Focusing on Severe Maternal Morbidity (The Rest of the Iceberg)

Unlike maternal death rates in most nations, rates in the U.S. are rising. While absolute risk for death in the context of pregnancy is low — thereby hindering recognition of patterns and contributing factors — some demographic groups are at much higher risk than others. We have long recognized maternal mortality as the “tip of the iceberg,” with a vast mountain of morbidity just beneath. Attaining a more systematic understanding of severe maternal morbidity and its prevention is now a focus of intense effort.

In a retrospective review of births to 115,502 women, severe morbidity (defined with a scoring system involving factors such as transfusion of >3 units of red cells, intubation, and unanticipated surgical intervention) occurred in 2.9/…