The United States has reached a tipping point in how we care for mothers before, during and after birth, and the status quo is not acceptable.
A report recently released by the Illinois Department of Public Health examined the factors that related to the 93 women with pregnancy or pregnancy-related deaths in 2015. Among the startling findings, the report showed black mothers in Illinois were six times more likely to die from pregnancy-related conditions. It also showed that 72 percent of maternal deaths were preventable.
This tragedy is not unique to Illinois. In its report on the high rate of statewide maternal deaths, the Texas Task Force on Maternal Mortality identified common factors related to maternal deaths, including delays and poorly coordinated response to diagnosis and treatment in the pregnancy, delivery, and the postpartum period; lack of leadership and communication; and delayed or no response to warning signs. And many other states also have similarly high rates of maternal mortality.
If we cannot protect our vulnerable mothers and children, we are failing as a society. Even one death that could have been prevented is unacceptable. Policymakers and health care leaders must not rest until substantive changes are made to protect mothers.
First, we must affirm our core commitment to providing every expectant mother, whether pregnant, in labor, or in the critical “fourth trimester” after delivery, with consistent and unconditional medical care.
According to the most recent data from Centers for Disease Control and Prevention (CDC), 15 percent of U.S. women receive inadequate prenatal care. Similarly, forty percent of women do not have a postpartum visit, even though that care helps ensure that women with potentially treatable post-pregnancy conditions — such as hypertension, blood clots, heart failure and hemorrhages — are immediately identified. The Illinois Health Department report contains a number of recommendations that are a very good start to providing more accessible and consistent care.
Second, we must work harder to eliminate racial inequities. The American College of Obstetricians and Gynecologists (ACOG) has taken a leadership role in addressing health disparities, advocating for adoption of federal standards for collection of race and ethnicity information to better identify disparities, and research that identifies structural and cultural barriers to care. Physicians and providers must take a hard look at whether they provide culturally appropriate care or harbor unconscious biases that affect how they care for patients.
Finally, the Health Department report recommended that policymakers adopt ACOG-endorsed “maternal level-of-care designations” (MLOCD) as a means of improving maternal and infant outcomes. Under the ACOG designation Levels III and IV designations require an OB/GYN to be on site at a hospital at all times.
This is the model used at multiple Illinois hospitals in partnership with Ob Hospitalist Group, in which experienced OBs and midwives are in the hospital — not “on call” — 24 hours a day, seven days a week. This provides coverage and support to community physicians and midwives until they can arrive at the hospital or when the woman has no assigned obstetrician. With a clinician on site at all times, urgent health concerns and emergencies are quickly addressed by an OB/GYN with specialized training in those situations — during pregnancy emergencies, labor and delivery, and in the months that follow.
The maternal mortality report sensitively acknowledges the 93 women who passed away, saying they “hope that our efforts to better understand the underlying causes of maternal mortality in Illinois will help prevent others from suffering from a similar fate.” That commitment to prevention, coupled with a transformation in how we care for pregnant women, can improve health outcomes for Illinois mothers and babies.
Dr. Mark Simon, chief medical officer of Ob Hospitalist Group, is a board-certified OB/GYN and former head of the Department of Obstetrics and Gynecology for a U.S. hospital. Dr. Nicolai Hinds is an Illinois based board-certified OB/GYN and an OB hospitalist for the Ob Hospitalist Group.
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December 7, 2018 at 08:20PM