Healthcare

Part 3: Combatting Maternal Mortality

Legislative Action:

On June 19th, the New York State Senate passed S.8907. This legislative action was implemented in an attempt to reduce maternal mortality and morbidity. Looking at the disparities in maternal death, particularly within New York, this legislation aims to not only improve overall outcomes of maternal health but also increase their equity.

 

The formation of Maternal Mortality Review Committees (MMRCs) is essential for solving the data-deficit and addressing potential factors behind maternal deaths. As stated in a previous post, 33 states currently have MMRCs. Once these MMRCs are founded, they form individualized plans to combat risk factors in their own states. For example, the Ohio Pregnancy Associated Mortality Review (PAMR) championed increased physician preparedness during obstetric emergencies. In 2014, the Ohio Department of Health and Ohio State University joined forces for the first PAMR Initiative: a simulation training for three rural Ohio communities. In totality, 14 hospitals (122 health care professionals) participated in the training.

 

The Michigan Mortality Surveillance (MMMS) found that motor vehicle accidents were a major cause of maternal deaths within their state. Their study revealed that 2/3 of pregnant women killed in motor vehicle accidents were not wearing seatbelts, a sharp contrast to the state seatbelt wearing rate of 94.5 percent (for women). As a result, the Michigan Department of Transportation and the American College of Obstetricians and Gynecologists developed an outreach program in 2007 to educate and promote seat-belt wearing among pregnant women. The same program was repeated in 2010. The MMMS has attributed these campaigns with a subsequent decrease in maternal deaths due to a lack of seatbelt-wearing.

 

One state that has been particularly successful at reducing maternal mortality rates is California. From 2006 to 2013, maternal mortality has decreased by 55 percent (from 16.9 deaths per 100,0000 live births to 7.3 deaths per 100,000 live births). This rapid downtrend can be largely attributed to the California Maternal Quality Care Collaborative (CMQCC), which was born from the combined efforts of Stanford University and the California Department of Public Health (CDPH). 200 hospitals (which represent 90 percent of California’s total births) currently participate in CMQCC’s efforts. The CMQCC has created evidence-based qualitative improvement toolkits for widespread causes of maternal death such as: cardiovascular disease, hemorrhage, and preeclampsia. In addition, they have played an active role in supporting vaginal birth and reducing primary Caesarians. Each toolkit contains a compiled set of best practice tools and articles, as well as care guidelines. The toolkit further contains ways to implement these practices on a hospital-wide level.

 

“The Preventing Maternal Deaths Act” was introduced in the House of Representatives in 2017 and was discussed this past September at an Energy and Commerce Committee hearing. This Act would authorize the CDC to aid states (and the District of Columbia) in forming or expanding their MMRCs. $7 million would be allocated to this purpose in fiscal years 2018 through 2022. These MMRCs would share information collaboratively and nationally through the CDC. Additionally, each MMRC would report their data-driven results to Congress and recommend strategies to the State Departments of Public Health. Furthermore, this Act instructs the Department of Health and Human Services to research current disparities with respect to maternal mortality.

 

On October 10th 2018, the House Ways and Means Committee announced via a press release that it will launch an investigation into the rising maternal mortality (and morbidity) rates. It will also analyze how government entities and health care facilities can intervene.

 

Conclusion:

 

Maternal mortality is an increasingly prevalent and relevant issue in the 21st century. Lack of expansive and conclusive data regarding maternal deaths has led to a deficit of understanding, hindering the ability to implement crucial solutions. The hundreds of maternal deaths that occur each year shed light on the benefit of a policy solution. The implementation of MMRCs has demonstrated how essential data can be collected and issues relevant to pregnant and postpartum mothers can be effectively addressed.

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