United States maternal mortality crisis: A new approach

By: Yeonah Suk, PharmD Candidate c/o 2020

Of all the industrialized countries in the world, the United States (US) still ranks number one in having the highest rate of maternal mortality. Data from the World Health Organization demonstrates that overused procedures including early labor induction, restricting food and drink, as well as mandating bed rest are all categorized as overused interventions that are not always needed. Because all medical procedures come with risks as well as benefits, they should not be used for the convenience of health care providers or institutions and should only be utilized with the mother’s consent. It is recommended that mothers’ preferences for their birth plan are followed. Additionally, midwifery has recently been praised for yielding higher rates of normal vaginal delivery, without complications. It is important to recognize that women in childbirth are not sick; they are admitted to the hospital so that a medical team can intervene in the event that something unexpected occurs during this natural phenomenon. Otherwise, the female body is designed by nature to be able to deliver a child, and therefore, over-medication and instruction are actually harmful to both the mother and baby.

The rate of maternal mortality in the United States is on the rise. The cause of these increasing rates lies not in our lack of medical advancements but within our rush to use them when they are not necessary. Additionally, many childbirth protocols incorporate a number of procedures that address the health of the babies delivered, but not of the mothers who deliver them. Therefore, although infant mortality has decreased over the last few decades, maternal mortality continues to rise.

Less than twelve of the fifty states in the US have steady or declining rates of maternal mortality. Among the twelve is California, which passed legislation mandating a maternal mortality review board. This board constitutes members of various disciplines, both in health care and otherwise, that examine cases of maternal mortality and morbidity. It also requires a report summarizing case analyses along with proposed techniques to solve the issues in each case which resulted in the maternal mortality or morbidity. In April 2018, New York State (NYS) adopted a similar bill amending the current public health law to create a maternal mortality review board. This allows both state and local review boards to examine and integrate improvements for women’s health with a focus on maternal mortality and morbidity. NYS has also implemented other legislation, such as amendments to state finance laws and allocating a twenty-million-dollar fund for public awareness campaigns on maternal depression. Other states such as Washington and Massachusetts have updated their legislation to include more comprehensive delivery care that incorporates greater measures concerning maternal health maintenance.

There is a new, widespread movement that involves prioritizing maternal health because early term healthcare and education provide benefits for both mothers and their babies. Every Mother Counts is an international organization dedicated to inclusive care that emphasizes optimal care for new mothers. It has programs that offer doula training to low-income, at-risk mothers of color and helps conduct community doula training which, in turn, have helped reduce rates of unnecessary medical intervention during childbirth. The organization has also worked on the Commonsense Childbirth & Changing Women Initiative, which provides prenatal care and childbirth education to low income, at risk mothers around the world.

All members of the healthcare team share in the responsibility of tackling the alarming maternal mortality rates that our nation faces. Principle causes of maternal mortality include infections, hemorrhage, toxemia of pregnancy and various other complications which share common risk factors that begin with subpar prenatal care. Even prenatal vitamins and medication counseling done by pharmacists, the last line of healthcare, play a critical role in delivery outcomes as well as minimizing risk level throughout the duration of pregnancy. Pharmacists have extensive knowledge about how different medications impact expecting mothers, even on the pre-conception level, and can help potential mothers ease safely into pregnancy when they are on drug regimens for other conditions. Additionally, many expecting mothers are quick to reach for over-the-counter medications to avoid strong doses of prescription drugs when health conditions arise during pregnancy, which makes pharmacists directly responsible for ensuring the safe and accurate use of these products. Pharmacists are labeled as one of the most overqualified and underutilized professionals in the healthcare industry. Integrating pharmacists’ drug knowledge and patient communication skills into initiatives to tackle this issue fortifies the opportunity to amend this national problem.

SOURCES:

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