US Women Most at Risk in Developed World During Childbirth
Women in the US today are 50% more likely to die in childbirth than their mothers. This chilling statistic flies in the faces of modern medicine, and expanded life expectancy for women. Women in the U.S. are the most likely to die from complications related to pregnancy or childbirth than any others in the developed world.
In 2018, there were 17 maternal deaths for every 100,000 live births in the U.S. — a ratio more than double that of most other high-income countries (Exhibit 1). In contrast, the maternal mortality ratio was three per 100,000 or fewer in in the Netherlands, Norway, and New Zealand¹.
The difference is even more staggering for women of color. According to the CDC, Black, American Indian, and Alaska Native (AI/AN) women are two to three times more likely to die from pregnancy-related causes than white women — and this disparity increases with age. (Emily E. Petersen, et al., 2019)
Thankfully, we see exciting work being done in this space to improve the quality, and dignity of care for expecting mothers. For example, March for Moms brings together policymakers, traditional healthcare providers, midwives, and families to focus on maternal health advocacy. I had the privilege of working pro bono with March for Moms as they looked to identify the organization’s focus for the future. From our partnership with March of Moms, we see opportunity in the following areas:
· Improving the Patient Experience during pregnancy
One in 6 mothers feel disrespected by healthcare providers during pregnancy. Patients’ voices are the most important voice during any clinical interaction. Providers are likely not intentionally disrespecting women, but underlying biases can play a role in making assumptions about patient care. For example, women are seven times more likely than men to be misdiagnosed when having a heart attack. This gender bias is rooted in the research around heart attacks which focused on male physiology. (Women Are Dying Because Doctors Treat Us Like Men, n.d.). While labor and delivery is clearly focused on women’s bodies, these biases can trickle in from other areas.
Bringing in patient advocates and professionals like midwives and doulas can help create a more open collaborative setting for care. Doulas can provide education on what the labor and delivery process is like, providing the patient an additional source of knowledge and emotional support during that time. Midwives are certified practitioners (varies by state) who can deliver babies in other settings, such as the home.
Partnerships between OB/GYNs and other birthing professionals are becoming more common as patients opt for a more holistic approach. One potential way for providers to provide better communication during prenatal care as well as Labor & Delivery is to have strong communicators in the room who can raise concerns for the patient and create a more open dialogue. This could be doulas, midwives, advocates or even trained physicians and nurses.
· Incorporating women into birthing decisions
Caesarean section is the most common surgery performed in the United States every year. Since 1990, babies being born via C-section have tripled. In the United States, over 1 million c-sections are performed each year². C-sections are an invasive surgery and carry different complications than a vaginal birth. For a mom, risks include bleeding, uterine rupture, hysterectomy and more. For babies, birth by C-section can raise the chance of obesity or autoimmune diseases. This may be attributed to a lack of exposure to vaginal microbiomes during delivery³.
This increase in C-sections is likely tied back to risk management by providers, and financial concerns. While researchers vary on what the optimal c-section rate should be, we know that the risks and birthing mom’s preferences should be considered before the decision is made. Communication of these risks is key to improving that birthing experience.
· Expanding holistic care and patient communication during pregnancy
Medicaid is the payer with the most births each year. In the United States, Medicaid covers more than 40% of births. These low-income patients may have different needs during the labor and delivery process. For instance, birthing mothers may not have received comprehensive prenatal care, either due to lack of awareness about the coverage or due to work schedules or other competing priorities.
According to a 2019 study, Medicaid-Covered C-sections actually pose a higher risk of infection. Similarly, women with Medicaid coverage are more prone to higher mortality risks during pregnancy⁴. Several factors may be at play here including the quality of the provider institution, a lack of adequate prenatal care or patient health literacy. Incorporating some of these patient communication and holistic care models into our Medicaid programs can make a huge difference in patient safety during Labor and Delivery, especially in vulnerable patient populations, such as those with transient living situations.
March for Moms has been advocating for opportunities to design better public policies that focus on inequities in healthcare. For example, the Black Maternal Health Momnibus Act of 2021 was introduced into Congress and all 12 bills have been endorsed by more than 190 organizations. The bills address many issues such as improving data collection and qualities measures, providing funding to community-based organizations working to improve maternal health outcomes, growing and diversifying the perinatal workforce, and improving maternal healthcare and support for incarcerated moms to name a few. These bills will undertake the maternal health crisis in America and ensure that birthing people have access to the care and support needed to be able to thrive.
“March for Moms will engage in thoughtful, action-oriented conversation that will center birthing people that are disproportionately being impacted by health inequities. We will work across a broad coalition of consumer and family, professional, policymaker and industry representatives to align and amplify their voices to ensure that every American family can grow with dignity,” says Laneceya Russ, Executive Director of March for Moms. “We plan to do this by: educating stakeholders on policy changes that will lead to positive outcomes in the lives of birthing people and developing the capacity of community organizations and advocates through resource sharing and education. We aim to track the progress that is being made in the maternal healthcare space through the many amazing organizations that are on the ground doing the work to ensure birthing people are not only surviving but that they are thriving.”
Please visit MarchforMoms.org to learn more about their mission to improve the health and well-being of all mothers through advocacy and awareness.
This article is the second in a series focused on Women’s Health. Stay tuned for additional articles and points of view from our Slalom Life Sciences and Healthcare team.
References
1.Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries. Maternal Mortality Maternity Care US Compared 10 Other Countries | Commonwealth Fund. (n.d.). https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries#:~:text=Women%20in%20the%20U.S.%20are,income%20countries%20(Exhibit%201).
2. Jauniaux, E., & Grobman, W. A. (n.d.). Caesarean section. Oxford Medicine Online. https://oxfordmedicine.com/view/10.1093/med/9780198758563.001.0001/med-9780198758563-chapter-1.
3. Neu, J., & Rushing, J. (2011, June). Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis. Clinics in perinatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/#R10.
4. Psqh. (2019, July 2). Medicaid-Covered C-sections Pose Higher Risk of Infection. Patient Safety & Quality Healthcare. https://www.psqh.com/analysis/medicaid-covered-c-sections-pose-higher-risk-of-infection/.
Slalom is a modern consulting firm focused on strategy, technology and business transformation. Our healthcare and life sciences industry teams partner with healthcare, biotech and pharmaceutical leaders to strengthen their organizations, improve their systems, and help with some of their most strategic business challenges. Find out more about our people, our company and what we do.
