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Advocates Call For Maternal Mortality Solutions

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Nov. 17, 2017 -- Larry Bloomstein, a New Jersey-based orthopedic surgeon, traveled to Washington, D.C., this week to join patient advocates and doctors to make sure no other family shares the loss he had in October 2011.

His wife, Lauren, died just hours after she gave birth to their first daughter, Hailey. She died because her hospital caregivers failed to recognize symptoms of preeclampsia or pregnancy-related hypertension.

“I have thought about this tragic failure every day for 6 years,” Bloomstein told a group of Capitol Hill staff, some of whom were openly crying. The meeting, organized by the American College of Obstetricians and Gynecologists, the Preeclampsia Foundation, and the March of Dimes, aimed to raise awareness of maternal death.

“All that was needed in Lauren’s case was for her providers to be aware of the signs and symptoms of preeclampsia, know the treatment, and know where to get help if they were unsure,” said Bloomstein. “If the states have the opportunity to review deaths like Lauren’s, to collaborate and educate and implement protocols, I am confident we’ll see a dramatic decline in maternal deaths.”

Despite all the money spent on health care, more women in the U.S. die from complications related to pregnancy than any other industrialized nation in the world. The rate of maternal deaths in the U.S. seems to be rising, though researchers aren’t yet sure if it’s because more women are dying in pregnancy or because of changes to the ways states count these cases.

Between 2000 and 2016, statistics from University of Washington’s Institute for Health Metrics and Evaluation show, maternal deaths jumped from 16 deaths per 100,000 live births to 29 deaths per 100,000 live births in the U.S.. These figures translate to about 700 women dying annually from pregnancy complications.

The death rates were highest among African-American women -- they were 3 to 4 times more likely than white women to die of pregnancy-related or associated complications.

Many more women are seriously harmed by pregnancy or childbirth. Annually, there are about 50,000 instances of severe injuries, or near deaths, to mothers around the time of childbirth, according to a CDC study.

Public health officials, however, aren’t certain why the maternal death rate appears to be rising.

“We don’t have routine data to explain what is going on,” said Wanda D. Barfield, MD, director of the CDC’s Division of Reproductive Health.

To address the gap, Rep. Jaime Herrera Beutler, R-WA, introduced H.R. 1318, which would require the CDC to give grants to every state to create a maternal mortality review board. The boards would analyze every maternal death to find out what went wrong and come up with training and other ways to lower the mortality rate. Sen. Heidi Heitkamp, D-ND, introduced a similar measure, S. 1112.

About 30 states have maternal mortality review boards already, but many don’t have the money they need to be effective, says Haywood Brown, MD, president of the American College of Obstetricians and Gynecologists.

California has one of the most successful review boards. The California Pregnancy Associated Mortality Review was launched 10 years ago by the state. The group had maternal deaths over several years examined and found that in almost every case, there was at least some chance the death could have been prevented. Among the leading causes of the deaths were hemorrhage and preeclampsia.

The program then had toolkits created to train doctors and nurses on what to watch for and how to handle maternal complications. Maternal deaths at hospitals that used the collaborative’s toolkit fell by 21%, while hospitals that didn’t use it only had a 1.2% drop in maternal deaths.

Without legislation, Brown said his organization created the Alliance for Innovation on Maternal Health, which is working with hospitals, public health officials, clinicians, and patient advocates to help caregivers cut maternal deaths and injuries, but Brown says the efforts need federal support.

“Tell your bosses to support” H.R.1318, he told attendees. There are 60 co-sponsors of H.R. 1318 and five for S. 1112. It takes 218 votes for a bill to pass the House and 51 to pass the Senate, suggesting the legislative effort has a ways to go.

 

WebMD Article Reviewed by Arefa Cassoobhoy, MD, MPH on November 17, 2017

Sources

ProPublica: "The Last Person You'd Expect to Die in Childbirth."

CDC: "Pregnancy Mortality Surveillance System."

American College of Obstetricians and Gynecologists: "Hypertension in Pregnancy."

Congress.gov: "H.R. 1318 - Preventing Maternal Deaths Act of 2017," "S. 1112 - Maternal Health Accountability Act of 2017."

Council on Patient Safety, Women & Mothers' Health Care: "AIM Program, Alliance for Innovation on Maternal Health."

National Center for Biotechnology Information, "The Black–White Disparity in Pregnancy-Related Mortality From 5 Conditions: Differences in Prevalence and Case-Fatality Rates."

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