Recent reporting by the Investigative Journalism Bureau on maternal deaths in Canada, and the creation of a public maternal death tracker, shine a spotlight on outcomes that are thankfully rare but devastating when they occur. These efforts are important: we cannot prevent what we do not measure.
As a perinatal epidemiologist, I spend much of my time studying severe complications of pregnancy and childbirth. And while maternal deaths are among the most serious outcomes we can measure, they represent only a small fraction of the burden that pregnancy-related illness places on individuals, families, and health systems.
For every maternal death, many more people experience life-threatening complications during pregnancy, childbirth, or the weeks that follow.
These complications, known collectively as severe maternal morbidity, include major hemorrhage requiring blood transfusion, severe infections, strokes, organ failure, cardiac events, and severe hypertensive disorders such as severe preeclampsia. Many individuals survive these events, but survival does not necessarily mean they recover fully. The physical, psychological, and social consequences can persist for years.
Historically, conversations about maternal health have focused on labour and delivery. Birth is a period of intense physiologic stress, and some of the most dramatic complications occur during this time. Yet recent Canadian evidence suggests that this focus is too narrow.
In a population-based study of more than one million births in Ontario, nearly half of severe maternal morbidity occurred outside the labour and delivery hospitalization. Some complications developed during pregnancy, before labour even began. Others occurred well after birth, when individuals had returned home and were no longer under the close observation of obstetric care providers.
The postpartum period deserves particular attention.
For many people, the transition from intensive prenatal care to postpartum care is abrupt. In Canada, formal follow-up has traditionally consisted of a single visit around six weeks after birth. While care models are evolving, access to ongoing physical and mental health support remains inconsistent even though the physiologic and emotional consequences of pregnancy do not end when a baby is born; the risks persist beyond the traditional six week window.
This disconnect between the period when care is concentrated and when complications may occur has important implications. In our provincial study, one in five severe maternal complications first came to medical attention through emergency departments rather than obstetric settings. In other words, individuals experiencing some of the most serious pregnancy-related complications chose to enter the health-care system through pathways that are not traditionally considered part of maternal care.
These findings challenge us to rethink how we approach maternal health.
Tracking maternal deaths remains an essential metric of health system performance; every maternal death is tragic, and many are preventable. But if our goal is prevention, deaths alone provide only part of the picture. Severe maternal morbidity offers earlier opportunities to identify problems, understand risk factors, and intervene before lives are lost or devastated.
Importantly, these complications are not experienced equally. Significant inequities in maternal health persist across populations defined by race, geography, and socioeconomic circumstances. Understanding why these disparities exist—and how to eliminate them—requires moving beyond rare individual clinical events to examine the broader social and structural conditions that shape health before, during, and after pregnancy.
The IJB’s maternal death tracker is an important step forward because it makes visible outcomes that have too often remained hidden. But the next challenge is to look beyond deaths alone. If we want to improve maternal health in Canada, we must pay attention not only to the lives lost, but also to the thousands of individuals who survive severe complications each year and the systems of care that failed to prevent them.
Maternal deaths matter. So do the many warning signs that precede them.
