3 Steps Healthcare Facilities Should Take to Reduce Post-Roe Maternal Mortality Rates

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Following the decision Dobbs v. Jackson of the United States Supreme Court overruling Roe v. Wade, obstetric care teams are rightly focused on how already essential efforts to protect maternal health and reduce maternal mortality will be affected.

Tragically, maternal mortality in the United States has increased. In 2020, the maternal mortality rate was 23.8 deaths per 100,000 live births, down from 17.4 per 100,000 in 2018. The rate was 55.3 deaths per 100,000 live births among non-Hispanic black women, or 2.9 times the rate among non-Hispanic white women. women.

Black women face significant barriers in accessing contraception, and there is growing concern that maternal mortality among black women could increase further, given that maternal mortality is associated with complications during birth. childbirth and unsafe abortions. A study from the University of Colorado at Boulder found that a national abortion ban would increase maternal mortality by 24%.

Obstetric care clinicians are focused on finding new ways to mitigate maternal mortality and improve maternal health outcomes, but it won’t be easy.

Cardiovascular conditions, obstetric hemorrhages (excessive bleeding), eclampsia (convulsions), obstructed labor and overuse of caesarean section are among the main causes of complications during childbirth.

To reduce maternal mortality rates, one must understand why the maternal mortality rate is so high in the United States compared to other countries, even those that spend much less on health care.

First, complex socioeconomic factors are 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 find it difficult to travel to medical facilities for care. Additionally, 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 from hospital to hospital. Some health facilities lack sufficient funds, trained obstetrical clinicians, or more advanced technology and equipment, which may make some facilities less equipped to respond to maternal emergencies.

Third, the United States still has a high C-section rate compared to other countries. Some American women believe caesareans are less risky. For working women or those without adequate maternal health benefits, opting for a caesarean section gives them control over when they give birth.

Obstetric care 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 factors above.

Steps Obstetric Care Professionals Should Take Immediately

  • Improve preparedness for maternal emergencies. When complications arise during childbirth, every minute counts. Obstetric care professionals must respond effectively and make the right decisions to save the life of mother and baby. Obstetric care teams should provide consistent education and training to care teams, not only on risk factors for chronic diseases such as hypertension and obesity, but also on how to identify early warning signs. -runners of complications at an early stage. For example, in cases of eclampsia and other hypertension-related conditions, the obstetric care team must be able to promptly administer intravenous blood pressure medications and magnesium sulfate to prevent seizures. Comprehensive prenatal and postnatal follow-ups are also essential to identify potential risk factors.
  • Detect complications early. The health care team should monitor the mother’s blood pressure frequently throughout pregnancy, especially during childbirth, as well as monitor for obstetric hemorrhage from the onset of labour. The obstetrics team and hospital clinicians should be trained in how to identify pre-existing risk factors for obstetric hemorrhage and eclampsia. Low blood pressure, dizziness, and nausea are all signs that bleeding has occurred. By detecting these problems early, healthcare teams can minimize blood loss from bleeding or prevent seizures. These measures can significantly reduce the maternal mortality rate.
  • Educate the obstetric care team and pregnant women about caesarean sections. A cesarean section that is not medically necessary can lead to significant complications, such as infection, blood loss or blood clots, damage to internal organs, and even risk to the baby. Members of the obstetrical team should be continually educated about when caesarean sections are medically necessary for the health of mother and baby. Cesarean section rates vary widely from hospital to hospital and from medical facility to medical facility. Comprehensive education and training of care teams on evidence-based best practices can reduce this variation so that cesarean section rates are more consistent across facilities. But more importantly, mothers-to-be should be made aware of the medical benefits and evidence-based research supporting vaginal birth when a caesarean section is not medically required. Uniform strategies to reduce over-ordered caesarean sections can significantly reduce the risk of maternal health complications.

Although maternal mortality can affect anyone, disturbing statistics show that death rates can vary widely from state to state. For example, California has the lowest maternal mortality rate, at 4.0 deaths per 100,000 live births according to 2018 data. Louisiana has the highest rate, with 58.1 deaths per 100,000 live births. , more than 10 times that of California. Rates are even higher among black women.

Many of these deaths are preventable, especially when hospitals and obstetric care teams have the appropriate technology, materials and tools, and most importantly, training and ongoing education about the risk factors associated with complications. during childbirth. We may never reduce the maternal mortality ratio to zero, especially with the deeper societal and socio-economic factors involved that transcend the effectiveness of maternal health care.

But especially today, when the health of more mothers may be at risk, we can reduce the potential harm and save thousands of lives through evidence-based education, ongoing training and awareness. that will help our obstetric care teams make informed and accurate medical decisions with effective interventions that mitigate complications early and often.

Photo: Ridofranz, Getty Images

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