We Must Improve the State of Maternal Mortality

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We are writing regarding USA TODAY's recent article titled "Deadly Deliveries: Women Share Their Near-Death Pregnancy Experiences". As high-risk obstetricians, the issues raised in the article strike at the heart of our passion for our profession. We have dedicated our career to caring for the highest-risk pregnant women, making ourselves directly responsible for their pregnancy outcomes – their very lives. While we applaud USA TODAY for shedding light on this very serious issue, we are concerned the piece does not address the systemic problems that obstetric care providers face daily on the front lines of this battle to save women and their babies.

Firstly, the USA TODAY article provided a real opportunity to discuss the serious, practice-wide problems that medical professionals try their hardest to address. But, disappointingly, it erred on the side of patient-sided, click-grabbing exposé rather than attempting a robust exploration of the life challenges facing the folks who put their hearts and souls into caring for patients whose dramatic and serious stories are illuminated.

For example, a quick response to an obstetric emergency is key. Without the necessary tools to do so, those in an obstetric emergency are left paralyzed. Many rural/community hospitals around the country have chosen to close their labor and delivery units to avoid the high insurance coverage and cost. These closures have led to a paucity of providers for wide swaths of areas, leaving pregnant women without an option that sometimes is less than 100 miles from their home. We must recognize that these hospitals are struggling because of a maldistribution of resources and funding. I have the utmost respect for physicians and nurses who have dedicated themselves to caring for women in rural areas with limited resources.

Secondly, the changing demographics of our patient population needs to be discussed. Increasing obesity rates among American reproductive-age women have led to increasingly more women entering pregnancy with hypertension, diabetes and the consequences thereof. This statement is not to shift responsibility but it cannot go without saying that a sicker patient population increases the incidence of maternal morbidity and mortality. Thus, we emphasize the importance of pre-conception counseling for such women, as optimizing a woman's chances to have a good pregnancy outcome can mitigate such morbidity. Consequently, increasing access to affordable and effective contraception and well-woman care would allow women to control their own futures and make the best decisions for their health and families.

Thirdly, due to the state of health insurance in America, many of the highest risk women only have access to health care when pregnant. Medicaid promptly runs out at the 6-week postpartum mark, leaving women with multiple co-morbidities without access to preventive or preconception care. This then bleeds over into subsequent pregnancies and women enter their next pregnancy sicker and worse off than before, leading to a deadly vicious cycle.

Lastly, it should be noted that 50% of pregnancies are unplanned. Meaning, many women have not optimized their lifestyles or medical comorbidities (as discussed above) prior to getting pregnant. Increasing access to affordable and effective contraception and terminations would allow women to make the best decisions for their health and families. As Title X clinics are in grave jeopardy under the current administrations' proposed changes, women would have even fewer places to access preventive sexual health care, contraception, and terminations. With increasingly restrictive termination laws being passed throughout the country, women with medical comorbidities that significantly increase their maternal mortality due to lack of pregnancy options. We cannot ignore that access to affordable and safe terminations has to play a role in improving the maternal mortality in the country.

 As Americans, as human beings – we can, and must, do better. Know that physicians are aware and actively working towards solutions to improve the current state of maternal mortality in our country.

Dr. Zahedi-Spung is a first-year Maternal-Fetal Medicine fellow at Washington University in St. Louis. She completed her residency in Obstetrics and Gynecology at Emory University. Her interests include maternal mortality, termination training, and periviability. She has no financial disclosures or conflicts of interests. Dr. Young is an assistant professor of Obstetrics and Gynecology in the Division of Maternal-Fetal Medicine and Ultrasound at Washington University in St. Louis School of Medicine, where he also serves as the associate residency program director. His clinical interests include clinical obstetrics, obstetrical simulation and curriculum design.

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