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A Qualitative Study of Pregnancy and Maternal Mortality in the US


This paper explores how women endanger their pregnancies by their behaviors and what barriers to healthy lifestyles they encounter. Qualitative research using a semi-structured interview with a recent mother was conducted. The findings show that pregnancies are threatened by an unhealthy diet and physical inactivity, and barriers to healthy lifestyles include work and a lack of social support.

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Despite advances in obstetric medicine, maternal mortality is still a topical issue in the US. The concern about high rates of maternal mortality is highly justified since the death of every mother negatively affects her newborn child, her family, and the whole community. Maternal mortality rates in the US were 17.4 deaths per 100,000 live births in 2018 (Hoyert & Miniño, 2020). Although this rate is not significantly larger than in 2002, it is still greater in the US than in other developed countries (Hamilton, Stevens, Lillis, & Adams, 2018). Therefore, it is important to study this topic to find strategies for reducing maternal mortality rates in the US.

Researchers widely explored the causes of deaths related to pregnancy. In 2018, 77% of maternal deaths were related to direct obstetric causes, the most prevalent of which were obstetric embolism, eclampsia and pre-eclampsia, hemorrhage and placenta previa, and abortive outcomes (Hoyert & Miniño, 2020). The risk factors leading to pregnancy complications that may result in maternal death include pre-existing chronic conditions, excess weight, increasing age, African-American race, cesarean delivery, and poor quality of care (Hirshberg & Srinivas, 2017). Furthermore, mothers in rural areas are at higher risks of maternal mortality than those residing in urban areas because of the slow diffusion of new practices, a lack of resources, and limited access to care (Kozhimannil, Interrante, Henning-Smith, & Admon, 2019). Thus, mothers’ health and living conditions can serve as predictors of maternal mortality risks.

Some researchers paid particular attention to studying late maternal mortality. Although the statistics usually exclude maternal deaths occurring between 43 and 365 days after the delivery, the maternal mortality rate in the first year after the delivery reaches 7.3 deaths per 100,000 live births (Hoyert & Miniño, 2020). Goldman-Mellor and Margerison (2019) studied the causes of postpartum maternal deaths and discovered that drug-related deaths were the second leading cause after obstetric-related disease. Their findings also showed that suicide was also among the leading causes potentially resulting from postpartum anxiety and depression (Goldman-Mellor & Margerison (2019). Hamilton et al. (2018) argue that women in the first year after the delivery the least attention from healthcare professionals because all care in this period is focused on the infant. Thus, although postpartum maternal deaths are not included in maternal mortality rates, they are still an important issue that needs to be addressed.

The current debate surrounding the topic of maternal mortality does not cover mothers’ experiences regarding pregnancy. Mothers’ behaviors during pregnancy and their awareness of the possible complications may influence their risk of maternal mortality. This paper aims to address this gap in the research debate by exploring a recent mother’s experience. The research question is how mothers can endanger their pregnancies and what prevents them from leading a healthy lifestyle during pregnancy. The findings show that women may fail to change their diet and physical activity during pregnancy, even if they have complications. The main barriers to lifestyle changes are work and a lack of family support.


Qualitative research was conducted with a recent mother recruited from an urban hospital in the US. A semi-structured interview with a white 34-year-old mother of two children was completed on September 4, 2020. Before the interview, the participant was informed about the purpose of the research and gave her consent to participate in the study but wished to preserve her anonymity. The interview was conducted in person in a hospital where the mother came for a routine checkup with her 4-month-old child. This participant was chosen for two reasons; firstly, she recently delivered a child, so she had the experience relevant to this study. Secondly, the woman was overweight, which might signify that she had certain difficulties in maintaining a healthy lifestyle.


The participant was a 34-year-old mother of two children, a five-year-old boy, and a 4-month-old girl. Her first pregnancy occurred when she had normal weight, and it proceeded without any complications. When asked about her diet changes, the woman said that the only changes were abstaining from alcohol consumption and taking vitamin supplements recommended by her doctor. She said that she worked until the 32nd week of her first pregnancy, and she often did not have the time or was too tired to cook homemade meals. Therefore, she sometimes ordered pizza or other dishes from nearby restaurants. The woman gained excess weight during her first pregnancy and did not lose it since then. Thus, when her second pregnancy occurred, she was overweight. During her second pregnancy, she was diagnosed with gestational diabetes and was advised to control her diet, but sometimes failed to do so: “I tried to eat less sugar, but my son loves sweets, and we often have plenty of it at home, so I occasionally ate some candy or something.”

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When asked about changes in activity, the woman said that she tried to avoid lifting weights and walk more. However, she mentioned that pregnancy made it difficult for her to involve in any other physical activity. After the birth of the first child, she also did not engage in physical activity because she felt exhausted by baby chores. She said that her mother and husband occasionally helped her with the baby, but most of the work she had to do herself. In response to the question about the frequency of her doctor visits, she said that she missed several of them before the 32nd week of both pregnancies because of work and, later, because of her first child’s illness.


The findings of this study suggest that women may endanger their pregnancies by failing to change their lifestyles to avoid pregnancy complications. The interview revealed that pregnant women might disregard medical recommendations as to lifestyle changes even if they have developed some complications, such as gestational diabetes, as in the described case. Pregnant women may also experience difficulties in maintaining their physical activity, which may lead to such complications as gestational diabetes or the need for a cesarean section that increases the risk of pregnancy-related death. Women may also endanger their pregnancies by missing appointments, which may lead to an untimely diagnosis of complications and threaten the infant’s and mother’s lives.

Another key take-away point is that work and a lack of social support are the factors that prevent women from adhering to healthy lifestyles. In the described case, the work made the woman make unhealthy food choices. The lack of social support may manifest itself in family members’ unwillingness to adjust their lifestyles to that of a pregnant woman to facilitate her adherence to a healthy diet and activity.


The limitation of this study is the small sample size, which does not show the difference in endangering behavior and lifestyle challenges depending on the race, socioeconomic status, and place of residence. The study did not answer the question about mothers’ postpartum experience that may lead to complications. Therefore, future studies may investigate how women endanger their lives in the first year after the delivery.


Goldman-Mellor, S., & Margerison, C. E. (2019). Maternal drug-related death and suicide are leading causes of post-partum death in California. American Journal of Obstetrics and Gynecology, 221(5), 489.e1-489.e9. Web.

Hamilton, N., Stevens, N., Lillis, T., & Adams, N. (2018). The fourth trimester: Toward improved postpartum health and healthcare of mothers and their families in the United States. Journal of Behavioral Medicine, 41, 571-576. Web.

Hirshberg, A., & Srinivas, S. K. (2017). Epidemiology of maternal morbidity and mortality. Seminars in Perinatology, 41(6), 332-337. Web.

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Hoyert, D. L., & Miniño, A. M. (2020). Maternal mortality in the United States: Changes in coding, publication, and data release, 2018. National Vital Statistics Reports, 69(2), 1-18.

Kozhimannil, K. B., Interrante, J. D., Henning-Smith, C., & Admon, L. K. (2019). Rural-urban differences in severe maternal morbidity and mortality in the US, 2007-15. Health Affairs, 38(12), 2077-2085. Web.

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