Independence Day Reflections
America may be the land of the free and the home of the brave, but with the highest rate of maternal mortality in the developed world, it’s no place to have a baby. While our lawmakers have been “making the world safe for democracy,” American mothers have been dying at an alarming rate from largely preventable causes.
Across the Atlantic, mothers in the United Kingdom have much better expectations, with only nine deaths per 100k births compared to the 14 per 100k (or 18/100k, depending on the source) of the United States. In honor of our country celebrating the 243rd anniversary of its Declaration of Independence from Britain, we should be taking a look at what our neighbors’ across the Atlantic are doing to keep their mothers safe.
The difference lies primarily in postpartum care: though most maternal deaths in the United States occur from factors that arise during the postpartum period, obstetric care in the US virtually stops after birth. Most new moms are left to navigate this period on their own — after an average of 2 to 3 days of inpatient care, they are sent home with information about breastfeeding and other infant care, but with little to no guidance on how to monitor their own health.
While new mothers in the US will not typically see a health professional until they meet with their OB/GYN in a single follow-up appointment, six weeks after giving birth, the United Kingdom closely monitors women during this period. New mothers in the UK are aided by local midwives, doulas, and nurses in the days and weeks following delivery.
While on the surface this solution seems simple, there is an obvious obstacle to its implementation in the US: the physician shortage. When nurses, doulas, and midwives are already taking on extra duties to fill the gaps left by over-extended OB/GYNs, how can health systems spare a body to monitor a postpartum mother?
This is where technology holds great potential. Remote monitoring, text messaging, push notifications and reminders — these digital solutions can continuously deliver the connectivity that care teams provide in the physical setting, filling the gaps that are created by human limitations by communicating data back to providers.
A mental health survey, for example, delivered to a new mother in the postpartum period through an email or her phone can effectively identify postpartum depression, intercepting problems before they become fatal. Similarly, remote monitoring of blood pressure levels after childbirth can be the difference in identifying and managing postpartum hypertension, one of the primary culprits in maternal mortality rates.
In the 1940s, the UK and the US had comparable maternal mortality rates, but since then, the UK has seen a steady decrease while the US struggles to keep its rates from rising. This success has been attributed to the British commitment to researching the problem and establishing clear protocols for health professionals, something that the US should take note of.
While policy-makers have an important role to play in jumpstarting such research, progress cannot wait on the government. There needs to be a committed effort from stakeholders (providers, payers, families, social workers, etc.) to combine the benefit of their experience and data, setting aside their competitive relationships to address the needs of mothers and develop comprehensive metrics for managing pregnancy complications.
In this month of celebrating “liberty and justice for all,” we should be looking at all the ways in which we can truly deliver on that promise — even if it means looking outside of our own country — because our mothers deserve it.