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Two Events on U.S. Maternity Care Suggest a Trend

Source: Womens eNews - Thu, 5 Dec 2013 05:08 AM
Author: Womens eNews
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Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.

Subhead:  In a one-week period last month two major developments--both tied to Women's eNews' coverage--could signal a rousing from complacency. One was a New York hearing; the other was $6 million in funding by pharmaceutical giant Merck. Byline:  Rita Henley Jensen

 

Credit: Timothy Wood/Code Arachnid on Flickr, under Creative Commons (CC BY-NC-SA 2.0)

NEW YORK (WOMENSENEWS)--Years' of complacency about the worsening rates at which U.S. women are dying or being injured during childbirth might be ending.

In a one-week period last month maternal mortality in the United States suddenly gained significant attention in the political and corporate spheres.

9 Questions to Raise about Quality of U.S. Birthing Facilities

To improve the understanding of U.S. maternal health, Women's eNews invites its readers to seek answers to some or all of the following questions from their city or state health departments and to send the results to editors@womensenews.org. Women's eNews will publish the information once we have 10 cities or states to compare and update the data as it comes in throughout the year. If no data is available, please send us that information as well. Questions to consider:

How many births were recorded at each birthing facility during the most recent calendar year?

For each birthing facility, what are the current standard charges for a vaginal birth, paid for by Medicaid, by private insurance, by an uninsured patient?

For each birthing facility, what are the current standard charges for a Cesarean birth, paid for by Medicaid, by private insurance, by an uninsured patient?

How many maternal deaths were recorded at each birthing facility during the most recent calendar year?

Of those who died, what type of health insurance coverage did the patient have: Medicaid, private or none?

What is the birth facility's readmission rate for maternity care patients (a measure of maternal morbidity) during the most recent calendar year? What type of insurance did the readmitted patients have: Medicaid, private or none? Of those readmitted maternity care patients, what is the racial and ethnic breakdown?

What percentage of patients who underwent C-sections had Medicaid? Private insurance? Were uninsured? What were the racial and ethnic breakdowns?

What percentage of the birthing facility's revenue come from Medicaid fees for vaginal births for the most recent calendar year? For C-section births?

What percentage of patients who underwent C-sections died or suffered from maternal morbidity in the most recent calendar year? What is the racial and ethnic breakdown of these patients?

In New York, the health committee of the City Council held on Nov. 13 a public hearing on the city's high maternal mortality rate among women of color. The city, where 9 percent of all African Americans live, reported in 2010 that African American women in New York City died nine times as often as white women from pregnancy-related causes.

Six days after the council hearing, Merck announced, in an unrelated event, a total of $6 million in donations to eight organizations to work toward reducing the number of U.S. women not living to see their child's first birthday. Merck, the drug-making giant based in Whitehouse Station, N.J., will be donating $150,000 each to four grassroots organizations providing direct care to pregnant women and new mothers. The rest of the money--Merck would not specify an amount--will go toward a collaborative research project among six states with maternal mortality review boards to develop best policies and practices to reduce maternal deaths and three projects with health professionals to improve responses to obstetric emergencies.

These two developments could indicate a growing realization that healthy mothers are crucial to reducing racial disparities in maternal deaths and premature or low-birth weight infants.

Women's eNews is tied to both developments. With support from the W.K. Kellogg Foundation we have been reporting over several years on the unexplained and rarely questioned disparities in the high death rates among African American women giving birth. After Women's eNews hosted a Brooklyn meeting in May of this year, based on our coverage, the staff of the City Council health committee contacted us for assistance in planning the hearing.

The same series of news articles and videos also informed Merck about the need for leadership in saving the lives of mothers in the United States, in addition to other nations.

"On behalf of Merck for Mothers I would like to thank Women's eNews for all of your dedication in helping to raise awareness of maternal mortality, particularly here in the United States," Dr. Naveen Rao, head of Merck for Mothers, a $500 million global initiative, wrote to us in an email. "'Healthy Births, Healthy Moms: Black Maternal Health in America' is a powerful series that will go a long way towards helping us reduce the growing rates of women dying from complications experienced during pregnancy and childbirth."

Women's eNews named Rao as a Women's eNews 21 Leader in 2013.

Increasing Death Rates

The United States has the highest maternal mortality rate among developed nations. While across the globe the rates are dropping, by 2010 rates in the U.S. rose to 21 deaths per 100,000 births, according to the World Health Organization, twice the rate it was in 1990.

African American families suffer a maternal mortality rate that's three to four times higher than white women in the United States, according to the Association of Maternal and Child Health Programs. In addition, the number of maternal deaths in the United States may be significantly undercounted. Since 2007 the Atlanta-based Centers for Disease Control and Prevention has stopped publishing current U.S. maternal mortality data on its website because data is reported inconsistently.

Outside the circles of maternal health advocates, the growing numbers of U.S. women dying from pregnancy-related causes, regardless of race, has failed to catch public attention. For example, who knows that there is a federal program that hears experts' testimony on what is needed to reduce maternal mortality in the United States? To find it you have to know what you are looking for and search "Task Force on Infant Morality" on the Health and Human Services website. The task force is said to be on hiatus and has no meetings planned.

As for African American maternal health, reports from the Office of Minority Health make rare, if any, mentions of maternal death disparities. The same is true for many other organizations advocating for improved health in African American communities.

Dr. Priya Agrawal, executive director of the Merck for Mothers campaign, said mothers dying in childbirth are an "unacceptable tragedy." She added that the U.S. health care system does not have a standard routine for treating obstetric emergencies.

"If you see one hospital, you have seen one hospital," she said, emphasizing the lack of standard protocol for medical providers when mothers in labor are in urgent need of life-saving care.

"Every death must be counted and reviewed," Agrawal said, "and the lessons shared."

She added that the leading causes of maternal mortality in the United States are the same as elsewhere: post-partum hemorrhage, embolisms and preeclampsia.

Merck-Sponsored Programs

The four maternal care practice and policy organizations receiving grants for Merck-sponsored programs are:

Association of Maternal and Child Health Programs: a collaboration among Colorado, Delaware, Georgia, New York, North Carolina and Ohio to strengthen the states' maternal mortality review boards and translate findings into policies and practices.

Association of Women's Health, Obstetric and Neonatal Nurses: a program to improve current responses to post-partum hemorrhage in Georgia, New Jersey and Washington, D.C.

American Congress of Obstetricians and Gynecologists: A New York State project to work with 10,000 health care providers and 130 birthing facilities to develop standard approaches for handling severe bleeding, blood clots and extremely high blood pressure.

California Maternal Quality Care Collaborative: A large-scale implementation of strategies for all birthing facilities in the state to adopt quality improvement toolkits for hemorrhages and extremely high blood pressure.

The four direct-service organizations receiving Merck grants are:

Baltimore Health Start to improve prenatal and primary care for women with chronic conditions.

Camden Coalition of Healthcare Providers in New Jersey to design a model for data-sharing among care providers of pregnant women with complex medical issues to coordinate care during pregnancy and beyond.

Philadelphia's Maternity Care Coalition to support its Safe Start MOMobile, a home-visiting program for at-risk pregnant women.

New York City's Northern Manhattan Perinatal Partnership to support preventive programs that reduce chronic health conditions among women of reproductive age.

At the New York City Council hearing last month, the chair of the committee, Maria del Carmen Arroyo, insisted that it was just the "beginning of the conversation" and promised to spend her next four years on the council pushing for better maternal health in the city. She also agreed to support a $2.5 million funding request for the Bronx Health Link, which provides prenatal care and post-delivery follow up care, and a related volunteer doula program in the heart of Brooklyn. The two boroughs of New York experience the city's highest rates of maternal mortality.

Deborah Kaplan, assistant commissioner for maternal, infant and reproductive health at the city's health department, was the first public official to testify at the hearing. Kaplan said the city's maternal morbidity rate--a measure of chronic poor health resulting from injuries sustained during labor--was 100 per 100,000 births, double the national rate.

Kaplan also said the city used two different time periods when reporting maternal mortality in 2010 (African American women were reported to have died nine times as often as white women) and 2011 (African American women were reported to have died three times as often as white women). She said in 2010, the city counted deaths up to a year after delivery and the following year counted deaths occurring only up to 42 days after delivery.

Personal Testimony

In my testimony, I told the story of Akira Eady, whose death is similar to events that continue to be played out in New York City.

Eady died shortly after giving birth at Mount Sinai Medical Center in 2007. The official cause of death of the 21-year-old mother of three, as recorded by the New York City medical examiner, was heart failure after post-partum seizures.

Eady's aunt, Carole Eady, recounted to Women's eNews that her niece, employed and with private medical insurance, bled heavily after receiving an epidural to ease the pain of labor. After giving birth, she complained of headaches. Nevertheless, the hospital released her. Two days after giving birth, she had a seizure and then a heart attack. She was brain dead four days after giving birth.

Carole Eady, now raising Akira Eady's older daughter Nivea in her Harlem home, acknowledges that her niece's partner might have played a role in her death by hitting her on the morning of her seizure, but she feels strongly that the hospital staff did not properly administer the epidural or respond to her headache. Regardless, the hospital staff sent her home.

Less than a year later, Akira Eady's son, 2-year-old Khamerin Antwine, was savagely beaten to death in the Bronx while in custody of his father. The infant born the week she died is being raised by the infant's father, also in Harlem.

To put Akira Eady's death into context, I reported to the committee that a review of the New York City maternal deaths from 2001 to 2005, published by the city's health department, indicated that 82 percent of those mothers who died from embolisms were black non-Hispanic, 14 percent were Hispanic, 4 percent were Asian/Pacific Islander and 0 percent were white.

In the three other categories of most common causes of maternal death, the disparities were also pronounced. For example, 44 percent of those who bled to death were black non-Hispanic, 33 percent were Hispanic, 15 percent were Asian/Pacific Islander and 7 percent were white.

Cesarean sections are believed to put women at a greater risk for severe complications. The same health department report reveals that 54 percent of the women who died underwent C-sections and only 4 percent of those who died gave birth vaginally (28 percent died while pregnant and 14 were classified as non-applicable.)

I also informed the council that the Women's eNews team found that, nationally and in New York City, the explanation for the high rate of African American maternal mortality can't be found in the answers that quickly come to mind: teen pregnancy, obesity, lack of pre-natal care, poverty, pre-existing conditions or low education. These are other factors I encouraged the council to explore:

That not a single hospital in New York City meets the World Health Organization's guidelines for Cesarean sections. In some hospitals in the city, more than 40 percent of births are via C-sections.

With proper care the numbers of mothers dying could be cut nearly in half, according to Dr. Jo Ivy Bufford, president of the New York Academy of Medicine.

Due to an interpretation of the federal privacy act, the causes and birthing sites of these maternal deaths are not made public.

Rita Henley Jensen is founder and editor in chief of Women's eNews.

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