On average, 70 women died in Missouri while they were pregnant or within a year after they gave birth each year from 2018 to 2022, according to the state’s Perinatal Quality Collaborative. That data comes from the Missouri Pregnancy-Associated Mortality Review Board in their 2025 annual report.
According to PQC, mental health conditions, including substance use disorders, were the leading cause of pregnancy-related deaths during that time frame. The pregnancy-related mortality rate was 32.3 deaths per 100,000 live births. That was higher than the national rate of 22.3. And the PQC said the review board determined that 80% of those deaths were preventable.
"We know that Black women are two and a half to three times more likely to die during the time of pregnancy or the first year after pregnancy, the postpartum period, as White women," said Marth Smith, the state director for maternal, child and family health at the Missouri Department of Health and Senior Services. "We also know that those moms that have more risk factors, whether those be physical risk factors such as a cardiovascular condition or diabetes or other chronic condition, women who are obese as well as women who have some of those more socioeconomic risk factors and some of those social drivers of health that contribute to their overall health before they get pregnant that then can create risk scenarios and high risk for them during pregnancy, are more likely to die."
Severe maternal morbidity
Besides maternal deaths, severe maternal morbidity or SMM is also a concern. That includes unexpected outcomes of labor and delivery that can result in significant short- or long-term health consequences, according to the Centers for Disease Control and Prevention. SMM can include hemorrhage, acute renal failure, sepsis, respiratory distress, eclampsia, aneurysm and cardiac arrest among other things. SMM, it said, has been steadily increasing in recent years. Impacts besides health effects for women include increased medical costs and longer hospital stays.
Prenatal care
Smith said good prenatal care is vital in preventing maternal morbidity and mortality.
"Women sometimes don't fully understand because maybe we haven't done as good a job across the board as a society and a health care system in informing the public of the need for early prenatal care, for example," she said. "The earlier that a woman knows that she's pregnant and goes ahead and gets enrolled in health care services, than the earlier she also can get connected to the full scope of all the resources available to her."
"Lack of knowledge around how things contribute to health and understanding of how healthy you are before you get pregnant," said Smith, "can impact the outcome of your pregnancy and understanding the need to take care of yourself and your health to the best that you can — those can all create barriers to adequate health care and positive and optimal outcomes."
Access to care
Lack of access to care contributes to poor outcomes for pregnant women.
“Our surrounding communities don't have hospitals that include labor and delivery," said Jennifer Brooks, an obstetrician/gynecologist (OB-GYN) with Mercy Springfield. "We have a few communities here and there, but there's just it's called a maternity health desert, where we just don't have OB-GYNS or hospitals that offer those services. And if you live outside of Greene County, unfortunately you're going to have to make your way into Greene County to receive those cares."
According to a 2025 March of Dimes report, 35% of U.S. counties are maternity care deserts, meaning they are without a birthing facility or obstetric clinician. The report found that Dade, Douglas, McDonald, Ozark, Stone, Webster and Wright Counties were fell into that category.
Not only can access to care lead to better physical health outcomes, it can also help with mental health concerns such as substance abuse disorder and depression.
"Every one of my patients, when I see them for the first time, I screen them," said Brooks. "I ask them about how their mental health is. And even if they feel that their mental health is good at the time, I always ask them about history because if they have a history
of depression or anxiety, they will be at increased risk for postpartum depression or anxiety. And at that moment, I make it a point to let them know that if they do experience those issues, then they are not alone, and it's important for them to talk to us and reach out to us rather than trying to deal with it on their own because it can be serious, and like I mentioned before, it can be (a) very isolating feeling in the postpartum state when you feel like, 'I just had a baby, I should be happy. Why am I feeling like this?' I reassure patients, there's nothing wrong with you. This could be a normal part of hormone fluctuations, and we can seek help. So, we do use antidepressants a lot in pregnancy for patients who struggle with depression and anxiety."
She said most of the antidepressants they use have not been shown to cause harm to the baby. Even if there's a small risk, they weigh that risk versus the benefits, "and to us a mom's mental health usually outweighs the risk."
What is being done?
The State of Missouri offers several programs that are working to reduce maternal mortality and morbidity. And Smith said action taken by the legislature is also helping to get numbers down.
"A couple of years or so ago, our state legislature voted to extend postpartum coverage under Medicaid for a full 12 months after delivery. And we believe that over time we will see positive impacts for that. So instead of a woman only being able to be seen for those first few weeks after delivery, they can be seen and receive the full scope of health care services for that full first 12 months, which really for a woman, especially for a woman who is uninsured outside of that pregnancy and postpartum period, that assures that for that time period they can receive health services that they need, including behavioral health, which would include substance use identification and treatment, as well as other mental health conditions and then also oral health," she said. "And a lot of people don't understand the implications of oral health for overall health and how not taking care of our mouth and having poor oral health can impact all of your body systems and can lead to other conditions such as cardiovascular conditions."
She said an interagency maternal health consortium, led by the chief medical officer at DHSS Heidi Miller, meets regularly. According to Smith, it brings together top leadership from various state agencies and key partners, including the Missouri Hospital Association and the Missouri Primary Care Association, to share information and brainstorm innovation and paths forward. The focus is on both mom’s health as well as baby’s. And PQC works to connect community, public health and clinical leaders to improve the care and support systems that lead to better health and health outcomes before, during and after pregnancy. Smith said improving the health of pregnant women can also improve the health of babies.
"Many times, fetal death is associated with maternal health," she said, "And infant death many times is from prematurity or low birth weight, which also is many times associated with maternal health."
Many women use doulas during pregnancy and birth to advocate for them and help ensure the best possible outcomes. Smith said DHSS offers training for doulas named in honor of Cora Faith Walker and her passion for maternal health and doula services. It also helped develop a plan with MO Health Net to provide reimbursement for doulas services.
DHSS has a state-funded maternal mortality prevention plan in place, which includes the Maternal Health Access Project, established by the University of Missouri.
The agency also offers some home visiting initiatives and programs for high-risk pregnant women. Those start during pregnancy and continue into the child’s early years.
"Home visiting is an evidence-based strategy for reducing and preventing maternal mortality as well as infant mortality and improving outcomes," she said. "So those are important strategies for us as well."
You may contact your local public health department for information about those home visiting services, according to Smith.
