The Gourd

Vol 2, Issue 1 January 17, 2022

Maternal Mortality

The maternal mortality rate (MMR), as defined by the World Health Organization (WHO), is the number of deaths per 100,000 live births from the beginning of pregnancy to 42 days after delivery. It has received a fair amount of attention in the United States in the past decade with much of the discussion related to the apparent progressive rise in that rate. But in 2003, the US started a staggered implementation of a new reporting methodology that found more late maternal deaths and also misclassified many deaths. The 2020 National Center for Health Statistics (NCHS) report shows a rate of 17.4 deaths per 100,000 live births in 2018, up from the previous rate of 12.7 in 2007; much of this rise can be attributed to the change in reporting methodology (a detailed explanation of this can be found here). However, even if the rate has remained flat, it would still place the U.S. at the top of the range for developed countries.

Whether the national rate has increased or remained flat, racial disparities persist with non-Hispanic Black women suffering a mortality rate more than twice that of non-Hispanic white women. The situation is more dire in New Mexico where the average rate of 28 is much higher than the national average and the rate for Black women is four times higher according to a 2020 legislative brief from the New Mexico Birth Equity Collaborative.

Several reasons for the high MMR in the U.S. have been proposed, including an absence of guaranteed postpartum home visits, as is the case in other developed countries. The potential impact of postpartum home visits is unclear but at least a third of maternal deaths occur in this period (the number is higher if the postpartum period is extended out to a year, as some have advocated). Timely completion of postpartum visits remains a problem in the U.S. and requiring new mothers to go to an office visit is certainly a barrier.

A study showing a 50% improvement in survival of Black newborns through physician-patient racial concordance failed to show a similar benefit for the birthing mother. I have not found a study examining the effect of gender concordance on maternal survival.

The CDC has suggested strategies for providers, hospitals, local government agencies, and women and their families (Vital Signs). These include better early management of chronic conditions, standardized protocols for assessment and response to reported symptoms (which may partially mitigate racial bias), and standard educational materials for pregnant women so they know when to report symptoms. Structurally, anything that can reduce barriers to care, including in the postpartum, would be a step in the right direction.

Do you have ideas for reducing maternal death? Send them to the email at the bottom of this page and we will start a dialogue. Perhaps we will find a few ideas we can support for implementation in the state.

The Cork Board

Happy Martin Luther King Day to all. Dr. King delivered his "I Have A Dream" speech in 1963, five years before his assassination. Yet, this seems to be the only speech many people know. Let's remind ourselves and others of the less well-known and less comfortable speeches he gave after 1963.
If you have information you would like to share with this provider community, send it to DRoss@NMBLC.org.
The Gourd will be published monthly starting in 2022.

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