An analysis of more than 27 million deliveries found the gap held even after researchers accounted for insurance, underlying health conditions and other factors.
Dr. Bayo Curry-Winchell, a Reno family physician who nearly died after giving birth to her second daughter, speaks at the Flow Space Women’s Health Summit in Los Angeles on Oct. 15. (Katie Flores/SHE Media via Getty Images)
Nearly a decade ago, Dr. Bayo Curry-Winchell knew something was wrong soon after she was moved to her hospital room. The Reno family physician, who lives with lupus and an autoimmune blood-clotting disorder, was 38. She had just delivered her second daughter, Jaylin, by cesarean section at the hospital where she served as a medical director.
She struggled to speak, felt intense pain and could barely follow what her husband was saying. She pressed the call button again and again, and a nurse who studied her face told her everything looked fine.
Her husband, James, called her OB-GYN, who returned to the hospital, and she was taken back to the operating room. Doctors found placenta and fetal tissue still in her uterus. She was bleeding internally and had lost so much blood that she needed a transfusion.
Emergencies like hers grew more common in U.S. hospitals in recent years. Severe childbirth complications rose 40.5% between late 2015 and 2022, according to a study published Nov. 3 in JAMA Network Open. Black mothers faced higher rates than white mothers whether they had private insurance or Medicaid.
"I told her that something was wrong at least three to four times," Curry-Winchell said in an account published by The Nevadan and republished by Ms. magazine. She survived, but she has no memory of her first two or three days in the hospital, and with them, her earliest moments with Jaylin.
Researchers at the University of Calgary, led by Amelia Srajer, analyzed a national sample of hospital records representing more than 27 million deliveries. About 563,000, or 2.1%, involved severe maternal morbidity, the medical term for potentially life-threatening complications such as blood transfusions, sepsis, heart failure and kidney failure.
The CDC warns that serious pregnancy complications can arise during pregnancy and up to a year after delivery, and urges women to seek care right away for urgent warning signs.
The rate climbed from 175 per 10,000 deliveries in 2015 to nearly 246 in 2022. Blood transfusion, the treatment Curry-Winchell needed, was the most common.
The Centers for Disease Control and Prevention defines these complications as unexpected outcomes of labor and delivery that can lead to significant short- or long-term health consequences.
Among privately insured mothers, Black women had about 295 severe complications per 10,000 deliveries. That is more than twice the rate for white women, at about 139. Among mothers covered by Medicaid, the rate for Black women was about 339, compared with about 194 for white women.
After accounting for insurance, underlying health conditions, delivery method, region and year, Black women still had 43% higher odds of severe complications than white women. Native American mothers had 57% higher odds, Asian and Pacific Islander mothers 47% and Hispanic mothers 42%.
Insurance coverage told its own story. Medicaid covered 45.5% of deliveries in the study but 55.3% of those with severe complications. Medicaid patients had 22% higher adjusted odds of severe complications than privately insured patients. Among Black mothers, Medicaid coverage was linked to 13% higher odds.
By the Numbers
Severe Childbirth Complications in U.S. Hospitals
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Source: Srajer et al., "National Trends in Severe Maternal Morbidity by Insurance and Race and Ethnicity," JAMA Network Open, Nov. 3, 2026. Based on more than 27 million U.S. delivery hospitalizations, October 2015 through December 2022.
Deaths were rare, occurring in less than 1% of cases with severe complications. Even so, Medicaid patients had nearly twice the odds of an in-hospital death involving a severe complication.
The study shows associations and cannot pinpoint causes. The authors describe Medicaid coverage as a marker of broader structural and institutional challenges. They point to gaps in coverage before and after pregnancy, which can interrupt care for chronic conditions. They also cite lower Medicaid reimbursement, which can limit how many clinicians accept those patients.
The researchers called for Medicaid coverage that extends from before pregnancy through the postpartum period and for fairer reimbursement to strengthen provider networks. They wrote that their findings can serve as a baseline for measuring newer policies, including the option for states to extend postpartum Medicaid coverage to 12 months and Medicaid payment for doula services.
The study has limits. It relied on hospital billing records, which document diagnoses without showing whether a complication could have been prevented. It counted only complications recorded during delivery hospitalizations, so it missed those that develop before a woman is admitted to give birth or after she goes home. The data end in 2022 because the federal database the researchers used dropped its race and ethnicity information the next year.
About 1 in 50 U.S. hospital deliveries from 2015 to 2022 involved a severe complication, researchers found. (Johnny Greig/Getty Images)
The CDC warns that life-threatening complications can arise during pregnancy and up to a year after delivery. Its list of urgent warning signs includes a headache that won't go away or gets worse over time, dizziness or fainting and changes in vision. Others are a fever of 100.4 degrees or higher, chest pain or a fast-beating heart, trouble breathing and extreme swelling of the hands or face.
The list also includes severe belly pain that doesn't go away and overwhelming tiredness. After childbirth, the CDC flags heavy bleeding that soaks through one or more pads in an hour, clots bigger than an egg and vaginal discharge that smells bad. Thoughts of harming yourself or your baby are also on the list.
Women with any of these symptoms should get medical care immediately, the CDC says, and tell providers they are pregnant or were pregnant within the past year. The agency also urges women to contact a provider when something doesn't seem right, even if they are unsure it is serious.
Curry-Winchell now urges expectant mothers to interview doctors before choosing one, to ask how they would handle a complication and to have an advocate with them during labor. Her own advocate was her husband. His phone call brought her doctor back to the hospital.
