Maternal joy, not sorrow

By Jo Ivey Boufford, MD

Amsterdam News, April 1, 2011

More than 75 years ago, the New York Academy of Medicine released a report on the alarming number of women who were dying during or shortly after giving birth in New York City. Common causes of death included blood poisoning, kidney and liver infections, heart disease, respiratory infections, hemorrhage and abortion-related complications.

Tragically, women who give birth today are still at risk of dying. Our state ranks among the worst in the nation in terms of the number of women dying in childbirth. It is estimated that 40 percent or more of these deaths are preventable. The risks associated with maternal mortality include embolism, hemorrhage, pregnancy- induced hypertension and infection. Recent statistics also reveal alarming disparities in terms of race. Nationally, pregnancy-related mortality rates are three times higher for Black women compared to white women, and in New York City the rates are seven times higher.

As women increasingly delay pregnancy to their late 30s and over age 40, there is greater likelihood that, because of the national epidemic of obesity and the national pattern of earlier onset of chronic diseases like hypertension and diabetes, more pregnant women will suffer from these chronic conditions, increasing the chance of death.

This past year, government health officials, health professionals, community leaders and other stakeholders met to address New York’s deadly legacy for women. Participants identified three key areas for action statewide that could lead to reductions in maternal mortality. These include mandatory and consistent reporting and case review of each maternal death; prevention and risk reduction
before and during pregnancy; and early hospital-based identification, screening and intervention for high-risk women.

First, we must develop a system that reports all maternal deaths occurring in the state each year. This critical information, combined with a consistent approach to chart and on-site reviews, will help us better understand maternal deaths before, during and after delivery so that we can design community-based interventions to reduce them.

Second, as New York implements new national health care reforms, there is an opportunity to build in the systems and incentives needed to prevent future tragedies for pregnant women in New York. Primary care providers can play a critical role in ensuring that pregnant women in their practices with identified risk factors are linked to the appropriate level of specialty care during their pregnancy, and that hospitals where delivery is planned have the information they need about each woman.

Patients need to fully understand risk factors so that they can make informed decisions about becoming pregnant, and they must  communicate these risk factors to providers who may not know them if there is an emergency.

Third, hospitals need to implement better screening systems to identify high-risk pregnant patients as soon as they arrive and enter them into a system of case management that addresses potential medical and surgical risks. Women at the highest risk are often those in labor who seek care at a hospital that has had no previous contact with them, even if she has been receiving appropriate prenatal care.

While great strides have been made to manage the medical and surgical complications that may arise, more can be done to ensure that these are standardized and implemented throughout the state. Existing regional systems established by the state to assure that the appropriate level of care is available to newborns need to be reviewed to assure that high-risk pregnant women can deliver at
hospitals with the necessary specialty expertise, facilities and equipment.

Finally, there is general agreement that we need active and strong leadership by the State Health Department to build consensus with the health care community on clear goals and priorities for statewide action. This consensus can assure the coordination needed to turn the good work being done on this issue by many talented and committed individuals and organizations across the state into concrete strategies with a specific timetable to prevent unnecessary maternal deaths.

Putting these recommendations into action, especially in times of austerity, requires champions—political champions to support needed investments; government and professional champions to implement the programs; and increased public awareness of the problem and the solutions. The time is right to reduce the unacceptably high rates of maternal death in New York State.

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Contact:
Andrew J. Martin
Director of Communications
The New York Academy of Medicine
1216 Fifth Avenue
New York, New York 10029
212-822-7285
amartin@nyam.org

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