August 20, 2019

Searching for Solutions to the Maternal Health Crisis

By Megan Ritchey, SWHR Communications Intern

Maternal mortality rates in the United States are higher than anywhere else in the developed world, and the majority of the estimated 700 pregnancy-related deaths each year are preventable.

In a recent blog post, we reviewed the maternal health crisis, its troubling racial disparities, and some of the contributing factors, including weaknesses in the health care system such as disparities in hospital quality, limited access to hospitals in rural areas, and other gaps in health care coverage and access.

Public outcry over this alarming problem has resulted in a variety of efforts addressing maternal health in the U.S. In December 2018, Congress passed the Preventing Maternal Deaths Act, which aims to help states improve how they track and investigate maternal deaths in order to understand what causes these deaths and put relevant stakeholders in a better position to enact preventative measures.

The bill provides funding for states to establish or strengthen Maternal Mortality Review Committees (MMRCs), which are tasked with identifying maternal deaths, analyzing factors that contribute to maternal mortality and morbidity, and ultimately using this information to enact policy changes. In 2010, only 22 states had MMRCs. Now, 46 states and the District of Columbia have some level of maternal death review, with 38 states with active MMRCs recognized by the Centers for Disease Control and Prevention.

The establishment and improvement of MMRCs under the Preventing Maternal Deaths Act is a positive step forward for maternal health in the United States — but one state has made additional improvements that successfully reversed the trend of rising deaths there and reduced maternal mortality by 55% in just seven years. In 2006, California and Stanford University founded the California Maternal Quality Care Collaborative (CMQCC), which uses “research, quality improvement toolkits, state-wide outreach collaboratives and its innovative Maternal Data Center to improve health outcomes for mothers and infants.”

The CMQCC and a newly formed MMRC reviewed maternal deaths in the state for the previous five years and determined that hemorrhage and preeclampsia were the most preventable obstetric emergencies that frequently caused maternal death. Based on this knowledge, they implemented standardized approaches to obstetric emergencies and trained doctors to prepare for worst-case scenarios in the delivery room and to think of each and every woman as “at-risk” for complications like hemorrhages.

CMQCC creates toolkits for health care providers to use during obstetric emergencies that contain items doctors may need to tackle complications like hemorrhage and preeclampsia, including checklists, necessary equipment, medications, and more. Now, about 88% of hospitals in California use the toolkits — and those that use them have seen close to a 21% decrease in maternal deaths. Hospitals without the toolkits have lowered their maternal death rates by less than 1%.

Establishing programs similar to the California Maternal Quality Care Collaborative in other states would likely aid the efforts of the Preventing Maternal Deaths Act to improve rates of maternal mortality in the United States.

However, despite CMQCC’s tremendous success, racial disparities in maternal mortality persist in the state. “The expectation was that widespread adoption of CMQCC’s clinical safety bundles would reduce the gap in the number of maternal deaths among Black women,” the group states. “However, the difference in outcomes for Black mothers compared with all other racial groups has persisted.” In response, the CMQCC has launched the California Birth Equity Collaborative to evaluate and develop approaches to address this continuing problem.

Some policymakers and health care advocates are also calling for new initiatives, such as the proposed Maternal Care Access and Reducing Emergencies (CARE) Act that would address systemic racial bias in the health care system in an effort to reduce the racial disparities in maternal health. Yet policies alone are not the answer. While concurrently improving policy and procedure, investments should be made in research areas related to maternal morbidity and mortality to advance our foundational knowledge on maternal health.