It’s hard to believe, but the United States has the highest maternal mortality rate among the 50 most developed countries in the world. Although the U.S. spends more on health care than any other country in the world, more than two women die during childbirth every day.
The numbers are astounding. Between 2000 and 2014, the Centers for Disease Control and Prevention (CDC) reported that the maternal mortality rate in the U.S. increased from 18.8 deaths per 100,000 births to 23.8 deaths per 100,000 births — an increase of 26.6 percent.
Maternal mortality refers to the death of a woman during pregnancy or up to a year after the pregnancy has terminated. It only includes causes related to the pregnancy and does not include accidental causes.
At No. 19, Nebraska rates among the top half of states. But, with an average of 16.8 mothers/ 100,000 live births dying each year, there is plenty of room for improvement, said Ann Anderson Berry, M.D., Ph.D., who is professor in the UNMC Division of Neonatology and chief of newborn medicine for Nebraska Medicine.
In spite of its huge population and high poverty and immigration rates, California ranks as the No. 1 state in maternal mortality with just 4.5 deaths per 100,000 births. Georgia is last with 46.2 deaths per 100,000 births. The three leading causes of maternal mortality are blood clots, hemorrhages and hypertension.
“There’s no reason we shouldn’t be able to achieve the same results as California,” Dr. Anderson Berry said. “California is renowned for its innovation. They do a great job of making sure every hospital has a protocol in place to ensure a safe delivery.”
California’s perinatal collaborative was started in 1997 — 18 years before Nebraska — so Nebraska has some catching up to do, Dr. Anderson Berry said
Robert Bonebrake, M.D., a maternal-fetal medicine specialist at Methodist Women’s Hospital, and Dr. Anderson Berry serve as medical directors of the Nebraska Perinatal Quality Improvement Collaborative (NPQIC), a collaborative formed in 2015 in an effort to improve the delivery of and access to evidence-based health care for all Nebraska mothers and newborns.
They work with all of the delivery hospitals across the state to improve outcomes and are excited to bring a new initiative to Nebraska.
In 2018, Nebraska qualified as one of only 21 states who are part of the Alliance for Innovation on Maternal Health (AIM), the national data-driven maternal safety and quality improvement initiative. With its membership in AIM, Nebraska has taken a key step forward in addressing the maternal mortality issue, Dr. Anderson Berry said.
“We know that practice drives outcomes,” she said. “If you use a systematic approach, you can dramatically change maternal mortality. In Nebraska, there is risk of maternal mortality in both urban and rural parts of the state.
“In rural areas, AIM protocols can help because there is a low density of high-risk events – it’s not engrained in their system. One of the keys is to get health providers to recognize high-risk pregnancy events early, so that they can refer mothers to high-risk centers who have more resources. In urban areas, the volume can work the other way with busy caseloads, and early symptoms can fall through the cracks. AIM protocols help by making sure every important issue is evaluated.”
On April 5 in Grand Island, NPQIC will hold its fourth annual conference in an important effort to address the maternal mortality issue. The event will bring together more than 100 health professionals, including physicians, nurses, insurers, community advocates and state officials.
I have some questions on this topic. What I notice is that when researching this topic there is very, very little information about the health of the father or significant other in the home and the effect of his lifestyle practices on maternal mortality? What do we know about the use of alcohol, gun ownership or the role of previous reports of domestic abuse by the mother's partner. In Lindheimer's and Barron's Medical Disorders during Pregnancy diabetes gets a chapter, hyperthyroidism gets 3 pages and domestic violence gets a mention. They do mention that it is a complex issue, which you would think might warrant it more space. This seems to be the prevalent attitude – women are told to maintain a healthy lifestyle even before pregnancy, which makes sense as pregnancy is a difficult period to improve one's health. But it is as if the lifestyle of the father and/or significant other in the home have no effect. Especially considering that we are generally talking about people from 15 to 45 years in age we know that risky behaviors to some degree are apart of most people's lives. It would seem only common sense to study any and every behavior that could be factor.