sental

When you think of “digital health tools,” you might think of telehealth apps and patient portals—platforms that you only access when you’re in need of medical attention.

In reality, you’re likely using a digital health tool right now. Whether it’s a menstrual-tracking or fitness app, the text chain with your therapist, or even someone on TikTok giving advice about how to alleviate headaches—these are all examples of digital health tools that anyone with a phone can easily access.

For a lot of pregnant patients, these digital tools can go from being a crutch to being a lifeline. A 

 from the Deloitte Center for Health Solutions, which surveyed 2,000 people who were pregnant in the past two years, found that 77% of respondents used digital tools to help with their mental health, appointment scheduling, ovulation tracking, and more.

These digital tools can massively improve the birthing experience. A 2024 

 published in journal Obstetrics & Gynecology, cited in the report, found that virtual support from a doula was positively associated with “lower odds of cesarean birth and an improved birth experience.”

“Maternal health equity can be supported by digital transformation,” Heather Nelson, coauthor of the Deloitte report and a managing director at the Big Four accounting firm, told Healthcare Brew. “But we need to really be mindful that there is also a digital divide.”

Around a third of survey respondents who used these tools reported that their digital care teams rarely 

, believed what they were saying, or treated them fairly. These patients were also more likely to be Black or African American.

The Deloitte report also found that Black, mixed-race, and Hispanic/Latino patients were almost twice as likely as white patients to agree that digital tools for maternal healthcare should be more culturally informed.

These findings exacerbate one of Nelson’s most central questions about digital health tools: “How do digital solutions change biases within the system? And not just digitize the already biased system in which we operate?”

One way to address these biases is with equity-centered design for digital tools. Equity-centered design means that instead of treating its users as consumers, a product takes into account the needs and preferences of its users as if they were codesigners.

Of the Deloitte survey respondents, over 80% agreed that those with lived experience in maternal health should be involved in the entire process of creating a digital resource for maternal health—before development, during development, and after it’s launched.

Luckily, it won’t be hard to find people with lived experience who are willing to help. Around 90% of survey respondents said they would participate in each of the development processes, a statistic that was “consistent across racial groups.”

“We are at the point, I think, in our industry trajectory, and the ecosystem writ large, where there’s enough out there from a digital tools perspective [...] to really activate the ecosystem so that we get it right,” said Nelson. “We don’t have to be perfect, but we have to be perfect for those who are on this journey of surviving pregnancy in this country.”

An image of a red cross, pill bottles, and health carts surrounding a phone. 