In February, the U.S. Centers for Disease Control and Prevention released a new report Revealed an alarming rise in maternal mortality.In the first year of the pandemic, the U.S. maternal mortality rate — already Worst of all developed countries – Higher growth, 14% YoY in 2020. While the report cites possible causes such as the pandemic and lapses in antenatal or postnatal care due to Covid-19-related disruptions, the data shows serious inequities.
Of the 861 pregnant and new mothers who died in 2020, one-third were black.as New York Times Note that black Americans make up just over 13% of the population, making them almost 3 times more likely to die than white women. For Hispanic women, the percentage jumped 44% year over year.While the report did not detail maternal mortality rates for Asian Americans or Pacific Islanders, their populations also Disproportionately affected by maternal mortality.
A final note on how devastating these maternal losses are: current estimates suggest Two-thirds of maternal deaths are preventable. In this context, the 4 additional deaths per 100,000 births from 2019 to 2020 becomes even more tragic. This year, we must reverse that trend. The following sections explore ways to improve the health and well-being of expectant and new mothers by establishing a standardized continuum of care, implementing policy changes, and putting stakeholders on a path to increase advocacy to address inequalities. These actions can drive systemic changes that lead to healthier, more equitable outcomes for all.
Health equity begins with a true continuum of care
In the United States, the term “continuum of care” is a bit of an oxymoron. The patient journey is tortuous, full of unpleasant financial decisions, and relatively unclear.In Denmark, there is a clear definition standard of care, mothers and babies seem to thrive. The entire pregnancy process is pre-determined, from regular visits to the midwife to post-natal home visits, and both mum and newborn are supported in the first few months after discharge. Community groups build a support network during the complex postpartum period and beyond.
In this context, it is not surprising that Denmark is in the top 10 in the world for maternal mortality, while the US is in the top 10 in the world. 57th. While Denmark’s welfare system and universal health care isn’t a near-real reality for Americans, some elements of the system can make a huge difference here. evidence It is shown that advocacy and support through the pregnancy process can reduce complications during childbirth, reduce maternal mortality, increase the rate of natural childbirth at term, and reduce the rate of emergency room visits and readmissions after discharge.
In fact, based on our nearly two decades of experience supporting women, babies and their families, we’ve found that building a thoughtful care management model can make a huge difference. By investing in ongoing relationships throughout the maternal continuum of care, we are able to conduct health risk assessments, build trusted long-term case-manager relationships, guide women through pregnancy or NICU events, and identify and resolve healthy social decisions Factors that affect these women and their families. Developing a more continuum of care, including community-based maternal care and prenatal and postnatal support networks, is our greatest opportunity to help offset the alarmingly high maternal mortality rate of the past 20 years.
New policies are an introduction to real systemic change
The policy changes outlined below can help achieve standardization, a continuum of care, and a more equitable future.
Advocate: Midwives, obstetric managers or maternal advocates help create a The appearance of standardized care By promoting regular antenatal and postnatal checkups, healthy nutrition, emotional and physical habits, and better communication with your doctor during labor.States must invest in culturally relevant models that extend the continuum of care by providing subsidized home health visits, such as those Wyoming and North Carolina Trials are underway.
Paid Family Leave: While every Danish resident has four to six months of family leave with full pay, only about 19% of Americans Any form of paid family leave is available.For many new mothers, returning to work two weeks postpartum is their actual situation.In addition to supporting new mothers, Paid Family Leave will help unlock additional If we achieved full gender parity, global GDP would increase by $28 trillion.
postpartum: 50% of maternal deaths occur after birth, which means that equal attention should be given to new mothers after discharge from the hospital. Experts agree that complications most often occur within six months of delivery; however, many insurers only cover a limited period of time, some as little as 6 weeks. To fully support new mothers and their newborns, postpartum protected care and parenting instruction should be extended to twelve months.
To create change in our fragmented health system, we must unite policymakers, advocates, physicians, health systems, payers, midwives, doulas and community organizations to develop a standardized continuum of care. Only then can we begin to address our maternal mortality issues and make meaningful, lasting changes that improve the maternal experience for future generations in America.
Photo: Prostock Studio, Getty Images
