Why Are Disparities in Obstetrics and Labor & Delivery Still Rising and Causing Deaths?
Introduction
Today, another headline reported the death of a Black mother during childbirth.
This is not an isolated event.
This is a pattern.
Black women in the United States continue to experience significantly higher rates of maternal morbidity and mortality compared to their White counterparts even when controlling for income, education, and access to care (Centers for Disease Control and Prevention, 2023).
Most of these deaths are preventable.
So why are they still happening?
A System That Still Misses Early Signs
Many obstetric emergencies do not begin with dramatic symptoms.
Postpartum hemorrhage, hypertensive crises, and other complications often start with subtle changes:
Slight increases in bleeding
Mild shifts in vital signs
A patient saying, “I don’t feel right”
Disparities emerge when these early warning signs are:
Overlooked
Minimized
Not escalated in time
Maternal Mortality Review Committees consistently identify delayed recognition as a key contributor to preventable deaths (Centers for Disease Control and Prevention, 2023).
Communication Breakdowns in High-Acuity Settings
Labor and delivery requires rapid, clear, and decisive communication.
However, delays occur when:
Concerns are not escalated
Hierarchical structures discourage speaking up
Urgency is not clearly communicated
Communication failures remain a significant factor in maternal morbidity and mortality (American College of Obstetricians and Gynecologists, 2019).
Structural Barriers and Access to Care
In many areas, including parts of Arkansas:
Labor and delivery units have closed
Patients must travel long distances for care
Postpartum follow-up is inconsistent
These barriers increase the risk of:
Delayed treatment
Missed warning signs
Complications occurring outside the hospital
Access to maternity care remains a key determinant of outcomes (March of Dimes, 2022).
Inequities in Care Delivery
Disparities are not explained by access alone.
They persist even when controlling for socioeconomic status.
Contributing factors include:
Implicit bias
Differences in how symptoms are interpreted
Delays in diagnosis and treatment
Research demonstrates that systemic and structural inequities contribute significantly to maternal health disparities (Howell, 2018).
Equity is not only about access it is about how patients are treated in real time.
Gaps in Postpartum Care
A significant portion of maternal deaths occur after discharge.
Challenges include:
Limited follow-up access
Inadequate discharge education
Lack of continuity of care
Postpartum care remains a critical gap in maternal health systems (American College of Obstetricians and Gynecologists, 2018).
Inconsistent Use of Evidence-Based Care
Evidence based protocols exist.
Frameworks such as the Alliance for Innovation on Maternal Health obstetric hemorrhage bundle and guidance from Association of Women's Health, Obstetric and Neonatal Nurses emphasize standardized approaches to care.
However, disparities arise when:
Protocols are not consistently followed
Escalation is delayed
Responses vary between patients
Consistency is critical to equity (AIM, 2023; AWHONN, 2022).
The Role of Nurses in Changing Outcomes
Nurses are central to improving maternal outcomes.
They:
Detect early changes
Listen to patients
Escalate concerns
Advocate for timely care
Nursing assessment and early intervention are essential components of safe maternal care (AWHONN, 2022).
Moving Forward: What Must Change
To reduce disparities:
Standardize Early Recognition
Focus on trends and patient reported symptoms.
Strengthen Communication
Normalize escalation and speaking up.
Advance Equity
Ensure consistent, unbiased care.
Improve Postpartum Care
Expand access and strengthen education.
Support Nursing Practice
Empower nurses as leaders in early intervention.
Conclusion
Disparities in obstetrics and labor and delivery persist because gaps still exist in recognition, communication, and equitable care.
Most maternal deaths are preventable.
That means change is possible.
Because in maternal care,
who is heard and how quickly we respond can determine who survives.
PPHequity.org
Advancing awareness. Supporting nurses. Improving maternal outcomes.
This article is part of the PPHequity initiative to advance awareness, support nurses, and improve maternal outcomes.
References
Alliance for Innovation on Maternal Health. (2023). Obstetric hemorrhage patient safety bundle. Council on Patient Safety in Women’s Health Care. https://safehealthcareforeverywoman.org
American College of Obstetricians and Gynecologists. (2018). Optimizing postpartum care (Committee Opinion No. 736). https://www.acog.org
American College of Obstetricians and Gynecologists. (2019). Levels of maternal care (Obstetric Care Consensus No. 9). https://www.acog.org
Association of Women’s Health, Obstetric and Neonatal Nurses. (2022). Quantification of blood loss: AWHONN practice brief. https://www.awhonn.org
Centers for Disease Control and Prevention. (2023). Pregnancy-related deaths: Data from maternal mortality review committees in the United States. https://www.cdc.gov
Howell, E. A. (2018). Reducing disparities in severe maternal morbidity and mortality. Clinical Obstetrics and Gynecology, 61(2), 387–399. https://doi.org/10.1097/GRF.0000000000000349
March of Dimes. (2022). Nowhere to go: Maternity care deserts across the U.S. https://www.marchofdimes.org