The United States is proud of its medical advances, yet it remains the most dangerous high-income nation in which to give birth.
May C M Pian-Smith, M.D., M.S.
Associate Professor of Anaesthesia, Harvard Medical School; Immediate Past President, Society for Obstetric Anesthesia & Perinatology (SOAP); Board of Directors, SOAP, APSF, and FAER
In 2023, 669 women died from pregnancy-related causes — 18.6 deaths per 100,000 live births — more than double Canada’s rate and nearly ten times Norway’s. Black mothers were 3.5 times more likely to die than white mothers, a gap that widened last year. Behind every statistic is a devastated family and an avoidable loss.
Eighty percent of these deaths are preventable. Leading culprits include cardiovascular disease, preeclampsia, sepsis, and obstetric hemorrhage. Because most fatal events unfold after hospital discharge, solutions must span prenatal, hospital, and postpartum care. Yet patients still face barriers to insurance, transportation, and culturally competent care, and best-practice guidance is used unevenly by clinicians.
Collaboration — deliberate, data-driven, and multidisciplinary — is our most powerful weapon. Researchers must probe how social stress, chronic illness, and bias intersect with pregnancy. Payers and policymakers must fund that science and guarantee every mother access to the lifesaving care it reveals. Professional societies, community advocates, and families must insist that proven protocols become routine, not optional.
Collaboration in action
Bright spots show the way. The California Maternal Quality Care Collaborative combined evidence-based “toolkits” with hemorrhage carts, checklists, and rapid-response drills, cutting the state’s maternal death rate by 55% in just four years. Its free toolkits on hemorrhage, hypertension, sepsis, and cardiac disease are ready for hospitals nationwide to adopt today.
Nationally, the Alliance for Innovation on Maternal Health (AIM) has distributed standardized patient-safety bundles to 49 states. Early adopters who implemented hemorrhage and hypertension bundles saw severe maternal morbidity fall 8-22%. Bundles succeed because they fold checklists, drills, and data review into everyday workflow. Every team member knows their role before a crisis begins.
Expert anesthesia care is another pillar. The Society for Obstetric Anesthesia and Perinatology (SOAP) created its Center of Excellence (COE) designation to certify facilities with 24/7 anesthesia coverage, simulation training, evidence-based protocols, and ongoing outcome measurement. More than 90 hospitals now carry the COE seal, setting a national benchmark for high-reliability maternity care. In the spirit of fostering collaboration, the Anesthesia Patient Safety Foundation (APSF) will be hosting as its annual Stoelting Conference: “Transforming maternal care: Innovations and collaborations to reduce morbidity and mortality,” Sept. 3-4 in Chicago.
Next steps for improvement
How do we bring these successes to every delivery room? Congress can sustain funding to boost maternal health research and support impactful collaboratives. States can require hospitals to adopt bundles, support rural obstetric units, and report outcomes transparently. Health systems can invest in simulation, early-warning scores, and culturally responsive care. Industry can focus on innovations in medications, monitors, and other life-saving devices that play a role in the perinatal period. Clinicians must listen to women’s voices and apply the best evidence without delay. Communities can support doulas, midwives, and local programs that bridge trust gaps and extend care beyond hospital walls, ensuring every mother has an advocate.
America already knows how to save mothers’ lives. The task before us is to weave today’s bright spots into a nationwide fabric of safety — one that leaves no mother, baby, or family behind. By choosing collaboration over competition and action over complacency, we can transform a potentially dangerous day in a woman’s life into one of the best.
