Better tracking and better preventive care can help combat the serious problem of maternal mortality in the U.S., an expert panel urged.
In a Capitol Hill briefing Thursday -- organized by the , a non-profit that focuses on pregnancy and childbirth -- a variety of maternal health experts provided statistics on disparities in maternal mortality, shared stories about interventions that have worked in certain states, and encouraged the support of (Preventing Maternal Deaths Act) and of (Maternal Health Accountability Act).
Specifically, H.R. 1318 would authorize $7 million for the CDC to assist states in establishing or strengthening maternal mortality review committees.
Providing background information on maternal mortality, Shanna Cox, MSPH, associate director for science at the CDC's Division of Reproductive Health, said that 700 women die of pregnancy-related complications every year. And these numbers are going up, potentially due to the role of increasing maternal age and chronic conditions. Moreover, almost 60% of pregnancy-related deaths are preventable, she added -- with mental health and substance abuse as common contributors -- but that these vary by race and ethnicity.
"By rigorously implementing quality care initiatives, we can also reduce disparities," Cox said. "States need to develop fully functional review committees to put this data into action."
One state that developed a system was California, which created a "coalition of the willing" to implement the first-ever statewide review of maternal deaths. Christine Morton, PhD, of the Lamaze Institute for Safe and Healthy Births, added that it "requires a political commitment that women's lives are worth saving."
Morton added that the U.S. has not released the maternal mortality rate in the last 10 years, meaning the country is not accurately counting maternal deaths, nor is it capturing the whole of women's experience with birth and postpartum care.
But she said that there is "no simple answer" -- and California found many points of failure and opportunity to improve and to change. One area where they were able to implement change was distribution of maternity safety toolkits, to address preventable causes of maternal death, such as hemorrhage, preeclampsia, and severe hypertension.
Michael Lu, MD, of the Milken Institute School of Public Health at George Washington University, provided the sobering statistic that the rate of maternal mortality has more than doubled in the last 30 years.
Adding a physician's perspective, he spoke about the different factors driving these increased risks for preventable death, including that about half of women go into pregnancy overweight or obese.
"A key strategy for eradicating maternal mortality has to be to improve one's health," he said.
But he added that maternal complications often result from delayed recognition or misdiagnosis, and that through protocols, drills and simulation, and maternity care bundles of best practices, clinicians can help improve the quality and safety of maternity care.
"We want to get these safety bundles into every hospital in the U.S.," Lu said, urging representatives and senators to support these bills, as part of a national movement to do something about maternal mortality.
Cox added that the type of maternal mortality review committees they want to implement are not new -- they have been around since the 1950s, but were based on the efforts of volunteers. "We need to be able to review not just the medical and clinical causes, but also the social causes of maternal mortality," she said.
Sometimes, however, certain aspects of maternity care are out of a clinician's control. Claudia Booker, a certified nurse midwife in the Washington, D.C., area, spoke about how the closing of hospitals has impacted maternity care -- not just in cities, but also rural areas of the U.S. -- forcing patients to travel further to get their care.
"In the city, families have to go find care -- care is no longer brought to the families," she said.
An assistant for Rep. Jaime Herrera Beutler (R-Wash.) -- who sponsored H.R. 1318 in 2017 along with 107 co-sponsors -- provided an update on the bill's progress, describing it as a "top priority" for her boss.
She characterized support for the bill as "very bipartisan," and said that they have been having encouraging conversations with leadership. The bill was referred to the House Subcommittee on Health in March 2017.
S. 1112, sponsored by Sen. Heidi Heitkamp (D-N.D.), was read twice and referred to the Committee on Health, Education, Labor and Pensions in May 2017.