Markers of Maternal Morbidity: Research Recommendations for Severe Perineal Lacerations, Severe Maternal Morbidity, and Other Complications.

Maternal health has received increasing attention in recent years in the United States. Despite the growth of research and policy in this area, important measurement issues persist (e.g., reporting and validity issues for maternal death) (Joseph et al., 2017), and definitions of key variables remain contested (Knight, 2020; Knight & Joseph, 2020). Moreover, there is a general lack of conceptual grounding to clarify connections of maternal health outcomes to each other or within a person’s overall reproductive health, life-course, and other facets of life (e.g., satisfaction, pleasure, and personal meaning). In this commentary, we explore one example: the potential inclusion of severe perineal laceration (SPL) in analyses of more widely accepted indicators of severe maternal morbidity (SMM). We compare SPL with other SMM indicators conceptually, clinically, and statistically and use these comparisons to make recommendations regarding future research on these outcomes. Our overall goals are to inform the continued process of defining SMM (building on our prior work) (Carmichael et al., 2022), articulate the need for more work on SPL and other outcomes with great personal resonance, and encourage a stronger and more cohesive conceptual basis for outcome definition in maternal health research.