When we first published this post in 2021, the maternal mortality rate in the United States stood at 17.3 deaths per 100,000 live births — a figure we described as an alarming high. Since then, the numbers have shifted, new research has emerged, and the regulatory landscape has evolved. But the core problem remains: too many mothers are dying from conditions that are largely preventable, and simulation training is still one of the most powerful tools we have to change that.
Maternal Morality Rate: The Numbers Today
According to the most recent data from the CDC’s National Center for Health Statistics, the U.S. maternal mortality rate was 17.9 deaths per 100,000 live births in 2024, a modest and statistically insignificant decrease from 18.6 in 2023. In total, 649 women died of maternal causes in 2024.
While any reduction is welcome, the broader picture is sobering. The U.S. continues to have the highest maternal mortality rate of any high-income country in the world. And progress, where it exists, is fragile. As the March of Dimes noted in response to the 2024 data, these figures are a reminder that we cannot afford complacency.
Severe bleeding — maternal hemorrhage — now accounts for roughly one in six maternal deaths in the United States. It remains the leading cause of maternal mortality worldwide.
The Racial Disparity Crisis
Perhaps the most urgent development since 2021 is the growing recognition of the staggering racial gap in maternal outcomes — a gap that demands to be addressed head-on in any conversation about maternal safety.
In 2024, the maternal mortality rate for Black women was 44.8 deaths per 100,000 live births, more than three times the rate for White women (14.2). According to the March of Dimes, American Indian and Alaska Native women face the highest rate of any group at 60.8 per 100,000. These are not statistical abstractions. These are lives.
Public health experts have been clear that these disparities are not explained by income or education alone. They are rooted in systemic factors: structural racism, unequal access to high-quality care, and documented differences in how patients are treated within the healthcare system. In 2023, The Joint Commission responded directly with a Sentinel Event Alert specifically focused on eliminating racial and ethnic disparities causing mortality and morbidity in pregnant and postpartum patients.
Multidisciplinary simulation training is not a complete solution to systemic inequity, but it is a meaningful intervention. When teams train together on standardized protocols, the variability in care that contributes to disparate outcomes can be reduced.
Hemorrhage Is Still Preventable
The CDC has long estimated that approximately 60% of maternal deaths are preventable. The Joint Commission has reinforced this framing specifically in the context of hemorrhage, describing maternal hemorrhage as “the most frequent cause of severe maternal morbidity and preventable maternal mortality.”
Understanding why hemorrhage deaths occur helps explain why simulation training is so effective at preventing them. The primary causes of postpartum hemorrhage (PPH) are what clinicians call the “4 T’s”:
- Tone — uterine atony (failure of the uterus to contract), which accounts for 70–80% of all PPH cases
- Trauma — lacerations or uterine rupture
- Tissue — retained placenta or clots
- Thrombin — coagulation deficiencies
PPH occurs in approximately 1–3% of all deliveries. Common reasons deaths occur even when PPH is recognized include missed or miscommunicated signs of active blood loss, underestimation of the amount of blood lost, and the absence of a standardized emergency response. These are exactly the gaps that simulation training is designed to close.
The Joint Commission Standards: Still in Effect, Now Fully Enforced
When we wrote this post in 2021, the Joint Commission’s seven Elements of Performance (EPs) for maternal hemorrhage — which took effect July 1, 2020 — were relatively new, and on-site hospital surveys had been paused due to COVID-19. That is no longer the case. Surveys are fully reinstated, and compliance is actively assessed.
As a reminder, the seven EPs require accredited hospitals to:
- Perform a hemorrhage risk assessment using an evidence-based tool upon admission to labor and delivery and postpartum care
- Develop written, evidence-based procedures for stage-based hemorrhage management
- Standardize a hemorrhage supply kit (a dedicated crash cart with all required elements)
- Deliver role-specific staff and provider education about OB hemorrhage procedures — including in situ simulation, which is strongly encouraged
- Conduct hemorrhage drills at least annually, with multidisciplinary representation and a team debrief
- Perform OB hemorrhage case reviews after actual events
- Provide patient and family education about signs, symptoms, and when to seek care
EPs 4 and 5 speak directly to simulation training. The Joint Commission doesn’t just recommend it — it expects hospitals to build it into their culture of readiness.
What the Research Now Shows
Since 2021, the evidence base for simulation-based training has grown considerably — and it’s compelling.
A 2025 systematic review covering more than 177,000 deliveries found that simulation-based training produced a significant reduction in adverse outcomes. Postpartum hemorrhage requiring transfusion dropped from 6.9% pre-training to 3.8% post-training. The review, which examined eight studies published between 2014 and 2023, concluded that improvements were most pronounced when training was interprofessional and scenario-based.
A 2024 before-and-after study published in BJOG: An International Journal of Obstetrics & Gynaecology evaluated the impact of the Obstetric Simulation Training and Teamwork (OB-STaT) curriculum on PPH rates and outcomes across maternity hospitals in the U.S. The findings confirmed that in situ multiprofessional simulation-based training had the best impact on decreasing severe blood loss (≥1,500 ml) and reducing blood transfusions of four or more units.
The takeaway: in situ training — conducted in the actual clinical environment where emergencies will occur, consistently outperforms classroom-only approaches. The setting matters because it tests not just clinical skills, but also systems, equipment, communication, and team coordination in real time.
A Multidisciplinary Approach Remains Essential
The American College of Obstetrics and Gynecology’s Simulations Working Group continues to emphasize that acquiring clinical and surgical skills must go hand-in-hand with training in teamwork, effective communication, and demonstrated competency — before residents and staff face these situations in actual patient care.
That framing is as relevant today as it was in 2021. Maternal hemorrhage is not a failure of individual skill alone — it is often a failure of systems and teams. A blood bank that won’t release products quickly enough. A nurse who underestimates blood loss. A physician who doesn’t have a shared mental model with the anesthesiologist. Multidisciplinary in situ drills surface these exact vulnerabilities in a controlled environment, where they can be addressed without cost to a patient.
When building your simulation program, consider mapping every department that intersects with your hemorrhage response — blood bank, pharmacy, ICU, anesthesia, nursing, OB — and ensure drills include each of them. Debrief after every drill. Share successes across the system. The Joint Commission recommends drills at least annually; best practice is to retrain whenever protocols change.
OEI’s Role
Operative Experience, Inc. (OEI) provides the world’s only fully operative, hands-in-the-body simulators for mastering emergency labor and delivery procedures. Our Postpartum Hemorrhage Control Simulator is specifically designed to teach the interventions most critical to saving lives, including:
- Complex lacerations and uterine artery injuries
- Hemorrhage control techniques including Bakri balloon, B-Lynch suture, Hayman suture, and O’Leary stitch
- Teamwork and human factors training for hemorrhage control in an emergency C-section scenario
The simulator provides unprecedented anatomical and surgical fidelity. Standard instruments can be used to incise, dissect, retract, and suture realistic tissue. Simulated amniotic fluid and blood create real-world conditions for truly immersive learning.
We recommend pairing skills-based simulator training with full multidisciplinary in situ drills — building competency first, then testing the entire system.
The Bottom Line
The data from 2024 tells us we are making incremental progress — but incremental progress is not good enough when hemorrhage alone accounts for one in six maternal deaths, when Black mothers die at rates three times higher than their White counterparts, and when the CDC continues to classify the majority of these deaths as preventable.
The tools exist. The standards are in place. The evidence is clear.
In situ simulation training saves lives. The question is whether your team is ready.
Operative Experience, Inc. (OEI) is the leader in high-fidelity, hands-in-the-body medical simulation for labor and delivery emergencies. To learn more about our Postpartum Hemorrhage Control Simulator or to discuss building a simulation program for your facility, contact us here.
References:
- Hoyert DL. Maternal mortality rates in the United States, 2024. NCHS Health E-Stats. 2026. https://www.cdc.gov/nchs/data/hestat/hestat113.htm
- March of Dimes. CDC Issues New Data on Maternal Mortality Rates in the U.S. March 2026. https://www.marchofdimes.org/about/news/cdc-issues-new-data-maternal-mortality-rates-us
- Commonwealth Fund. Maternal Mortality in the United States, 2025. July 2025. https://www.commonwealthfund.org/publications/issue-briefs/2025/jul/maternal-mortality-united-states-2025
- The Joint Commission. Sentinel Event Alert: Eliminating Racial and Ethnic Disparities Causing Mortality and Morbidity in Pregnant and Postpartum Patients. 2023.
- Cureus. Impact of Simulation-Based Training on Maternal and Neonatal Outcomes in Delivery Rooms: A Systematic Review. 2025. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12882978/
- BJOG. Interprofessional obstetric simulation training improves postpartum haemorrhage management and decreases maternal morbidity: a before-and-after study. 2024. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.17640
- ACOG Practice Bulletin No. 183: Postpartum Hemorrhage. Obstetrics & Gynecology. 2017.
- The Joint Commission. R3 Report Issue 24: PC Standards for Maternal Safety. 2020.
- Laerdal Medical. The Joint Commission Perinatal Standards. https://laerdal.com/us/information/the-joint-commission-perinatal-standards/
