Understanding the Top 5 Causes of Maternal Mortality, and How We Can Prevent Them
- Jan 23
- 7 min read
Anne Wallen is a respected figure in women’s health with over 30 years of experience and is a leading voice on global change in maternity care, particularly for those at greatest risk.
Becoming a mother should be a time of celebration, healing, and transformation, not a time of risk to life. Yet every year, far too many women die from preventable complications during pregnancy, childbirth, or postpartum. Maternal mortality remains a global health crisis, and while some countries have made impressive progress, others, like the United States, are seeing troubling trends.
Let’s explore the top five leading causes of maternal death, compare how the U.S. differs from other nations in both causation and care, and discuss how these deaths can often be prevented with the right support systems, clinical practices, and community care.
Maternal mortality: A global snapshot
Globally, approximately 287,000 women die every year due to pregnancy-related causes (WHO, 2023). The majority of these deaths occur in low- and middle-income countries, often due to limited access to skilled care.
But the United States, despite its wealth and medical technology, has one of the highest maternal mortality rates among high-income nations. According to the CDC, the U.S. maternal mortality rate was 32.9 deaths per 100,000 live births in 2021, with Black women experiencing rates, on average, nearly three times higher than white women. This does not include even higher statistics in places like New York City, where the maternal mortality rate for Black women includes estimates of up to nine times higher than white women. This is a complex issue rooted in healthcare access, systemic bias, and gaps in postpartum care.
Top 5 leading causes of maternal mortality
Let’s take a closer look at the main causes of maternal death, many of which are preventable or manageable with timely, respectful, and equitable care.
1. Hemorrhage (severe bleeding)
What it is: Uncontrolled bleeding during or after childbirth, often from uterine atony (when the uterus doesn’t contract properly), retained placenta, or surgical complications.
Global context: Hemorrhage is the leading cause of maternal death worldwide, especially in countries without access to emergency obstetric care or blood transfusions.
In the U.S., hemorrhage remains a major cause, particularly in cases where warning signs are missed or treatment is delayed due to systemic issues or provider bias.
Prevention strategies:
Active, not aggressive, management based in patience and an understanding of the normal physiological process of the third stage of labor (for example, uterotonic medications like oxytocin). Often, premature pulling of the placenta can actually cause hemorrhage that then necessitates medication
Delaying cord clamping and stopping the selling of placental and cord blood and tissue products
Education for families so they know their rights and can reject procedures that endanger them or increase risk, even if those procedures are standard protocol in a profit-driven hospital system
Access to and funding for doulas and home birth midwives, who are able to educate, advocate, and support, as well as provide frontline, in-person evaluation after patients are discharged home
Proper training in emergency response
Quick access to surgical teams and blood products
Careful monitoring of uterine inversion and blood loss during postpartum, not just immediately after birth
Reduction in non-medically necessary inductions, because the medications used to create contractions can overwhelm brain receptors, reducing or impairing the body’s natural ability to clamp down after birth
2. Hypertensive disorders (preeclampsia and eclampsia)
What they are: Conditions involving high blood pressure during pregnancy, which can lead to seizures, stroke, organ failure, or placental abruption.
Global context: Preeclampsia is responsible for 10-15% of maternal deaths worldwide and is a leading cause of preterm birth.
In the U.S., rates of hypertensive disorders in pregnancy have risen. Racial disparities are stark, with Black women more likely to develop preeclampsia and less likely to receive early diagnosis and timely intervention.
Prevention strategies:
Routine blood pressure and urine checks throughout prenatal care
Providing education on warning signs and supporting a mindset of personal responsibility for one’s own healthcare
Nutritional education, as a large number of poor outcomes can be prevented with proper nourishment
Access to foods and supplements free from chemicals, pesticides, and other harmful agents that disrupt the body’s ability to absorb nutrients
Low-dose aspirin for high-risk pregnancies
Early detection and treatment with antihypertensives
Timely delivery if the condition becomes life-threatening
3. Infection (sepsis)
What it is: Severe infections during or after childbirth can lead to sepsis, a life-threatening inflammatory response in the body.
Global context: Infections are a major cause of maternal mortality in low-resource areas, often linked to poor hygiene, unsterile environments, or untreated UTIs and wound infections.
In the U.S., maternal sepsis is often preventable but can progress rapidly if symptoms are ignored or mistaken for normal postpartum discomfort.
Prevention strategies:
Access to and funding for home birth midwives, where patients are safe at home and not delivering in environments with unfamiliar germ profiles
Proper hygiene and sterile techniques in all delivery settings
Education for families on early recognition of symptoms, such as fever, chills, rapid heartbeat, and unusual discharge
Prompt antibiotics and supportive care
Access to effective probiotics after antibiotics are given, for long-term protection against recurring infection
4. Cardiovascular conditions
What they are: Heart-related complications, including peripartum cardiomyopathy, blood clots, and pre-existing cardiac disease worsened by pregnancy.
Global context: In high-income countries, cardiovascular issues are now a leading cause of maternal death, especially as more women give birth later in life or with chronic conditions.
In the U.S., cardiac-related deaths make up a significant portion of maternal mortality, particularly in the postpartum period. These deaths often stem from delayed diagnosis or inadequate follow-up.
Prevention strategies:
Preconception screening for high-risk women
Individualized birth plans for those with heart conditions
Access to doulas for support, education, and follow-up care
Monitoring blood pressure, shortness of breath, and fatigue postpartum
Stronger collaboration between midwives, OBs, and cardiologists
Reducing and working to eliminate exposure to medications, chemicals, and vaccines known to cause cardiovascular issues, especially during pregnancy
5. Mental health and suicide
What it is: Suicide and drug-related deaths are growing contributors to maternal mortality in some countries, particularly the U.S.
Global context: Mental health is often underrecognized in maternal health conversations. Stigma, lack of screening, and poor access to perinatal mental healthcare contribute to unnecessary deaths.
In the U.S., suicide and overdose have become leading causes of maternal death, especially in the postpartum period, up to one year after birth. These deaths often go uncounted if not directly linked to pregnancy.
Prevention strategies:
Routine mental health screening during and after pregnancy
Access to midwives for all basic prenatal care, including initial screening for home delivery, which should be the starting point for care, even if transfer to a hospital is necessary later for high-risk births
Access to doulas for educational and emotional support during the transition to parenthood as preventive care
Required education in trauma-conscious care for all individuals who interact with pregnant, birthing, and postpartum patients
Improved record keeping and statistical studies on mental, emotional, and psychological abuse and trauma during pregnancy, birth, and immediately after
Accountability for providers with a history of causing trauma
Culturally appropriate therapy and psychiatric care
Doula and peer support models that provide emotional safety after experiences of abuse and trauma
Consistent home care or in-patient couplet care, where mothers receive care with their babies present and do not have to seek support that harms the mother-infant attachment or causes further trauma. The goal is to prevent worsening mental health issues and make care more accessible, as finding childcare for a newborn can be prohibitive
Accessible substance use treatment programs tailored specifically to mothers
Why the U.S. is falling behind, and how we fix it
While global progress has focused on improving access to skilled birth attendants and emergency care, the U.S. continues to struggle with systemic issues such as racial bias, fragmented care, insurance barriers, and a lack of postpartum support.
Some key differences:
Other countries offer universal postpartum home visits, extended parental leave, and midwifery-led continuity of care
In contrast, U.S. postpartum visits often occur only once at six weeks, which is far too late to catch many complications
Doulas are often not covered by insurance and are therefore viewed as luxury services rather than the life-saving care that statistical evidence demonstrates
Implicit bias leads to providers dismissing pain or symptoms, especially in Black, Indigenous, and other women of color
Solutions that save lives
Preventing maternal deaths is not just about high-tech equipment or hospital settings. It is about listening to mothers, recognizing red flags early, and providing consistent, respectful care.
Here’s what works:
Midwives, doulas, and culturally matched providers offering holistic, continuous care
Better training in recognizing complications for all birth workers
Support and sustainable financial compensation for all birth workers
Universal health coverage for prenatal and postpartum care
Data tracking and accountability, especially regarding racial disparities, coercion, abuse, and trauma
Empowering mothers with education about their rights, their bodies, and warning signs
Maternal mortality should be rare and preventable. In many countries, it already is. Every mother deserves to survive childbirth and return home with her baby in her arms, not just in body, but in mind and spirit as well.
With the right systems, respectful care, and community-based support, we can change the statistics and write a different story for mothers across the U.S. and around the world.
Anne Wallen, Director and Founder of MaternityWise Intl
Anne Wallen is a respected figure in women’s health with over 30 years of experience and is a leading voice on global change in maternity care, particularly for those at greatest risk. She continues to educate and empower birth professionals in more than 20 countries, contributes to a variety of curricula, and shapes the future of maternal health through her impactful role as a speaker and mentor. Anne is the Director and co-founder of MaternityWise International, and her legacy lies in inspiring generational changes around and elevating women's healthcare worldwide.
