When I agreed to join the California Pregnancy-Associated Mortality Review Committee in 2019, I had no idea it would change the course of my professional life.
I had spent 14 years practicing obstetrics, and I had risen in my organization’s leadership to have oversight for outpatient maternity care across our 15 medical centers. I had taken care of thousands of pregnant patients from diverse backgrounds. I experienced my own pregnancy complications and was keenly aware of the disproportionate number of obstetric complications impacting Black women. Still, there was nothing like being so deeply engrossed in these fatal cases.
Spending hours pouring through and analyzing operation notes, laboratory values, vital signs, nursing notes, ambulance records, physician progress notes, etc immersed me in the details of how a previously young healthy woman dies. Some cases were catastrophic rapid events. Most were not. Consistent with the CDC reporting of 80% of maternal deaths being preventable, there were far more cases where the outcome could have and should have been different. As I made my way through scores of cases while simultaneously caring for pregnant patients during the pandemic and America’s racial reckoning of 2020, I knew I needed to use every platform available to me to advocate for safety and affirmation in Black birth. I committed to myself that their deaths would not be in vain. These voices from the grave would speak, and I would be a strategic megaphone to advocate and to innovate care delivery so that fewer of my sisters would lose their lives.
While there are potential interventions at all levels of society that can help address maternal health outcome disparities, hospital and health plan leaders have an important role to play. First, hospital quality data must be stratified by race and payer type to create targeted quality improvement projects for those who need it most. Next, patient feedback is best gathered close in time to hospitalization and should include questions specific to maternity care. Attention to intentionally sampling groups who traditionally are underrepresented in patient satisfaction data is vital to understanding unit performance, especially when there are large cultural differences between patients and staff.
Finally, providing wraparound services is essential to keeping mothers and babies safe when they are outside the medical center. Remote patient monitoring, especially for blood pressure, can help prevent maternal readmissions and make sure that the patients who do develop preeclampsia are cared for expeditiously. Doula support, lactation consultation, mental health support and nutrition coaching should not be considered luxury items. With such services in place, breastfeeding is optimized, decreasing neonatal readmission and childhood illness. Decreasing peripartum mood disorders not only increases newborn bonding, it supports return to work and wellness. Nutrition coaching contributes to wound healing and anemia recovery in addition to helping the patient return to a healthy weight. For maximum benefit, each of these wraparound services should be
easily accessible, integrated into care and delivered in a culturally humble fashion that honors the totality of the complex and exhausting mom/baby dyad experience.
Until all of these needs to optimize maternal health in the US are met, my work continues. Survival should be the floor, not the ceiling. Let’s help make the pregnancy journey the affirming and empowering experience it can and should be for all patients.