Where the danger actually is in the year after a birth
Of the deaths where the timing is known, more than half happen after the first week and nearly a third after six weeks.
Care is built around the birth. The risk is not.
Maternal mortality review committees in 36 states examined every pregnancy-related death from 2017 to 2019, 1,018 in all. For 1,002 of them the timing is known:
| When the death occurred | Number | Share |
|---|---|---|
| During pregnancy | 216 | 21.6% |
| Day of delivery | 132 | 13.2% |
| 1 to 6 days after | 120 | 12.0% |
| 7 to 42 days after | 233 | 23.3% |
| 43 to 365 days after | 301 | 30.0% |
CDC's own framing of that table: Among pregnancy-related deaths with information on timing, 53% occurred 7-365 days postpartum.
Nearly a third happened after six weeks, which is to say after the postpartum visit, after the leave has ended, and after obstetric care has usually stopped.
hemorrhage and amniotic fluid embolism were the major causes of death.Then
hemorrhage, hypertensive disorders of pregnancy, and infection were leading causes of death during the first 6 days postpartum.And then:
From 6 weeks postpartum (43 days) through the end of the first year (365 days), cardiomyopathy was the leading cause of death.
Across the whole year, the single largest underlying cause was mental health conditions, at 224 of the 987 deaths for which an underlying cause was identified, or 22.7%. That category includes suicide and overdose related to substance use disorder.
The committees judged 839 of the 996 deaths with a preventability determination, 84.2%, to be preventable. Preventable has a specific meaning here, and it is not about anything you did. The definition is that there was at least some chance of the death being averted by one or more reasonable changes to patient, community, provider, facility, and/or systems factors.
It is a judgement about care and systems.
ACOG puts the same point more broadly, across the whole period after delivery rather than after the first week: more than one half of pregnancy-related deaths occur after the birth of the infant.
"Who is watching me between six weeks and a year, and what am I watching for?"
"If I turn up somewhere else with a symptom, what do I need to tell them?"
The answer to the second one is always the same: that you were pregnant within the last year. Clinicians outside obstetrics routinely do not connect a symptom to a pregnancy that ended months ago.