While many grumble that Mother’s Day is just another holiday invented for guilting people into buying greeting cards, for others it’s a painful reminder of loved ones now gone.
Each year, maternal mortality brings that reminder to approximately 700 new families, and maternal morbidity rates bring another 50,000 mothers close to the same fate. Yet it’s estimated that 60 percent of pregnancy-related deaths are preventable.
Understanding and anticipating the circumstances that contribute to maternal morbidity can help physicians identify potential issues early-on and proactively work to prevent untimely deaths and the consequences that follow.
Poverty and the High Cost of Health
Between mid-March and April, nearly 26 million Americans filed for unemployment due to COVID-19, and one economic forecast suggests that the number will continue to grow through July. For patients, this means loss of income, insurance benefits and ability to pay for preventative care—even for those traditionally considered “middle class.” For providers, it means an uphill battle in recognizing potential morbidity risks early on.
When it comes to preventing maternal morbidity, proper prenatal care is key. And the lack thereof can be fatal.
Without appropriate prenatal care, the risk of maternal mortality is increased by three to four times. In addition, 33 percent of women with maternal mortality die between one week and one year postpartum, making follow-up appointments also crucial for both mother and baby.
Stacey’s Story
While working in a busy labor and delivery unit, I cared for pregnant women from all walks of life—each with their own unique story—but I will never forget Stacey and just how close she came to losing it all.
Stacey and her partner had recently graduated high school and set out to make a life together when she found out she was pregnant. They were excited, but fear of medical debt and lack of knowledge about available resources caused them to forgo routine prenatal care. She was young and healthy and believed if she stayed active and maintained a healthy diet everything would work out fine.
That all changed in the middle of her third trimester when her partner came home one day to find Stacey unresponsive behind the couch. The paramedic’s assessment revealed extremely high blood pressure, and she was rushed to the hospital. On the way she experienced a seizure.
When she arrived at our unit, she was quickly stabilized enough to perform an emergency Cesarean Section. Unfortunately, complications that could have been prevented with routine prenatal care led to a long NICU stay for the baby—and a prolonged recovery period for Stacey. Based on this experience and some familial history that was later discovered, she was advised not to have any more children.
Given the current circumstances, it becomes even more important for providers to work proactively with patients and payers to ensure that—even in times of financial hardship—women are getting the maternal care they need.
Racial and Ethnic Inequalities in Healthcare
In the past twenty years, the census shows that minority racial and ethnic populations have grown from 24 percent of our population to just under 40 percent. And the Brookings Institute suggests that the US could be “white minority” by the year 2045. Yet as representation for racial and ethnic minority continue to grow—doubling enrollment in undergraduate and post-baccalaureate programs and increasing representation in executive positions—many still face clear and unfair disparities in health insurance coverage.
Women of racial and ethnic minorities experience 28 percent more cases of severe maternal morbidity when compared to white women. And women of indigenous or black descent are more than twice as likely to die of a pregnancy-related condition. Much of this can be traced to lack of access to sufficient prenatal and postpartum care.
In recent years, multiple high-profile cases have highlighted these alarming statistics. Shalon Irving, an African American epidemiologist for the Centers for Disease Control and Prevention, was actively working to close disparities in health access and outcomes when she found out she was pregnant with her first child. Despite her vast healthcare knowledge, a B.A in sociology, two master’s degrees and a dual-subject Ph.D., she collapsed and died from complications of high blood pressure three weeks after delivering her daughter.
Famed tennis player, Serena Williams, has also talked openly about the need to advocate strongly for herself with doctors and nurses after she recognized that something was wrong after her emergency Cesarean section. After a series of tests, she was ultimately diagnosed with several pulmonary emboli.
As minority populations grow in the US, the health disparities they face will not disappear with a mere increase in numbers. Existing prejudice and discrimination, unless addressed, will continue to impact minorities by dictating the neighborhoods, schools and jobs these individuals have access to—affecting safety, transportation, nutrition and access to appropriate care.
As providers, we can take the first step in addressing the minority gap by looking at the whole patient. Evaluating not only the mother’s physical health, but taking time to identify other circumstances that could affect wellbeing—including, but not limited to, housing, employment and access to insurance, transportation and other social determinants of health—can help us better help our patients. With more knowledge, we become better-positioned to spot potential complications and address them before they lead to life-threatening conditions.
The Rise of the Older “New Mom”
In the past fifty years, the average age of first-time mothers has risen from 21 to 26. And for first-time mothers who have graduated from college, the average is even higher at 30. As opportunities for education and career advancement continue to rise for women, studies suggest that the average age of first-time mothers will continue to increase as well.
While plenty of women have and will continue to successfully start families at older ages, studies show that pregnancies for women age 35 and older can also bring higher risks of complications. Preterm delivery, hypertension, superimposed and severe preeclampsia and poor fetal growth are all more common in pregnancies where the mother is 35 or older. These complications can occur regardless of the mother’s race, ethnicity or socioeconomic position.
Successfully caring for this growing demographic of older first-time mothers requires providers to be ever more diligent. Knowledge of and attention to patient history during prenatal, delivery and postpartum care can help identify abnormalities and risk early-on. Improving collaboration between primary care providers, OBGYNs, midwives and hospital staff can ensure that as the ages of mothers increase, the mortality rates do not.
The Answer is in Connection
Maternal morbidity can leave mothers with both short and long-term physical and mental conditions. Physically, they may face malnutrition, infection, hemorrhoids, incontinence, hypertension and other complications. Psychologically, it can cause conditions like depression and PTSD. And of course, for some, these morbidities ultimately lead to mortality—shattering families and leading to increased growth and development difficulties for the child.
Reducing these morbidities and mortalities starts with making the right connections not only to providers—but between them. Technology serves to connect members of a mother’s care team, enabling them to synchronize care between payers and providers, identify patterns and risk factors of concern—including potential social determinants—and catch abnormalities early-on for better preventative care.
As care teams work together across organizational boundaries, the networks formed create a web effect that can begin to close these care gaps—catching these patients and preventing unnecessary morbidity and loss.
Related Reading: Interoperability: The best Mother’s Day present money can’t buy
Susan Pasley started her healthcare career in labor and delivery before becoming a registered nurse. She has worked as a nurse in pediatrics and the emergency department. She now serves as the Director of Clinical Solutions for Collective Medical.