| July 29, 2018

The U.S. is the Most Dangerous Place to Give Birth in the Developed World. Here’s Why.

Andreea Ciulac

Andreea Ciulac is former Chicago Tribune writer with almost a decade of reporting experience. She has a knack for deciphering... Andreea Ciulac is former Chicago Tribune writer with almost a decade of reporting experience. She has a knack for deciphering complex medical reports and statistics and conveying them into engaging stories that will help executives in healthcare keep up with the digital transformations in their industry. She covers an array of topics from pharma to startups and the Illinois healthcare system.

Maternal mortality is dropping worldwide, except in the United States, where new data points to an opposite trend.

Maternal death rates in the U.S. are among the highest for developed countries, according to a USA Today investigation.  

The statistics are based on a half-million pages of internal hospital quality records. Here is a graphic of this investigation.

More than 50,000 mothers suffer severe injuries during or after childbirth and about 700 mothers die.  

The CDC Foundation estimates that 60 percent of these deaths are preventable.

Of the deaths associated with hypertension or preeclampsia (blood pressure over 160/110) 60% were preventable.  

Death from hemorrhaging (severe bleeding after giving birth), could have been avoided in 93% of documented cases.

So why is the U.S. faring so poorly in this space?

Maternal mortality rates are directly correlated to how well hospital employees follow safety protocols after childbirth. Instead of being mere observers, doctors and nurses are instructed to be proactive and take simple, yet life-saving steps.

Postpartum preeclampsia is easily prevented if staffers are quick to spot early signs of high blood pressure and administer medications within the one-hour recommended deadline.

Left untreated, this condition can result in stroke, seizures, coma or organ damage.

Another first-line strategy to prevent maternal death is to closely monitor blood loss and weigh pads for an accurate estimation that could prevent postpartum hemorrhage (PPH).

In the U.S. alone, about 125,000 women a year are affected by PPH, which can lead to death by renal failure and cardiovascular collapse.

Despite these protocols being straightforward, only 31 of 75 birthing hospitals contacted by the USA Today reporters said they followed these steps.

Why are hospitals so lax about following recommended procedures?

Currently, there is no national tracking system for childbirth complications. Regulators such as the Centers for Medicare and Medicaid Service have done little to change that. The Joint Commission, a private commission that sets safety standards for thousands of hospitals doesn’t ask facilities to report childbirth medical errors.

On top of that, hospitals are ill-prepared for maternal emergencies, especially in rural America. It has also been reported that some doctors who enter the specialty of maternal-fetal medicine receive poor training.

Despite all these shortcomings, one thing is clear: the rate of maternity deaths can be reduced with a joined effort by safety experts, hospitals and patients.

One place in the country where this approach has been successfully employed for the past couple of years is the state of California.

The maternal death rate in California fell 50% between 2008 and 2013 thanks to “safety bundles”, of childbirth safety practices developed as a part of a program called “Access for Infants & Mothers” (AIM).

AIM, a coalition created by the nation’s leading medical societies, equipped hospitals and doctors with a list of strict safety protocols as well as training programs. Another decade-long initiative to make births safer for moms in the state is California Maternal Quality Care Collaborative (CMQCC).

CMQCC created downloadable “toolkits,” explaining how to best manage the complications that arise with childbirth.

The good news is that maternity hospitals nationwide have been slowly making progress.

About 40 percent of the nation’s birthing hospitals are currently enrolled in the AIM Program to reduce harm to mothers, organizers say.

Maternity facilities are now more willing to recognize errors and take actions to improve, instead of placing the blame on external factors such as a mother’s unhealthy lifestyle, low-income, higher weight or older age.

At University of Utah Hospital in Salt Lake City, for example, 12 percent of their patients suffered hemorrhages in 2013, triple the national rate. After analyzing patient records, the hospital realized they diagnosed hemorrhages too late and doctors began adopting the AIM Program’s practices.

Lawmakers are currently working on a bill, the Preventing Maternal Deaths Act, that would encourage states to create committees to determine why women are dying from pregnancy-related causes.

This recent investigation has been a wakeup call for the entire ecosystem of doctors, nurses and midwives.

There is a clear need for stricter regulations, better training programs for health workers and comprehensive guides for new women on how to manage their health postpartum.

Illinois legislators trying to tackle the issue head on

Strong collaborations and practiced exchanges can save millions of lives. From May 2016 through June 2017, about 100 Illinois hospitals participating in an AIM Program-affiliated project increased from 42 percent to 79 percent the number of maternity patients getting treatment for dangerous blood pressure within one hour.

However, some legislators thinks that is still not enough.

Illinois State Representative Mary Flowers says the maternity mortality problem has gotten so bad that she has decided to convene a special hearing about the issue in an Illinois House committee on September 12 in Chicago.

“I’m particularly concerned about the high number of deaths during childbirth in the minority communities in and around Chicago,” said Flowers in an exclusive interview for Healthcare Weekly, who is the Assistant Majority Leader in the Illinois House.

“The problem is more serious and deadly if a mother is covered by Medicaid and doesn’t have the ability to pay for private pay care. That’s why I’m having this special hearing — to get the facts straight about how severe this terrible problem is in Illinois. Foreign countries have single payer health care. In America, health care is a for-profit industry and the only way to fix it to take the profit out of health care and provide adequate resources,” Flowers said.

Flowers plans to introduce legislation after the committee has heard enough testimony. One of the solution is to provide better funding for Illinois Department of Public Health to make sure health care institutions are safe. She also wants to review the Illinois Hospital Report Card to see if its adequately collecting data on this issue.

At the same time, Illinois Democratic U.S. Senators Sens. Dick Durbin and Tammy Duckworth, as well as eight Illinois U.S. Representatives, sent a letter in July to Governor Bruce Rauner urging him to address the crisis.

Durbin and Duckworth said black women in Illinois are three-and-a-half times more likely than white women to die from pregnancy-related causes and black infants are three times more likely than white infants to die, which is worse than national averages.

“This is simultaneously unacceptable and heartbreaking,” they wrote. “More must be done to help women and infants across Illinois—especially black mothers and babies.”

According to the letter, 60 percent of pregnancy-related deaths are preventable. Factors that contribute to these deaths include a delay in seeking care, misdiagnosis, implicit bias and lack of coordination between providers, the senators said.

“If these were car accidents, the public and policymakers wouldn’t tolerate it so we can’t sit by and watch as more people die.” Flowers said.


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