Alaska wants to tackle an increasing rate of obstetric hemorrhage among new mothers

The rate of mothers suffering obstetric hemorrhages — severe and potentially life-threatening bleeding during or immediately after childbirth — has been on the rise in Alaska, peaking at one in 10 births in 2022, according to new research released by the Alaska Division of Public Health this week.

Obstetric hemorrhages are considered the most common childbirth complications as well as the most deadly, accounting for more than a quarter of maternal deaths globally, according to public health experts. In Alaska, researchers found that the percentage of hospital deliveries involving hemorrhage increased from 7.4% in 2016 to 9.4% in 2023. In 2022, some 743 births involved a maternal obstetric hemorrhage, representing 10.1% of hospital deliveries. Fewer than five women have died from obstetric hemorrhages in Alaska over the past five years, according to Rebekah Porter, a nurse consultant with the state Division of Public Health.

The reason behind the increase isn’t clear, Porter said.

“It’s not clear whether the increase is due to improved detection or coding practices, or if it truly reflects the rise in hemorrhage cases,” she said in an interview Thursday.

The data shows racial and and geographic disparities. Pacific Islander and Alaska Native mothers had the highest rates of obstetric hemorrhages, while white and Black mothers recorded the lowest rates between 2020 and 2023.

In Southwest Alaska, roughly 16% of deliveries involved a hemorrhage, while in Anchorage around 9% did. That also may be due to Alaska’s hub hospital system, which sees most mothers with high-risk pregnancies receiving prenatal care deliver their babies in Anchorage, Porter said.

To tackle obstetric hemorrhage, the state is launching an effort to educate hospitals and birthing centers on hemorrhage, Porter said. That could involve anything from refining protocols for when a woman comes through the door heavily bleeding, to better detection and measurement of blood loss, to educating patients about warning signs for hemorrhage when they leave the hospital.

Alaska also has an increasing rate of what researchers call pregnancy associated mortality — defined as deaths while a person is pregnant or within one year of the end of pregnancy, due to any cause. In 2021, some 20 women died during that maternal period in Alaska — at a rate exceeding the previous five-year average by 109%, according to the Alaska Maternal and Child Death Review.

“Many of these deaths are related to injury or violence or other natural causes and may not have a direct association with the pregnancy, but they are still seen as important maternal health outcomes to track,” said Margaret Young, the epidemiology manager of the Division of Public Health’s women, children and family health section.