Maternal Mortality Review Panel

The Department of Health has submitted its 2025 Maternal Mortality Review Panel report to the Washington State Legislature, summarizing data and recommendations from maternal deaths in 2021 and 2022, as well as cumulative data from 2014–2022. 

Washington State Maternal Mortality Review Panel: Maternal Deaths 2021–2022 (PDF)

The report includes an addendum from the American Indian Health Commission, of Tribal and Urban Indian Leadership Recommendations.

The report includes 12 recommendations for the legislature. In a supplemental section, there are 75 recommendations for other entities, including agencies, health care systems, providers, organizations, and other audiences. All recommendations fall under three priority areas:

• Improving health care quality and access
• Strengthening community support services
• Providing equitable, culturally responsive care

The findings of the report include:

• Washington saw a rise in maternal fatalities in 2021–2022. Pregnancy-related maternal mortality rate reached its highest level in 2021, with 33.4 deaths per 100,000 live births, followed by 27.6 deaths per 100,000 live births in 2022. These are the highest rates of pregnancy-related death in the 2014–2022 period.
• The Panel identified 107 pregnancy-associated deaths from 2021-2022. These are defined as deaths from any cause during pregnancy or within one year of the end of pregnancy.
• Of the 107 pregnancy-associated deaths, the Panel identified 51 pregnancy-related deaths, defined as deaths due to a pregnancy complication, a chain of events initiated by pregnancy, or aggravation of unrelated condition(s) by the physiological effects of pregnancy.
• The Panel found 82 percent of pregnancy-related deaths were preventable, meaning there was at least some chance of the death being averted if a factor that contributed to the death had been different.
• Behavioral health-related deaths—including by suicide, homicide, and accidental overdose—accounted for nearly half (45%) of all pregnancy-related deaths in 2021–2022. Accidental overdose was the leading underlying cause. Other leading causes included COVID-19 and cardiovascular conditions.
• Disparities persisted among Washingtonians based on age, race and ethnicity, rural residence, and Medicaid coverage status; these were driven by factors like bias, structural racism, financial inequities, and limited access to care. American Indian and Alaska Native communities had the highest rate of maternal mortality. Their risk of dying from pregnancy-related causes was 7.3 times higher than that of non-Hispanic white people. Black, Native Hawaiian, Pacific Islander, and multiracial people also experienced higher rates. People living in rural areas experienced higher rates than people in urban areas. People enrolled in Medicaid faced higher rates than those with private insurance.

Based on findings from its review of 2021–2022 deaths, the MMRP developed recommendations to help reduce preventable maternal deaths and improve health care for people before, during, and after pregnancy. The report contains three priority recommendations, under which there are 12 more detailed recommendations for the legislature and 75 more detailed recommendations for other entities, including agencies, health care systems, providers, organizations, and other audiences. 

The three priority recommendations are:

1. Improve Health Care Quality and Access 
   Ensure Washingtonians have access to high-quality health care—including mental health care, substance use disorder treatment, and preventive care—throughout pregnancy, birth, and postpartum by strengthening and funding care coordination, improving communication and protocols, and ensuring providers have the skills, training, and professional support they need to provide high-quality care.
2. Strengthen Community Support Services
   Invest in, develop, and expand comprehensive community support services that address essential needs during pregnancy and postpartum. These include strengthened home visiting programs, social work services, doula care, wraparound support for mental health and substance use disorder, and housing and food assistance.
3. Provide Equitable, Culturally Responsive Care
   Ensure care and services throughout pregnancy, birth, and postpartum are culturally responsive, free from bias, grounded in trauma-informed practices, and actively address racial injustice.

Next Steps: Implementing 2025 Report Recommendations

Now that the 2025 Maternal Mortality Review Report has been published, DOH will offer learning opportunities that are open to the public, at which we will discuss report findings, recommendations, and future implementation activities. If you have questions or comments or would like DOH to present the report with your team or organization, contact us at maternalmortalityreview@doh.wa.gov.

MMRP report recommendations are not owned by any single entity. They are intended to guide action across a wide network of contributors—including health care practitioners, hospitals, community-based organizations, advocacy groups, and academic institutions. Each plays a vital role in reducing disparities and preventing severe maternal injury and death.

We recognize and appreciate the many people and organizations who continue to implement and adapt MMRP recommendations in their communities. We encourage any individual or organization to share with us how you are applying or hope to apply the Panel’s recommendations from the 2025 MMRP Report.

Since 2023: Implementing 2023 Report Recommendations

The previous MMRP report, published in 2023, contained over 100 recommendations. Since then, decision-makers, agencies, institutions, health care practitioners, and communities across Washington have worked to accomplish many of these recommendations—from policy to practice. Much work remains, and many 2023 recommendations are still relevant.

Building on these recommendations, DOH launched the Maternal Health Innovations (MHI) program in 2023. The program established a statewide maternal health task force to identify strategic priorities and improve how Washington collects and uses data on maternal mortality and morbidity. In 2025, MHI funded 2 organizations to expand maternal health services designed and led by American Indian and Alaska Native communities. MHI also funded 2 educational institutions to develop or expand rural nursing programs to help address workforce shortages that contribute to hospital closures and gaps in rural maternity care.

Washington helped more families receive home visiting services by increasing home visiting funding and services. Through Start Early Washington, the state is also developing and implementing core competencies to strengthen and standardize the home visiting workforce. Also in 2025, Washington launched a new Apple Health doula benefit, after DOH and Health Care Authority co-developed a statewide standing recommendation for doulas—a necessary step to enable Medicaid reimbursement. Doulas with state certification can enroll as Medicaid billing providers, connecting more Washingtonians covered by Medicaid to doula support in pregnancy, birth, and postpartum.

Here are some more examples of implementation of 2023 MMRP Report recommendations:

Birth Doula Medicaid Reimbursement

In January 2025, Washington state implemented Medicaid reimbursement for certified birth doulas, marking a major milestone in expanding access to culturally appropriate, evidence-based non-clinical perinatal support. This benefit allows Apple Health (Medicaid) clients to receive prenatal, labor, birth, and postpartum services from state-certified doulas at no cost to them.

The doula benefit is designed to improve pregnancy and perinatal health outcomes, reduce birth disparities, and enhance the birth experience, particularly for communities disproportionately impacted by maternal mortality and morbidity, including Black, Indigenous, and People of Color (BIPOC), as well as rural and low-income populations. DOH and HCA are working with community-based organizations to grow and sustain a diverse doula with a potential path for workforce and create a “doula hub” to maintain a centralized referral system and provide support functions for doulas including navigating Medicaid.

Birth Equity

DOH has expanded the Parenting and Birth Support Program (formerly Birth Equity Project), a community-led initiative aimed at reducing maternal mortality and addressing disparities in birth outcomes. The project focuses on supporting organizations led by and serving communities of color.

With increased funding, the program has broadened its reach, providing grants to additional community-based organizations that offer culturally relevant care, including doula services, midwifery, lactation support, and perinatal education. These efforts empower birthing people by ensuring they have access to care that respects traditional practices.

The Parenting and Birth Support Program was developed by a community advisory board comprising doulas, midwives, childbirth educators, parents, caregivers, and other community birth workers from priority communities. This collaborative approach ensures that decisions are made using community-partnered participatory practices, fostering trust and effectiveness in addressing the needs of birthing people.

Perinatal Data Dashboard

In May 2024, DOH launched an interactive Perinatal Dashboard on its Perinatal Data webpage to enhance understanding of pregnancy, birth, and parenting experiences across the state. This tool provides data on health conditions during pregnancy, birth outcomes, substance use, postpartum experiences, and overall pregnancy experiences. Information is disaggregated by age, race/ethnicity, Medicaid status, and geography to highlight disparities and inform research, programming, and policy development. The dashboard draws from birth certificates and the Pregnancy Risk Assessment Monitoring System (PRAMS)..

Centers of Excellence for Perinatal Substance Use

As of 2025, 6 hospitals in Washington have received certification as Centers of Excellence for Perinatal Substance Use. This represents a major achievement in creating comprehensive, evidence-based care and system-level change across hospital departments and disciplines. 

Certified hospitals are recognized for providing high-quality, family-centered care, including routine substance use screening, medication-assisted treatment, and support for both parent and infant during the perinatal period. This work was nationally recognized by the Association of Maternal & Child Health Programs (AMCHP) as a cutting-edge practice in maternal health.

Legislation to Improve Maternal Health Outcomes – SB 5580

Passed in 2024, Senate Bill 5580 strengthened Apple Health’s (Medicaid) role in supporting maternal mental health by expanding access and enhancing services for perinatal people. Key components include raising the income eligibility threshold for pregnancy and 12-month postpartum coverage from 193% to 210% of the Federal Poverty Level, allowing more Washington residents to maintain vital coverage during and after pregnancy. 

The legislation also established a hospital post-delivery and transitional care program specifically for people with a substance use disorder at the time of delivery—ensuring comprehensive support during a critical period. 

Additionally, it invests in the First Steps Maternity Support Services (MSS) program by modernizing screening tools, increasing benefit limits and reimbursement rates, and requiring systemic collection of client screening outcomes to improve care coordination and quality.

Plan of Safe Care Enhancements

Washington has strengthened its Plan of Safe Care (POSC) to better support infants prenatally exposed to substances while also supporting their families. As of 2022, infants with certain substance exposures and no safety concerns are now referred to Help Me Grow Washington for wraparound support, rather than routed to Child Protective Services, or left without services. Birthing hospitals can make referrals directly through an online portal. 

To align with this approach, the Center of Excellence for Perinatal Substance Use criteria include alignment with POSC practices. DCYF, DOH, HCA, and the Washington State Hospital Association issued a joint letter asking hospitals to update their relevant policies and procedures by January 1, 2025. DCYF, in partnership with Help Me Grow Washington affiliate WithinReach, offers technical assistance and hosts monthly Community of Practice sessions to support hospitals and providers in implementing POSC practices.

In early 2024, a pregnancy pathway was added to the POSC initiative through which Help Me Grow Washington connects pregnant people with substance use to voluntary prevention services like substance use disorder treatment, home visiting, and basic needs supports.

Smooth Transitions

DOH is supporting the expansion of the Smooth Transitions Program, which aims to improve the transfer of care for perinatal patients between health care facilities. Since 2023, the program has seen growth in the number of participating facilities and the implementation of EMS simulations and training to enhance the effectiveness of patient transfers. Additionally, protected case reviews are being conducted to identify areas for improvement and strengthen the transfer process. This work helps ensure that perinatal patients receive timely, coordinated, and high-quality care during transitions, ultimately contributing to better health outcomes and improved collaboration across the health care system.

TeamBirth in Washington Hospitals 

WSHA implemented TeamBirth across 51 birthing hospitals. This initiative aims to enhance obstetric outcomes and reduce disparities, particularly for birthing people experiencing structural racism and discrimination.

TeamBirth fosters shared decision-making by ensuring that birthing people and their care teams have aligned input throughout labor, delivery, and postpartum care. Key components include team huddles at critical decision points, with discussions documented on shared planning boards in patient rooms. These huddles happen upon admission, when there are changes in the care plan, and whenever requested by the patient or a team member.

The program is being implemented over 3 years, from 2023–2026, with hospitals participating in 1 of 5 cohorts. Each cohort participated in training and received support to integrate TeamBirth practices, aiming for full adoption across the state by 2026.

Improving Rural Access to Obstetric Care

To strengthen obstetric and newborn care in rural areas, Washington is investing in training and equipment for Rural and Critical Access Hospitals. In partnership between DOH and WSHA, this initiative supports tailored perinatal education and simulation-based training for staff, helping them maintain critical skills to safely care for pregnant and postpartum patients. A key focus is preparing obstetric and neonatal teams to respond to low-frequency, high-risk events, ensuring effective stabilization and transfer when needed. This work also supports Rural and Critical Access hospitals in making necessary equipment purchases and providing perinatal training services for obstetric and newborn staff.

Technical assistance and OB hemorrhage training are being offered to both hospitals with obstetric services and those without, including rural emergency departments. These efforts aim to improve safety and access to quality perinatal care across Washington’s rural communities.

Blue Band Initiative

Launched in September 2023, the Blue Band Initiative is a state-wide effort to improve early detection and management of preeclampsia and postpartum hypertension. At-risk patients receive blue wristbands during and after pregnancy to serve as visual alerts for health care providers, prompting timely monitoring and intervention. The initiative has been widely adopted across hospitals, doula organizations, outpatient services, and home visiting programs. To strengthen its impact, clinical guidelines were introduced to enhance emergency department awareness and education about postpartum hypertension and the significance of the blue bands. The initiative has contributed to more timely care for people with hypertension during and after pregnancy and is raising statewide awareness about this serious condition.

Expanding Access to Child Care and Early Learning Programs HB 2124

Passed in 2024, HB 2124 expands access to the Working Connections Child Care (WCCC) program by making participation in certain early learning programs—such as ECEAP, Head Start, and Early Head Start—an approved activity for WCCC eligibility. Families enrolled in these programs who meet the income threshold of 85% of the State Median Income (SMI) or lower may be eligible for subsidized childcare at no cost.

“Nothing About Us Without Us” Act

This legislation, effective January 1, 2025, ensures that survivors of domestic violence have a mandated role in shaping policies that directly affect them. By requiring survivor representation in policy development, the act aims to create more informed and effective interventions.

Washington Safe Haven Law Awareness

Washington’s Safe Haven Law (RCW 13.34.360) allows parents to safely and anonymously surrender an unharmed newborn within 72 hours of birth at designated locations—such as hospitals, staffed fire stations, and rural health clinics—without fear of criminal liability.

To enhance public awareness and accessibility, DOH has supported the development and funding of signage for these Safe Haven locations. The signs, available in both English and Spanish, provide clear information about the law and include a 24-hour Safe Haven Hotline.

In addition, DOH has created printable posters, also in English and Spanish, which are distributed at no cost to qualifying facilities. These posters mirror the signage content and are available for download directly from the DOH website.

For more information, contact: Tiffany Tibbs Christensen, Maternal Health Coordinator, tiffany.tibbschristensen@doh.wa.gov.

Applications are now closed to join the Washington State Maternal Mortality Review Panel (MMRP) for a three-year term (2025–2028). The deadline was July 31, 2025. If there are specific expertise areas for which we still need to recruit as we consider existing applications, we will reach out in those areas. We do always consider new applications from members of American Indian / Alaska Native Tribal, Indigenous, and urban Indian health communities.

All the Panel members serve in a volunteer capacity and do not receive compensation from the Department for their participation in the review process, as required by RCW 70.54.450. 

Nominees are appointed by the Secretary of Health to serve for a term of three years (2025–2028).

• Tribal health or urban Indian health leaders and providers
• Medical, nursing, and service providers specializing in perinatal, obstetric, newborn, or pediatric care, such as clinicians, midwives, doulas, community health workers, nurses, social workers, other providers, including those with postpartum or neonatal expertise. This may also include experts in obstetric care with other relevant clinical expertise areas, such as cardiology, oncology, pediatrics, or autoimmune disorders.

• Birthing hospital or licensed birthing center representatives
• Coroners, medical examiners, or pathologists

If you have any questions, or to be notified when the next round of MMRP applications opens (approximately 2028), please contact the Maternal Mortality Review Coordinator at maternalmortalityreview@doh.wa.gov.

Washington state’s maternal mortality law gives the Department of Health the authority to obtain pertinent vital records, medical records, and autopsy reports related to maternal deaths. The law also provides protections for those records and for the panel members who participate in the review. This authority and protection allowed the Department and the Panel to determine which deaths were preventable and identify the issues that lead to preventable deaths.

In 2019, Washington state expanded the law to support and strengthen the maternal mortality reviews conducted by the Maternal Mortality Review Panel. The law was amended to permanently establish the Panel and the maternal mortality review process in Washington. Other changes included:

• Requiring tribal representation.
• Expanding representation to include all types of obstetric, perinatal, and women’s health medical, nursing, and service providers, as well as individuals or organizations that represent populations most affected by maternal mortality and lack of access to maternal care.
• Data related to the maternal mortality review can be shared with the Centers for Disease Control and Prevention, local health jurisdictions, regional maternal mortality review efforts such as American College of Obstetrics and Gynecology District VIII, and tribal entities.
• Access to records from the Department of Children, Youth and Families.
• Requiring hospitals and birthing centers to make good faith efforts to report deaths that occur during pregnancy or within 42 days of pregnancy to the local coroner or medical examiner, who will then conduct a death investigation with autopsy strongly advised. Counties will be reimbursed 100 percent for autopsies. (For more information on reporting and death investigation requirements, see Resources below.)

• Maternal Deaths 2014–2020 Legislative Fact sheet 2023 (PDF)
• Prevention Recommendations and Activities for Policymakers 2023 (PDF)
• Prevention Recommendations and Activities for Providers and Facilities 2023 (PDF)
• Prevention Recommendations and Activities for Agencies, Organizations, and Institutions 2023 (PDF)
• Maternal Death Reporting and Death Investigation Requirements (PDF)
• Urgent Maternal Warning Signs Educational Materials (CDC)
• Maternal Obesity Anesthesia Checklists (PDF)
• Safer Care of Obese Pregnant Patients (PDF)
• Black Mamas Matter report on Maternal Mortality Review Committees
• Maternal Mortality Autopsy Guidelines (PDF)
• Maternal Mortality Frequently Asked Questions (PDF)
• Webinar: Investigating Maternal Mortality in Washington State
• Postpartum Follow-up Care Schedule Recommendations for Women Diagnosed with Hypertensive Disorders during Pregnancy (PDF)
• Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Strategic Plan: 2021-2024

Past maternal mortality reports

• 2023 Maternal Mortality Review Panel Report (PDF)
• Maternal Mortality Review – A Report on Maternal Deaths in Washington 2014-2016 (PDF) (2019 Report)
• Maternal Mortality Review – A Report on Maternal Deaths in Washington 2014-2015 (PDF)

Fact Sheets and Resources Archive

• Maternal Deaths 2014-2016 Legislative Factsheet 2019 (PDF)
• Maternal Mortality Review Panel: An early look at 2017 Maternal Deaths (PDF)
• Prevention Recommendations and Activities for Policy Makers and State Agencies (PDF)
• Prevention Recommendations and Activities for Perinatal Clinical and Service Providers (PDF)

The Department of Health welcomes your input on how the Maternal Mortality Review Panel can best meet the goals established by the legislature. There will not be a formal public hearing process (unless necessary to update the Washington Administrative Code). However, we encourage interested parties to share their ideas with Department of Health staff.

To ask questions, share ideas, please contact us at maternalmortalityreview@doh.wa.gov.