Slowly—but perhaps surely—the country is beginning to address maternal mortality, both through legislation and through initiatives on the part of health care providers.
This is critical. We have lost countless women to pregnancy and childbirth, and the majority of those deaths didn’t have to happen. This holds true especially for mothers of color. Black and American Indian/Alaska Native women are about three times as likely to die from pregnancy as white women, according to a study released earlier this month by the Centers for Disease Control and Prevention.
The study, which looked at statistics from 13 states’ maternal mortality review committees, said that three out of five of all pregnancy-related deaths are preventable.
Pregnancy-related deaths can occur as long as a year after birth. According to the CDC study, 31% happen during pregnancy, 36% happen during birth or within a week after, and 33% occur eight days to a year after birth.
Each death, said the report, was the result of several contributing factors, including a lack of access to care, unstable housing, inadequate transportation, missed or delayed diagnoses, and a lack of understanding by patients—and health care providers—about warning signs of symptoms that could be serious. Heart disease or stroke caused 34% of the deaths.
The CDC says roughly 700 women die from pregnancy-related complications in a year, out of 3.8 million births. The United Health Foundation’s America’s Health Rankings says the U.S. maternal mortality rate is 20.7 per 100,000 live births. That study puts Connecticut’s rate at 13.2, compared to Massachusetts at 6.1, and New York at 20.6.
By comparison, Mexico’s maternal mortality rate is 38 per 100,000 live births. Canada’s maternal mortality rate is 7 per 100,000 live births.
We’ve done so much wrong, but we can fix this.
CDC Director Dr. Robert R. Redfield said quality care for mothers “should be among our nation’s highest priorities.” For the longest time, though, discussions about improving survival among new mothers and infants have been rare. Last year, then-Gov. Dannel P. Malloy signed a bill that established Connecticut’s own maternal mortality review program within the state Department of Public Health. The state counted only eight pregnancy-related deaths between 2011 and 2014, but no one believes that figure includes all such deaths. Keeping accurate statistics costs money, and Connecticut has been hesitant to spend the money.
But there is evidence of forward motion. Yale New Haven Hospital and Yale School of Medicine just joined the National Institutes of Health Maternal-Fetal Medicine Units Network. The network was formed in 1986 to improve obstetric practice. Current network research focuses on premature birth and obstetric hemorrhage.
The topic has entered the 2020 presidential election, as well. Democratic presidential candidate Elizabeth Warren, U.S. senator from Massachusetts, has suggested hospitals that reduce deaths among African American mothers be rewarded with bonuses, and hospitals that don’t improve maternal survival rates should lose funding. Senators Kamala Harris, Kristen Gillibrand and Cory Booker, all of whom are also Democratic presidential candidates, have co-sponsored—with Connecticut Sen. Richard Blumenthal—the MOMMIES Act (Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services Act), which extends Medicaid coverage for new mothers from 60 days after childbirth to a year, increases access to health providers, and offers services from midwives, doulas, and holistic birth workers.
In Connecticut, there’s talk that more midwives, who tend to have more time to spend with each client, can decrease deaths among mothers and infants. (Currently, just 11% of Connecticut births are attended by a midwife.)
Meanwhile, around the country, lawmakers have introduced some 80 bills that seek to address deaths among mothers of color.
In addition, earlier this month the American College of Obstetricians and Gynecologists released new guidelines for treating heart disease among pregnant women, one of the leading causes of maternal deaths. Included in the guidelines is the directive that all women be tested for cardiovascular disease using a test created in California, where researchers found that 88% of the mothers who died would have been identified as high risk had they been tested using the new screening.
So we’re moving toward better health outcomes for mothers of color. Slowly, but—we hope surely—we are moving forward.
Susan Campbell is a distinguished lecturer at the University of New Haven. She can be reached at email@example.com.