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What’s New in the Patient Safety World

December 2021

Maternal Morbidity Costly in Human and Fiscal Terms



We often give talks on what is wrong with the US healthcare system and highlight areas in which our healthcare system has outcomes that are far worse than those in other OECD countries. One such area is maternal mortality and morbidity. In fact, the US maternal mortality ratio of 20 maternal deaths per 100,000 live births is worst among developed countries (Hoyert 2020). We discussed this in detail in our Patient Safety Tips of the Week for January 8, 2019 “Maternal Mortality in the Spotlight” and December 8, 2020 “Maternal Mortality: Looking in All the Wrong Places?”. The latter column focused not only on maternal mortality but also discussed many maternal morbidities.


A new study from the Commonweatlh Fund notes that maternal morbidity is not just of concern from a human standpoint, but also has significant fiscal implications (O’Neil 2021).


The Commonwealth study analyzed nine maternal morbidities (amniotic fluid embolism, cardiac arrest, gestational diabetes mellitus, hemorrhage, hypertensive disorders, maternal mental health conditions, renal disease, sepsis, venous thromboembolism) and considered not only direct medical costs but also societal costs (eg. loss of productivity, use of social services, etc.).


The estimated total costs of these nine maternal morbidity conditions for all US births in 2019 reached $32.3 billion from conception through the child’s fifth birthday. This amounts to roughly $8,624 in additional costs to society for each maternal–child pair associated with 6.3 million pregnancies and 3.7 million births in the U.S. annually. Two-thirds of these costs occurred within the first year postpartum.


The largest costs included maternal mental health conditions ($18.1 billion), hypertensive disorders ($7.5 billion), gestational diabetes ($4.8 billion), and postpartum hemorrhage ($1.8 billion).


The health care system bore more than half these costs (58%), with the rest shouldered by employers, public social services programs, and other nonmedical sectors. These nonmedical costs included losses in productivity ($6.6 billion), costs associated with behavioral and developmental disorders in children ($6.5 billion), and increased use of social programs like SNAP, WIC, Medicaid, and TANF ($239 million).


The authors note these data likely underestimate the true societal costs of maternal morbidity, because data on the many nonmedical costs associated with the nine conditions is lacking in the research literature.


A word of caution is necessary when we discuss either the US infant mortality and maternal mortality/morbidity standing. Social issues, socioeconomic issues, access to healthcare insurance, access to healthcare provision, and societal disparities clearly impact those outcomes. The US spends proportionately far less on social programs than many of the OECD countries.


But the Commonwealth study makes it clear that greater focus on maternal morbidities may well result in savings to US society.


Our December 8, 2020 Patient Safety Tip of the Week “Maternal Mortality: Looking in All the Wrong Places?” and several of the other columns listed below describe maternal safety bundles and other interventions that we, on the healthcare side of the equation, can focus on addressing the problem of maternal morbidity and mortality.



Some of our previous columns on maternal and ob/gyn issues:

February 5, 2008         “Reducing Errors in Obstetrical Care”

February 2010             “Joint Commission Sentinel Event Alert on Maternal Deaths”

April 2010                   “RCA: Epidural Solution Infused Intravenously”

July 20, 2010              “More on the Weekend Effect/After-Hours Effect”

August 2010               “Surgical Case Listing Accuracy”

September 7, 2010      “Patient Safety in Ob/Gyn Settings”

January 2011               “Surgical Fires Not Just in High Risk Cases”

February 8, 2011         “Inducing Too Early”

April 2011                   “Ob/Gyn Patient Safety Programs”

April 24, 2012             “Fire Hazard of Skin Preps Oxygen”

July 2012                    “WHO Safe Childbirth Checklist”

December 4, 2012       “Unintentional Perioperative Hypothermia: A New Twist”

September 2013          “Full-Time Laborists Reduce C-Section Rates”

October 2013              “Challenging the 39-Week Campaign”

November 2013          “The Weekend Effect: Not One Simple Answer”

January 2014               “It MEOWS But Doesn’t Purr”

May 13, 2014              “Perioperative Sleep Apnea: Human and Financial Impact”

August 19, 2014         “Some More Lessons Learned on Retained Surgical Items”

November 3, 2015      “Medication Errors in the OR - Part 2”

February 7, 2017         “Maternal Safety Bundles”

January 23, 2018         “Unintentional Hypothermia Back in Focus”

January 8, 2019           “Maternal Mortality in the Spotlight”

December 8, 2020       “Maternal Mortality: Looking in All the Wrong Places?”

August 3, 2021           “Obstetric Patients More At-Risk for Wrong Patient Orders”

November 16, 2021    “Cognitive Biases and Heuristics in the Delivery Room”






Hoyert DL. Maternal Mortality Rates in the United States, 2019. Centers for Disease Control and Prevention 2020; Apr. 1, 2020



O’Neil S, Platt I, Vohra D, et al. The High Costs of Maternal Morbidity Show Why We Need Greater Investment in Maternal Health. The Commonwealth Fund 2021;






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