The purpose of this study was to assess serious maternal morbidity associated with childbirth. This is a retrospective cohort study of women enrolled in the Tennessee Medicaid program who delivered a (live or stillborn) child in 1991. Data were drawn from medical records and from Medicaid

Nine women (6 black and eight cesarean) died within 60 days of delivery. The overall rate of serious childbirth related morbidity resulting in prolonged hospital stays or readmissions was 2.6% for those with vaginal deliveries. Among the 1% of women readmitted within 60 days of delivery, the greatest frequency of readmissions (11%) occurred on the second day after discharge.

Patient characteristics associated with cesarean delivery included older age, black ethnicity (RR=1.1, 95% confidence interval=1.0, 1.1), unmarried, no previous live births, low maternal education, adequate prenatal care, and not living in a major metropolitan area. The rate of serious childbirth related morbidity was 8.9% for those with cesarean deliveries. Among the 1.5% of women readmitted within 60 days, the greatest frequency of readmissions (16%) occurred 2 days after discharge.

Infection was the most common serious morbidity for all women, but was more than four times higher among women with cesarean deliveries than vaginal deliveries (1.8% versus 7.9%). Hypertensive conditions were the second most common type of serious morbidity for women with vaginal deliveries and the third most common for women with cesarean deliveries (0.7% and 2.0%). The overall frequency of hemorrhage was 0.5% for women with vaginal deliveries and 2.4% for women with cesarean deliveries. After adjusting for other factors, black versus white women with vaginal deliveries were 1.9 times more likely to have infection (95% confidence interval=1.4, 2.4), 3.1 times more likely to have a hypertensive disorder (95% confidence interval=2.1, 4.6), and 1.6 times more likely to have a hemorrhage (95% confidence interval=1.0, 2.5). The pattern was similar for women with cesarean deliveries.

Other factors associated with increased risk of these events among women with vaginal deliveries included high mother’s age, no prior live birth, low education (for infection and hypertensive disorders only), smoking status, and inadequate prenatal care (for hypertensive disorder only). For women with cesarean deliveries, high maternal age (for infection and hypertensive disorder), age 17-19 versus 20-27 (for infection), no prior live births, smoking status (for infection and hypertensive disorder), less than adequate prenatal care (for infection and hypertensive disorder), unmarried (for infection only), and residence in a major metropolitan area (for infection only).

The authors do not discuss potential explanations for the race patterns. An important limitation of this study is that it did not include data on comorbid conditions.