This year’s Society for Maternal and Fetal Medicine Meeting was the 40th annual meeting. To celebrate, their President, Brian Iriye, MD, a maternal-fetal medicine subspecialist in Las Vegas, NV, helped lead an initiative to put together a documentary following their society’s history.
Dr. Iriye wanted this year’s conference to focus on their growth as a society, and how their meeting is different than others: “People need to feel that they belong to something. And I think our society's really something special. It's grown from these giants in the past that have created a culture of science, a culture of inclusion, and a desire to make something bigger than themselves.”
Though the conference at its core features research both clinical and basic science-related, there are also educational opportunities and places to practice advocacy. In fact, the meeting itself is an advocating body, utilizing a certain clause in their contract when they disagree with policies.
“Our members are really into advocacy, and with the further infringement on reproductive health access and abortion rights around the country, we felt a need as an organization to stand up for our patients and the rights of our patients at-risk,” Dr. Iriye explained.
The solution: the frustration or purpose clause. They’re the only women's health organization that has a clause to pull out of a venue or move venues if that venue is located somewhere where laws may suddenly severely restrict reproductive health access.
This year’s meeting was located in Grapevine, Texas, but before it began, the society received some heartening news: the maternal mortality rate was not as high as previously thought, due to errors in calculation. The rate was not 26 per 100,000, but 17.4, a 30% decrease.
“We thought that our maternal mortality rate in this country was going up. But if you actually look at it over the years, it's actually stable or pretty stable,” Dr. Iriye said. But the news came with an edge to it, as well: Other countries’ maternal rates appear to still be going down, and health care disparities still exist, with African American women 2.5 times more likely to die during or from pregnancy than Caucasians (1).
Dr. Iriye pointed to three big pieces of research talked about at SMFM that address maternal mortality and the systemic issues that might be behind such disparities.
One positive study from Dr. Angela Burgess, a retrospective cross-sectional study going over maternal deaths and the location of where they occurred from 2003 to 2016, found that inpatient maternal mortality rates fell by 20% during that time, perhaps showing that recent Society efforts concentrating on improving patient safety and quality may be working.
But another study by Dr. Jasmine Johnson talked about how racial disparities persist despite educational status. Dr. Johnson looked at the rates of preterm birth based upon race and women with greater than 15 years of education, and found a more than 50% increase in preterm birth in African Americans, compared to Caucasians.
The last surprising study by Dr. Lynn Lee looked at more than 10,000 women to assess their health literacy by having them pronounce seven different words related to health. They found that, after controlling for confounding factors such as education, people with lower health literacy, had increases in low birth weight and in Cesarean delivery.
All of this research is important and groundbreaking, Dr. Iriye said, but he wished there would also be more of an emphasis on using research to improve the situation of health care inequity and maternal mortality: “Everybody says that we need more research. We do need more research, but also, our numbers are worse than other nations for maternal mortality. And we're working with the same research. So why is it worse with us?”
Dr. Iriye believes that the problem lies in a lack of using the research to change medical practice, and focused a lot during his presidency on improving implementation practices.
“Everything in implementation is behavior change,” Dr. Iriye said. “You have to have the capability, opportunity, and motivation to do something You have to look at: is this environment capable of doing it? If not, what do we need to change? What’re the opportunities we have to change the environment? Is it education? Is it a payer perspective? Is it the equipment that you need at a hospital? And then, you need to show the people there how it will improve the patient outcome to give them the motivation to change things in the future.”
Dr. Iriye hopes that implementation practices will continue to be a staple at SMFM meetings, and maybe even at meetings beyond pregnancy issues, as it’s a nationwide problem.
“American medicine is all breakthrough, no follow-through,” Dr. Iriye said. “It's all about finding the next big reason, evidence-based practice, but it's not about getting that to all the patients. And I think that's something that we really have to look at changing.”
Dr. Iriye is now the immediate past president of SMFM.
Illustration by April Brust