Maternal Mortality in the United States
Literature Review
Maternal morbidity and maternal mortality have been increasing drastically in the United States of America. There are various causes of maternal mortality, such as excessive bleeding during the gestation period or after birth, high blood pressure and cardiomyopathy, infections during pregnancy, embolism, and complications while giving birth.
In this literature review, enhancement of maternal data evaluation of death certificates is the foundation of public health systems in monitoring public health strategies and programs, racial /ethnic differences and birth hospital contribute to severe maternal morbidity in the U.S., the priority areas to address maternal mortality and extreme maternal morbidity as crucial issues in the United States, state-level changes influence maternal mortality.
There is a Rural-Urban variance in extreme maternal mortality and morbidity in the United States.
Enhancement of United States’ maternal mortality data analysis and reporting of literal texts concerning death certificates.
Exuberant statistics data is the foundation of the system of public health. It issues important data to monitor public health programs mainly related to maternal mortality in the United States. Maternal mortality is a sentimental representation of the quality of healthcare (MacDorman et.al, 2020). The type of research design that is employed in the research article is a meta-analysis.
It statistically analyzes the conclusions of multiple scientific studies that report the total number of maternal mortality data in the United States (MacDorman et.al, 2020). The maternal mortality data of the United States is employed for international and national contrast according to information reported concerning death certificates filed in the State’s essential statistics office and organized into national data by the nation’s crucial statistic system (MacDorman et.al, 2020). Multiple causes of death data files in 2016 and 2017 from the United States of America are utilized from the National Centre of Health Statistics (MacDorman et.al, 2020).
This study’s research question is ‘what are the possible over or under-reporting of maternal deaths and the analysis of cause-of-death literals?’ The primary data collection method used in the research article is through documents and records of death certificates that are already subsiding (MacDorman et.al, 2020). The researchers used secondary data sources.
The researchers analyzed the crucial statistics mortality data of the United States of America in 2016 and 2017 with literals of the causes of deaths (MacDorman et.al, 2020). The researchers strategized a coding formula aiming to code the primary cause of various deaths. They then collated to overall maternal deaths and, for death, subsets coded to ill-defined causes originally (MacDorman et.al, 2020).
The findings are that among the 1691 maternal deaths that were coded originally, 597 (35.3%) on the recording were still maternal deaths, and 1094 (64.7%) were recorded as non-maternal deaths (MacDorman et.al, 2020). Preeclampsia and Eclampsia, postpartum cardiomyopathy, obstetric embolism, and obstetric hemorrhage were the most usual causes of maternal deaths.
Diseases linked to the circulatory system and cancer were the most common causes of non-maternal deaths. The research study’s main strength is that the sample size increase hence enhances the impact of the research study’s effects, and the data collected by the researchers is significantly beneficial (MacDorman et.al, 2020). The research study’s weakness is that document, and record data collection methods may result in inaccurate findings as data might have tampered with.
Maternal mortality is a sentimental representation of the quality of healthcare. Still, reviews concerning the United States maternal mortality reporting quality have lingered for a long period.
The establishment of maternal mortality statistics in the United States of America plays a major role in identifying maternal deaths. Such as restricting pregnancy checkbox applications to individuals between ages 10-44 years and restricting maternal codes assignment to only the main cause as the checkbox is the only pregnancy indicator.
Literal texts have been proved to issue detailed data on the medical and disease circumstances that cause death.
Contributions of the birth hospital and racial /ethnic differences in severe maternal morbidity in the U.S.
The birth hospital is a significant contributor to extreme maternal morbidity disparities due to ethnic and racial differences. The research design employed in the research study is a cohort study design.
The researchers utilized data and information concerning all births less than or equal to 20 weeks of gestation in California from 2007 to 2012 (Mujahid et al., 2020). The researchers used the primary method to collect and analyze data (Mujahid et al., 2020). Severe maternal morbidity in the process of birth hospitalization was measured and collected by the centers for disease control and prevention index of at least 1 of the total 21 procedures and diagnosis (Mujahid et al., 2020).
The research question in this study is ‘Does birth hospital contribute to racial and ethnic differences leading severe the maternal morbidity and the mortality?’ The researchers used mixed-effects logistic regression models to contrast ethical and racial differences in severe maternal morbidity before and after adjustment for factors connected to pregnancy, the characteristics of a hospital, maternal social demographic, and comorbidities (Mujahid et al., 2020).
The main findings of the research study was that of the 3,020,525 females involved, 1.3% had severe maternal morbidity whereby;2.1% were people of color, 1.3%, 1.3% Pacific Islanders and Asians, foreign-born Hispanics, 1.6% Alaska Native and American Indian, and 1.3% U.S. born Hispanic (Mujahid et al., 2020). A significant strength of the research study is that several outcomes are easily measured for exposures, measured before the onset of maternal mortality and the morbidity (Mujahid et al., 2020).
The research study’s major weakness is that it has wider inclusion criteria, making it very expensive and time-consuming (Mujahid et al., 2020). Also, the cohort study design makes it difficult to develop casual impacts. In the United States of America, ethnic and racial disparities in extreme maternal morbidity vary by region in terms of their structural causes.
Further examinations need to be undertaken, aiming to examine and evaluate policies that are effective at birth facilities.
Priority areas to address maternal mortality and extreme maternal morbidity as crucial issues in the United States.
The research design employed in the research study is a systematic review. The National Institute of Child Health and Human development arranged, and experts were invited with varied views in a scientific workshop and a community engagement meeting to evaluate the underlying themes engaged in the increasing issue of maternal mortality in the United States (Chinn, 2020). The research question in this study is ‘Is it important to establish priority regions to address maternal mortality crisis?’
The researchers evaluate data through the document and record analysis concerning maternal mortality that was current; they identified and characterized research gaps emphasizing the measurement of data and reporting, evaluated social determinants, obstetrical and health system issues, and examined ongoing activities (Chinn, 2020).
The research study’s findings were that major scientific opportunities to decrease maternal mortality and severe maternal morbidities were measurements and enhanced quality of data, clinical research to confirm interventional and preventive strategies, understanding several etiologies, and understanding the people are affected (Chinn, 2020).
The research study’s main strength to employ document and record data collection and analysis is because it enhances the establishment of formulating certain deductions according to the study parameters (Chinn, 2020). The main weakness of using records and documents for data collection and evaluation is that it requires investigative and trained skills as data research agendas are not developed (Chinn, 2020).
The main purpose of measuring maternal mortality is to identify and characterize maternal death in communities and the cause of maternal death. Measuring maternal death is utilized in settings that medical certification of the death cause is not available.
Influence of State-level changes on maternal mortality.
The current increase in maternal mortality and persistent disparities has led to supposition concerning the high rates in the United States compared to countries with higher incomes.
The type of research design employed in the research study is a Quasi-experimental research study. The research study is based on the population, the difference-in-difference study utilized in 2007 to 2015 National Vital Statistic System microdata mortality data files engaging 38 states and D.C. (Hawkins et al., 2020). The direct revelations were five state-level reproductive and sexual health representations and six economic and health statuses (Hawkins et al., 2020). Several deaths of females characterized the rate of maternal mortality during pregnancy.
The research question in this study is ‘In what ways does the state-level changes influence maternal mortality?’ A difference-in-difference zero-inflated negative binomial regression model was approximated utilizing the race/ethnicity-age-state-year population as the denominator and fixing race/ethnicity, age, State, and year (Hawkins et.al, 2020). The findings were that 4,767 deaths among females up to 44 years of age were due to maternal mortality (Hawkins et.al, 2020).
States that reinforced legislation to restrict abortions according to gestation periods increased the rate of maternal mortality by 38% (Hawkins et.al, 2020). The research study’s main strength is that only a few resources are needed during the research and less expensive due to the utilizing of the quasi-experimental studies.
However, the major weakness of utilizing a quasi-experimental research design is that several causalities in the research article are due to the intervention that overtakes the outcome’s measurement (Hawkins et.al, 2020).
The maternal mortality rate has increased due to current legislative and fiscal changes decreasing the access to reproductive and sexual health services and access to family planning. The influence of state-level changes requires further studies to understand the influence of changes in the state-level factors connected to maternal mortality on preceding rates and by ethnicity or race.
Rural-Urban variance in extreme maternal mortality and morbidity in the United States.
Rural communities are extremely challenged by severe maternal mortality and maternal mortality due to decreased access to obstetric services. The research design used in the study is meta-analytic as the researchers use data collected from 200-2015 from the National inpatient sample. (Kozhimannil et.al, 2019).
The research question in this study is ‘Between rural and urban residents, who are more susceptible to maternal mortality and morbidity?’ The researchers analyze the data by employing diagnostic analysis (Kozhimannil et.al, 2019). The researchers analyze extreme maternal morbidity and the maternal mortality during childbirth hospitalizations in the rural communities and residents in an urban area in the United States (Kozhimannil et.al, 2019).
The research article’s findings are that among residents in the rural and also in the urban areas, the rate of maternal mortality has increased during the period of study from 109 to 10,000 hospitalizations of childbirths in 2007 to 152 per 10,000 in 2015 (Kozhimannil et.al, 2019).
Also, the rural residents experienced a 9% higher probability of going through the severe maternal mortality and morbidity as compared to the urban residents (Kozhimannil et.al, 2019). The research study’s main strength is that the sample size increase hence enhances the impact of effects of the research study, and the data collected by the researchers is significantly beneficial (Kozhimannil et.al, 2019).
The research study’s weakness is that document and record method of data collection may result in inaccurate findings as data might have been tampered with (Kozhimannil et.al, 2019). According to the literature-based evidence, attention to the issues that rural residents face and healthcare facilities is critical to the success of efforts to decrease the maternal mortality and the maternal morbidity.
Challenges are low patient volume, shortages of the workforce, racism, food security, poverty, trauma, and social determinants of health.
In conclusion, the reviewed literature suggests that improvement of accurate data recording and analysis of death certificates, racial and ethnical differences influence maternal mortality and the morbidity, rural residents experience high rates of maternal mortality and morbidity than urban residents, and regions that are before maternal mortality and morbidity.
State-level changes on issues concerning maternal mortality and morbidity highly influence the rates of pregnancy-related complications. Current research supports that maternal mortality and morbidity can be influenced positively by the advancement of public health facilities and helps decrease risks.
