Reported cases of extreme blood loss during or after childbirth have increased in Alaska over the past eight years, and an education initiative for health providers is planned as a response, state health officials said.

The cases are known as obstetric hemorrhage, which is defined as the loss of at least 1,000 milliliters — or more than 2 pints — of blood during pregnancy or within 24 hours of childbirth. It is the leading cause of maternal death globally. Nonfatal cases can also have long-term health consequences.

In Alaska, reported rates of obstetric hemorrhage increased from 7.9% of hospital deliveries from 2016 to 2019 to 9% of hospital deliveries from 2020 to 2023, according to a bulletin issued by the Alaska Division of Public Health’s epidemiology section.

Reported rates in Alaska increased for nearly all geographic regions and demographic groups in the period evaluated, the epidemiology bulletin said. However, it is not clear whether the statistics reflects a true increase in case numbers or better identification and reporting of cases, the bulletin noted.

The highest rates are in the southwestern part of the state, where 15.6% of hospital deliveries from 2020 to 2023 involved such hemorrhages, and the northern part of the state, where the rate during that period was 12.6%, according to the bulletin.

Among ethnic groups, Pacific Islanders had the highest rates of obstetric hemorrhage, at 14.2% of hospital deliveries from 2020 to 2023, according to the bulletin. Indigenous patients had the second highest rate, at 12.7% during those years, the bulletin said.

A new campaign to educate health providers about obstetric hemorrhage will be launched in January by the Alaska Perinatal Quality Collaborative, a volunteer group of maternity health care specialists from around the state.

Rebekah Porter, a nurse consultant with the Alaska Division of Public Health and an author of the bulletin, described the plans for that initiative.

“The Alaska Perinatal Quality Collaborative’s Obstetric Hemorrhage Initiative will focus on both prevention and treatment of obstetric hemorrhage by promoting evidence-based change ideas that facilities can select based on their specific needs,” she said by email.

Through education and use of an American College of Obstetricians and Gynecologists tool called the Obstetric Hemorrhage Patient Safety Bundle, “the initiative aims to standardize care, improve outcomes, and enhance the readiness of healthcare providers across the state,” Porter said.

Excessive bleeding after childbirth causes about 70,000 maternal deaths a year, according to the World Health Organization. Those deaths are concentrated in low-income nations.

In Alaska, bleeding-related maternal deaths are rare.

From 2012 to 2016, there were no recorded maternal deaths in Alaska that were attributed to obstetric hemorrhage, according to state data. In the past five years, there have been fewer than five cases, Porter said.

However, health officials who are monitoring what is known as “severe maternal morbidity” – defined as unexpected outcomes of labor and delivery that have severe health impacts – have noticed an uptick in hemorrhage cases in recent years, Porter said. 

“This increase is another key reason for launching the AKPQC initiative at this time,” she said.

Most pregnancy-related deaths in Alaska are from some kind of trauma rather than from pregnancy-related medical causes, with domestic violence a prominent feature, according to state records. Unintentional injuries, homicides, assaults, suicides and overdoses together accounted for about two-thirds of pregnancy-related deaths from 2015 to 2019, according to state records.

Nationally, rates of hemorrhage after childbirth have increased over the past two decades, according to a study published last year by the National Institutes of Health. From 2000 to 2019, the rate of postpartum hemorrhage increased from 2.7% to 4.3%, the study said.

ANCHORAGE, Alaska (KTUU) – Alaska senators Lisa Murkowski and Dan Sullivan shared their reactions on avoiding a government shutdown, with the government funding bill passing through Congress late Friday evening.

In a press release, Senator Lisa Murkowski said, “There is never, ever a time when a government shutdown is a good thing for Americans or Alaskans. I’m relieved that cooler heads prevailed and a needless shutdown was avoided.”

Murkowski supported extending the federal government funding deadline to March 14, 2025. This would provide disaster recovery funds for communities across the country.

After garnering support from both chambers of Congress, $300 million will go towards the U.S. Department of Commerce’s fishery disaster assistance, which according to the press release, Senator Murkowski played a crucial role in securing.

Senator Dan Sullivan also released a statement on “X” saying:

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ANCHORAGE, Alaska (KTUU) – With a federal spending bill now approved by the House and headed to the Senate for votes, the possibility of a government shutdown that was slated to begin at 12:01 a.m. ET (8:01 p.m. Friday AKST) on Saturday now seems to have been averted, but the stopgap measure will only last for three months.

If and when the federal government shuts down, each federal agency determines its own plan for how to handle a shutdown, although government operations deemed nonessential will stop happening.

The last time Alaska faced a government shutdown, the governor’s office issued a news release on Sept 26, 2023, stating, “Approximately 4,700 state executive branch positions are at least partially federally funded. Employees in these positions would see no disruption in their pay and will continue to report to work. A small number of federal employees work within state departments. Their status would be determined by the guidance from the federal agency that employs them.”

Alaska’s News Source has emailed the governor’s office requesting an update.

The longest previous federal shutdown was 35 days.

According to labor stats from the state, as of November of this year, there were 15,100 people were listed as “federal government” employees in Alaska with 81,600 in “government” jobs.

Compared to this time last year, there were 15,000 “federal government” employees and 80,400 “government jobs.”

Nationally, if legislators can’t reach a deal, 1.5 million federal employees will be furloughed or told to work without pay.

Most national parks will close.

Air traffic controllers and food safety inspectors would continue to work, but without pay.

“The State of Alaska administers many programs on behalf of the federal government,” the 2023 news release from the governor’s office stated. ”Federal programs that are mandatory by law, authorized outside of the annual appropriations process and have existing carry-forward funds, or classified by the federal administration as ‘excepted’ due to life, health and safety implications would continue to operate during a shutdown. These categories include programs such as Medicaid and federal air traffic control.”

A list of frequently asked federal government furlough questions is also available on the State of Alaska website.

This story was updated with new information.

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