3 steps healthcare facilities should take to reduce maternal mortality after Roe - MedCity News

In the wake of the US Supreme Court’s Dobbs v. Jackson decision overturning Roe v. Wade, obstetric teams are rightfully focused on how the already critical efforts to protect maternal health and reduce maternal mortality will be affected.

Unfortunately, maternal mortality in the US is on the rise. In 2020, the maternal mortality rate is 23.8 deaths per 100,000 live birthsfrom 17.4 per 100,000 in 2018. The rate was 55.3 deaths per 100,000 live births among non-Hispanic black women, 2.9 times the rate among non-Hispanic white women .

Faces of black women significant barriers to access to contraceptives, and there are growing concerns that maternal mortality among black women may increase further, given that maternal mortality is linked to complications during childbirth and unsafe abortions. A University of Colorado Boulder study found that a national abortion ban would increase maternal mortality by 24%.

Obstetrics clinicians are focused on finding new ways to reduce maternal mortality and improve maternal health outcomes, but it will not be easy.

Cardiovascular conditions, obstetric hemorrhage (excessive bleeding), eclampsia (seizures), difficult labor, and overuse of cesarean sections are among the leading causes of complications during childbirth.

Reducing maternal mortality rates requires understanding why the maternal mortality rate is so high in the US compared to other countries – even those that spend far less on health care.

First, there are complex socioeconomic factors at play. Globally, low-income regions have the highest prevalence of maternal mortality, and this is also true in the United States. Low-income women face difficulties traveling to medical facilities to receive care. In addition, black women experience higher rates of chronic diseases, such as hypertension and obesity, which are also risk factors for poor maternal health outcomes.

Second, care varies widely among hospitals. Some health facilities lack sufficient funding, skilled obstetricians, or more advanced technology and equipment, all of which can result in some facilities being less equipped to respond to maternal emergencies.

Third, the US still has a high cesarean rate compared to other countries. Some American women believe that C-sections are less risky. For working women or those who do not have enough maternal health benefits, choosing a C-section gives them control over the timing of their birth.

Midwifery professionals can reduce maternal mortality and save mothers’ lives by using a combination of evidence-based tools, training and precautions that address some of the above factors.

The steps obstetricians should take immediately

  • Improve maternal emergency preparedness. When complications arise during labor, every minute counts. Obstetricians must respond effectively and make good decisions to save the life of mother and baby. Midwifery care teams should provide equal education and training to their care teams, not only about risk factors associated with chronic diseases such as hypertension and obesity, but also how to identify early warning signs of complications. For example, when eclampsia and other hypertension-related conditions occur, the obstetric team must be able to administer intravenous hypertension medication and magnesium sulfate immediately to prevent seizures. Comprehensive pre- and postnatal follow-up is also critical to identify potential risk factors.
  • Detect complications early. The care team should frequently monitor the mother’s blood pressure during pregnancy, especially during labor, and monitor for obstetric hemorrhage immediately after labor begins. The obstetric team and hospital clinicians should be trained to identify existing risk factors for obstetric hemorrhage and eclampsia. Low blood pressure, dizziness, and nausea are signs that a hemorrhage has occurred. By detecting these problems early, care teams can minimize blood loss from hemorrhage or prevent seizures. These measures can drastically reduce the maternal mortality rate.
  • Educate the obstetric care team and expectant mothers on caesarean sections. A C-section that is not medically necessary can lead to significant complications, such as infection, loss of blood or blood clots, injuries to internal organs, and even risks to the baby. Obstetric team members should be continuously educated on when cesarean sections are medically necessary for the health of the mother and baby. C-section rates vary widely among hospitals and medical facilities. Comprehensive education and training of care teams on evidence-based best practices may reduce this variation so that cesarean rates are more consistent across facilities. But more importantly, expectant mothers need to be educated about the medical benefits and evidence-based research supporting vaginal birth when a cesarean section is not medically necessary. Unified strategies to reduce overprescribed cesarean sections can significantly reduce the risk of maternal health complications.

Although maternal mortality can affect anyone, statistics show that mortality rates can vary greatly by state. For example, California has lowest maternal mortality, at 4.0 deaths per 100,000 live births in 2018 data. Louisiana had the highest rate at 58.1 deaths per 100,000 live births — more than 10 times California’s. The rates are even higher among black women.

Many of these deaths are preventable, especially when hospitals and obstetric care teams have the right technology, equipment and tools and, above all, training and ongoing education about the risk factors associated with complications during childbirth. We may never reduce the maternal mortality rate to zero, especially with deeper societal and socio-economic factors involved that go beyond effective maternal health care.

But especially today, when the health of more mothers may be at risk, we can reduce potential harm and save thousands of lives through more evidence-based education, continuing education and awareness that will help our midwifery teams make informed and precision medicine solutions with effective interventions that mitigate complications early and often.

Photo: Ridofranz, Getty Images

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