Presented September 3, 2025 at the 2025 APSF Stoelting Conference on “Transforming Maternal Care: Innovations and Collaborations to Reduce Morbidity and Mortality”
SUMMARY
Jill Mhyre, MD’s presentation emphasizes that disparities in maternal health outcomes are persistent, prevalent, and largely preventable, with the vast majority of risk tracing back to the social determinants of health rather than the healthcare encounter itself. Black women face a 3.5-fold higher risk of maternal death compared to white women, a relative risk that has remained stable for decades. She highlights the widening gap in wealth inequality and the increasing risk faced by rural populations due to maternity care desert closures. For anesthesiologists, closing the disparity gap involves ensuring equitable access and high quality of neuraxial labor analgesia, as this improves patient experience and is the most important predictor for successful conversion to anesthesia for Cesarean delivery, thereby avoiding general anesthesia, which is used more frequently in vulnerable populations.
Key Points:
- Root Cause of Disparities
An estimated 80% of health disparities are attributed to social determinants of health (e.g., socioeconomic and environmental disadvantage), which are far upstream from the clinical encounter [01:05, 01:13]. - Racial Mortality Gap
The risk of maternal death for Black women is 3.5 times higher than for white women, a persistent relative risk that has been measured since 1965 [05:07, 03:58]. - Geographic and Socioeconomic Risk
The U.S. faces tremendous geographic disparity in maternal mortality, with a cluster of high-risk states in the South. This reflects increasing risk in rural populations due to the closure of maternity hospitals, creating “maternity care deserts” [05:31, 09:47]. - The Role of Neuraxial Analgesia
Studies show decreased use of labor neuraxial analgesia (epidurals) in Black and Hispanic women. This underuse is often rooted in distrust and fear-based decision-making, not a preference for natural birth [15:14, 16:33]. - Closing the Care Gap
Providing high-quality labor analgesia is the single most important predictor for successful conversion to anesthesia for Cesarean delivery, thereby reducing the need for general anesthesia, which is disproportionately used in vulnerable populations [20:06, 21:06].
ABOUT THE SPEAKER(S)
Jill Mhyre, MD
Dola S. Thompson Professor and Chair of Anesthesiology,
University of Arkansas for Medical Sciences, Little Rock, AR
Jill Mhyre, MD is The Dola S Thompson Professor and Chair of Anesthesiology at the University of Arkansas for Medical Sciences in Little Rock, Arkansas, USA. Her scholarly activity focuses on obstetric quality and safety. She is Executive Section Editor of Obstetric Anesthesiology for Anesthesia & Analgesia, a member of the ACGME Residency Review Committee for Anesthesiology, Senior Editor for the American Board of Anesthesiology Advanced Written Examination, and Chair of the SOAP Research Committee.
