Maternal death during pregnancy, childbirth, or postpartum is a tragedy with catastrophic impact on families. Even with increased attention to perinatal care, maternal mortality continues to rise. The World Health Organization defines maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes” (WHO). Significant differences in maternal mortality exist across racial, ethnic, geographic, and age groups. In 2023, the maternal mortality rate for Black women was 50.3 deaths per 100,000 live births, compared to 14.5 for white women, 12.4 for Hispanic women, and 10.7 for Asian women (WHO). Maternal mortality rates also increase sharply with age. Women over 40 experience nearly five times the risk of maternal death compared to those under 25. The leading causes of pregnancy-related deaths include hemorrhage, cardiovascular disease, cardiomyopathy, infection, and hypertensive disorders such as preeclampsia and eclampsia. For Black women, preeclampsia, eclampsia, and embolic events are the most common causes of death. For white women, mental health conditions including suicide and substance-related deaths are leading causes of maternal demise. Many of these causes are preventable with early detection, timely treatment, and coordinated care. Hemorrhage, one of the leading causes of preventable maternal deaths, requires clear policies, rapid recognition, and swift escalation of care. Case managers can advocate for women by ensuring that patients and families understand early warning signs of possible complications. By promoting these safety measures, case managers reinforce a culture of prevention and responsiveness.

A growing area of focus is improving quality of care at the hospital level, especially in the critical days immediately before and after childbirth. Case managers can collaborate with interdisciplinary teams to ensure that evidence-based protocols for managing obstetric emergencies such as hemorrhage, hypertension, and venous thromboembolism are implemented consistently. This collaboration not only improves clinical outcomes but also strengthens team communication and accountability.

Underlying health conditions including hypertension, diabetes, and obesity are increasingly common among women of reproductive age and contribute to poor pregnancy outcomes. The growing prevalence of these chronic conditions makes the need for ongoing preconception, prenatal, and postpartum care that extends beyond delivery critical.

Effective case management interventions begin with proactive risk identification and early engagement. Case managers assess medical, psychosocial, and social determinants of health factors that may increase risks such as chronic conditions, limited access to prenatal care, transportation barriers, or lack of insurance. Early identification enables targeted interventions, including referrals to high-risk obstetrics, mental health services, nutrition counseling, or substance use treatment when indicated. Patient education remains a cornerstone of maternal case management. Case managers empower women and families with information about warning signs of complications, postpartum depression, medication adherence, and safe infant care. Education delivered in plain language and culturally appropriate formats enhances health literacy and helps patients recognize when to seek care.

Addressing health equity is an integral part of perinatal care. Case managers can advocate for policies that reduce racial and socioeconomic disparities, ensure equitable access to prenatal and postpartum care, expand insurance coverage, and connect families with community-based supports such as home visiting programs, doulas, and maternal health navigators. Referral to regionalized perinatal levels of care represent another key intervention. Case managers can facilitate transfers of high-risk pregnancies to hospitals equipped with advanced resources and subspecialists such as maternal-fetal medicine, cardiology, and critical care. This system-level coordination helps ensure that women with complex conditions receive care in facilities that can meet their needs.

The role of case managers includes transforming a fragmented system into one that prioritizes every mother’s life and wellbeing. Care coordination and continuity are vital beyond delivery. Case managers can ensure follow-up appointments are scheduled, transportation arranged, and support systems engaged. By bridging the transition from hospital to home, they reduce the risk of complications during the vulnerable postpartum period when many maternal deaths occur. Through these interventions, case managers help create a safety net that not only saves lives but strengthens trust, communication, and continuity across the maternal care continuum.

Maternal mortality remains a persistent challenge in the United States. There is wide variation across states and populations. “Recent progress in surveillance and policy reform has laid important groundwork, but disparities in access, insurance coverage, and outcomes continue to shape maternal health.” (“Confronting the Maternal Mortality Crisis in the United States …”) Improving these outcomes will require coordinated efforts across policy, clinical care, and community settings, with a focus on extending postpartum coverage, supporting the workforce, and advancing integrated care models. “Sustained investment and evidence-based strategies will be essential to strengthen maternal and infant health nationwide” (“Confronting the Maternal Mortality Crisis in the United States …”).

Case management plays a pivotal role in addressing the maternal mortality crisis by promoting safety, quality, and equity of care during pregnancy, childbirth, and the postpartum period. Case managers are uniquely positioned to coordinate care across complex systems, ensuring that pregnant and postpartum women receive timely, evidence-based, and culturally sensitive interventions that can prevent adverse outcomes and save lives.

Maternal mortality is a crisis and a call to action. The path forward requires continued vigilance, early intervention, equitable access to care, and strong advocacy across all levels of the healthcare system. Preventing maternal mortality should be a priority.

We must do better.

REFERENCES

World Health Organization. International statistical classification of diseases and related health problems, 10th revision (ICD–10). 2008 ed. 2009.

Maternal mortality in the United States: are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance? Joseph, K.S. et al. American Journal of Obstetrics & Gynecology, Volume 230, Issue 4, 440.e1-440.e13.

Collier AY, Molina RL. Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions. Neoreviews. 2019 Oct;20(10): e561-e574. doi: 10.1542/neo.20-10-e561. PMID: 31575778; PMCID: PMC7377107.

Declercq E, Zephyrin LC. Maternal mortality in the United States, 2025. The Commonwealth Fund. July 29, 2025. Accessed July 30, 2025. https://www.commonwealthfund.org/publications/issue-briefs/2025/jul/maternal-mortality-united-states-2025.

The American Journal of Managed Care. (2025, July 30). Confronting the maternal mortality crisis in the United States: Insights from the 2025 Commonwealth Fund brief. AJMC. https://www.ajmc.com/view/confronting-the-maternal-mortality-crisis-in-the-united-states-insights-from-the-2025-commonwealth-fund-brief.

Janet Coulter, MSN, MS, RN, CCM, FCM, is the president of the Case Management Society of America (CMSA). She is a board-certified transplant case manager with extensive experience including nursing education, administration, team leadership, and case management.

Janet holds a Master of Science in Nursing from West Virginia University and a Master of Science in Adult Education from Marshall University. Her contributions to the field have been recognized with the CMSA National Award of Service Excellence and the Southern Ohio Valley CMSA Case Management Leadership Award. In 2022, she was honored as a Fellow of Case Management (FCM).

An active and dedicated member of CMSA at both the national and local levels, Janet continues to serve the Southern Ohio Valley Chapter. She has been a frequent presenter at CMSA Annual Conferences, delivering concurrent sessions and poster presentations on key topics in case management.

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