The Neglected Crisis in Maternity Care
Postpartum-Related Deaths in the US and Why Care Falls Short
Trigger Warning
This piece includes discussion of childbirth, birth trauma, postpartum complications, hospital readmission, mental health, gaps in care, and maternal health risks. If any of these topics feel heavy, seek support through Postpartum Support International (1-800-944-4773 or postpartum.net) or a trusted provider. This article is intended for informational and educational purposes only and should not be taken as medical advice, diagnosis, or treatment. Always consult your physician, OB, or qualified healthcare provider with any questions or concerns about your physical or mental health and seek immediate medical attention if you are experiencing urgent symptoms.
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The Lived Experience
Three years out from my own birth and the what-ifs still linger. My labor stretched over 22 hours, ending in an unplanned C-section and a panic attack on the operating table. A week later I was back in the hospital with postpartum preeclampsia, barely caught in time. In those moments I felt the fragility of life. The way a complication could spiral without intervention or the way the window between fine and not fine is narrower than anyone tells you.
Postpartum (for me) wasn’t the amazing fourth trimester glow social media portrays. Your body is healing from major physical trauma, hormones are crashing, sleep is shattered, and the mental load is overwhelming. For me, the postpartum depression and anxiety (PPD/PPA) brought numbness and guilt, and a level of hypervigilance I never known. I said I was fine, but I wasn’t.
Every year, hundreds of women don’t make it through postpartum because care falls short. Their stories echo mine but end differently. A hemorrhage unchecked, an infection dismissed, a mental health crisis that nobody caught in time. As a woman who has felt the edges of that, I know postpartum is a high-risk window, and neglecting it costs lives.
The Numbers
In 2023, 669 women died of maternal causes in the United States, at a rate of 18.6 deaths per 100,000 live births. That number is nearly double the rate from two decades ago. In 2023, at a time when maternal mortality was declining worldwide, the World Health Organization declared that the United States was one of only seven countries to report a significant increase in the proportion of pregnancies that result in the death of the mother since 2000. The others include Venezuela and Belize. We’re spending more on healthcare than any nation on earth and moving in the wrong direction on maternal death.
The racial gap isn’t just a gap, it’s a chasm. In 2023, the maternal mortality rate for Black women was 50.3 deaths per 100,000 live births, significantly higher than rates for White women at 14.5, Hispanic women at 12.4, and Asian women at 10.7. These are the measurable results of bias, inadequate access, and a system that has never fully extended its standard of care to all women equally.
Critically, and this is the part that doesn’t make it into the public conversation often enough, the majority of these deaths happen after birth. Around 66% percent of pregnancy-related deaths occur in the postpartum period, according to analyses from Maternal Mortality Review Committees. Mental health conditions, including suicide and overdose, are the leading cause of death in the first postpartum year, and are considered 100% preventable. That phrase should stop every healthcare professional reading this in their tracks. We’re not talking about rare, unforeseeable complications, we’re talking about deaths that the data tells us we could have stopped.
What Is Actually Killing Women
When most people think of maternal death, they may picture a hemorrhage on the delivery table. The leading causes of pregnancy-related deaths in the US include overdose/suicide, hemorrhage, infection/sepsis, and thrombotic embolisms. Cardiovascular conditions account for more than one-third of pregnancy-related deaths.
Here’s what the system doesn’t talk about enough: mental health conditions, including suicide and overdose, are the leading causes of death in the first postpartum year and are considered 100% preventable. I know I said this a few paragraphs earlier, but this statistic is so haunting, it’s worth repeating.
The leading cause of death in the first postpartum
year is preventable, and we’re not preventing it.
Mental health conditions including suicide and substance-related deaths are now recognized as a leading contributor to pregnancy-related mortality in the United States, with the highest risk occurring in the postpartum period rather than during pregnancy itself.
The postpartum period. The time after the birth, after the six-week appointment, after everyone has stopped asking how you’re doing. That’s when women are most at risk and that is precisely when the system stops looking.
Why Postpartum Care Falls Short
The honest answer is that postpartum care has never been resourced as if it matters as much as labor and delivery. We monitor pregnancy intensely, prepare for birth extensively, and then drop off dramatically the moment a woman is sent home.
The standard six-week checkup is a procedural formality: blood pressure, physical healing, contraception. Mental health screening is often a quick questionnaire that misses PPD/PPA or birth trauma entirely. Follow-up is rare unless a woman advocates hard for herself, and advocacy requires energy that most postpartum women don’t have.
The systemic reasons are real and well-documented. Over 2.2 million women of childbearing age live in counties without maternity care. Shortages of OBs, midwives, and mental health specialists leave entire communities without basic coverage. Black, Indigenous, rural, and low-income women bear a disproportionate burden of perinatal mental health disorders while remaining less likely to be screened, accurately diagnosed, or receive timely treatment.
Maternal mental health disorders affect roughly 600,000, or 20%, of U.S. mothers a year. Upwards of 50% of mothers are not diagnosed by a healthcare professional, and 75% of women never get the treatment they need.
Three in four mothers, in the wealthiest country in the world.
Between 2016 and 2023, the percentage of U.S. mothers reporting excellent mental health dropped by more than 12 percentage points, from 38.4% to just 25.8%. Rates of fair or poor mental health saw a relative increase of 64% during the same period. Women are getting worse and the system isn’t keeping pace. One of those facts is driving the other.
What Healthcare Professionals Can Do Right Now
This section is for the providers reading this and I know some of you are, because this problem does not get solved without you.
The research is not ambiguous. Training OB-GYNs, midwives, and primary care clinicians in perinatal psychiatry fundamentals is critical to closing care gaps and reducing delays in treatment initiation. Mental health care must be recognized as essential obstetric care, not an optional add-on.
Screening alone is not enough. A positive screen that goes nowhere, no referral, no follow-up, no treatment pathway, isn’t care, it’s documentation. Screening alone is insufficient without timely access to evidence-based treatment and referral pathways.
What actually moves the needle are extended postpartum visits, integrated behavioral health in OB settings, universal screening at every postpartum touchpoint including the pediatrician’s office, and referral systems that actually work. Not a pamphlet, a pathway.
What Women Can Do Right Now
If you are postpartum and something feels wrong, say it. Say it to your provider, your partner, someone. You don’t have to be in crisis to deserve care or hit a threshold of suffering before asking for help.
If your provider dismisses you, ask again. Bring someone with you, write it down. The research on postpartum mental health is clear. What isn’t always clear is whether the system in front of you is ready to act on it, so push until it does.
Know the warning signs that require immediate attention: thoughts of harming yourself or your baby, inability to care for yourself or your child, severe panic attacks, complete emotional detachment that doesn’t lift.
The women who didn’t survive their postpartum were less supported, less screened, and less seen. This means the outcome was never inevitable, it was a failure of the system around them.
Stay golden,
Casey 💫
References
Hoyert DL. Maternal mortality rates in the United States, 2024. NCHS Health E-Stats. 2026. https://www.cdc.gov/nchs/data/hestat/hestat113.htm
Hoyert DL. Maternal mortality rates in the United States, 2023. NCHS Health E-Stats. 2025. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2023/maternal-mortality-rates-2023.htm
Joseph KS, et al. Maternal mortality in the United States. Am J Obstet Gynecol. 2024;231(2). doi:10.1016/j.ajog.2024.01.005
Commonwealth Fund. Maternal mortality in the United States, 2025. July 2025. https://www.commonwealthfund.org/publications/issue-briefs/2025/jul/maternal-mortality-united-states-2025
America’s Health Rankings. Explore maternal mortality in the United States. https://www.americashealthrankings.org/explore/measures/maternal_mortality_c
Policy Center for Maternal Mental Health & George Washington University. 2024 Maternal Mental Health State Report Cards. May 2024. https://publichealth.gwu.edu/2024-maternal-mental-health-state-report-cards-released
American Medical Women’s Association. Maternal mental health: why pregnancy and postpartum care must address the mind as well as the body. 2025. https://amwa-doc.org/maternal-mental-health-why-pregnancy-and-postpartum-care-must-address-the-mind-as-well-as-the-body/
Society for Maternal-Fetal Medicine. Executive summary: Workshop on maternal mental health. Am J Obstet Gynecol. 2024. doi:10.1016/j.ajog.2024.04.036
Behavioral Health News. America’s hidden maternal mental health crisis. Summer 2025. https://behavioralhealthnews.org/americas-hidden-maternal-mental-health-crisis/
Health Affairs. Maternal health and perinatal mental health. April 2024. https://www.healthaffairs.org/health-policy-theme-issues/maternal-health-and-perinatal-mental-health