Maternal morbidity refers to any physical or psychological health condition that results from pregnancy or childbirth. It ranges from relatively common problems like urinary incontinence and perineal tears to life-threatening emergencies like organ failure, uncontrolled bleeding, and seizures. In the United States, severe maternal morbidity affects roughly 93 out of every 10,000 hospital deliveries, and the rate has been climbing for decades.
The term covers a broad spectrum. At one end are complications that resolve within weeks. At the other end is what the World Health Organization calls a “maternal near-miss,” defined as a woman who nearly died but survived a complication during pregnancy, childbirth, or within 42 days of delivery. Understanding this full spectrum matters because the consequences often extend well beyond the hospital stay.
How Severe Maternal Morbidity Is Defined
The CDC tracks severe maternal morbidity (often abbreviated SMM) using 21 clinical indicators. These include conditions like kidney failure, respiratory distress, blood clots in the lungs, seizures from eclampsia, sepsis, cardiac arrest, and dangerous blood clotting disorders. The list also includes procedures that signal a serious complication occurred: emergency hysterectomy, blood transfusions, temporary breathing tubes, and being placed on a ventilator.
Two screening criteria are widely recommended for hospitals to flag potential cases: receiving a transfusion of four or more units of blood, or being admitted to an intensive care unit during or after delivery. These two markers alone have strong accuracy for identifying women who experienced severe complications. Hospitals are encouraged to review every case that meets either threshold, looking for patterns and preventable failures in care.
The Most Common Causes
About half of all pregnancy-related deaths in the U.S. stem from just four categories: hemorrhage (severe bleeding), cardiovascular conditions, cardiomyopathy (weakening of the heart muscle), and infection. The same conditions drive the majority of non-fatal severe morbidity.
Cardiovascular problems are the single largest contributor, responsible for more than a third of pregnancy-related deaths. These include heart attacks, strokes, and heart muscle failure. Obstetric hemorrhage, which most people associate with childbirth emergencies, actually accounts for a smaller share (about 11.5% of pregnancy-related deaths between 2011 and 2014), though it remains one of the most common reasons for emergency blood transfusions during delivery.
Preeclampsia, a dangerous rise in blood pressure during pregnancy, is another major driver. Early-onset preeclampsia (before 34 weeks) increased by 33% in one large study and carried a tenfold greater risk of maternal death compared to pregnancies without the condition. When preeclampsia progresses to eclampsia, it causes seizures and can damage the brain, liver, and kidneys.
Sepsis, a body-wide infection response, and blood clotting disorders round out the leading causes. Many of these conditions can escalate quickly, which is why delayed recognition and slow response are frequently identified as preventable factors in morbidity reviews.
Who Is Most at Risk
Racial and ethnic disparities in maternal morbidity are stark and persistent. Black women in the U.S. die from pregnancy-related causes at 3.2 times the rate of white women. American Indian and Alaska Native women face a rate 2.3 times higher. These gaps do not shrink with education or income. In fact, Black women with a college degree or higher have a pregnancy-related death rate 5.2 times that of white women with the same education level, and 1.6 times the rate of white women who never finished high school.
The disparity also widens with age. Among women 30 and older, Black and Indigenous women face pregnancy-related death rates four to five times higher than white women in the same age group. These patterns hold across states with both high and low overall maternal death rates, suggesting the disparity is deeply embedded in how care is delivered and experienced rather than explained by geography alone.
Mental Health as a Risk Factor
About 6% of pregnant people in the U.S. have at least one diagnosed mental health condition at the time of delivery. Those individuals face a severe morbidity rate more than 50% higher than those without a mental health diagnosis (roughly 206 per 10,000 deliveries versus 135 per 10,000). Having two or more conditions pushes the rate even higher, to about 222 per 10,000.
Trauma and stress-related disorders carry the strongest association, with an 87% higher rate of severe morbidity compared to people without those conditions. Depression, anxiety, and bipolar disorder also increase risk. Medicaid-covered deliveries show higher rates of most mental health conditions compared to privately insured deliveries, pointing to the overlap between financial stress, access to care, and maternal health outcomes.
Long-Term Consequences
Maternal morbidity does not always end when the acute crisis resolves. An estimated 15 to 20 million women worldwide each year develop lasting physical or mental health conditions tied to pregnancy and childbirth. Some of these are life-altering: obstetric fistula (an abnormal opening between the vaginal canal and bladder or rectum), uterine prolapse (where the uterus drops from its normal position), and chronic high blood pressure. Others are more common but still significantly affect daily life, including urinary incontinence, hemorrhoids, painful intercourse, and severe anemia.
Postpartum depression and anxiety are among the most widespread forms of lasting maternal morbidity. These conditions can persist for months or years without treatment and affect not only the mother’s well-being but her ability to bond with and care for her child.
The ripple effects extend beyond health. Women dealing with chronic post-pregnancy conditions face economic consequences from lost work and ongoing medical costs. In many parts of the world, severe morbidity leads to social isolation, stigma, and family disruption. Even in high-income countries, the financial burden of severe maternal morbidity is substantial. One U.S. analysis estimated that mental health conditions alone add $102 million annually to the costs of delivery hospitalizations through their association with more severe complications.
What Makes Morbidity Preventable
State maternal mortality review committees have consistently found that a significant share of severe morbidity cases involve missed warning signs, delayed treatment, or breakdowns in communication between providers. Hospitals that implement structured emergency protocols for hemorrhage, hypertensive crises, and sepsis have shown measurable improvements in outcomes.
For individuals, the practical takeaway is knowing what symptoms to take seriously during pregnancy and in the weeks after delivery. Severe headaches, vision changes, swelling in the face or hands, difficulty breathing, chest pain, heavy bleeding, fever, and feelings of confusion or doom are all signs that warrant immediate medical attention. Many serious complications develop or worsen in the postpartum period, not just during labor and delivery.
The gap between the morbidity rate for different racial groups also highlights a systemic dimension. Addressing maternal morbidity at a population level requires not just better clinical protocols but changes in how providers listen to and act on the concerns of all patients, particularly those from communities where symptoms are more likely to be minimized or dismissed.