Maternal Health: A Pelican Primer

Aug 14

Despite its wealth, the United States has one of the worst maternal mortality rates in the developed world. The Center for Disease Control’s Pregnancy Mortality Surveillance System defines maternal mortality as the death of a woman during a pregnancy or within one year of the end of pregnancy from any cause related to or aggravated by pregnancy. Women of color suffer disproportionately from this tragedy. The CDC reports that “the number of reported pregnancy-related deaths in the United States [has] increased from 7.2 deaths per 100,000 live births in 1987 to 17.6 deaths per 100,000 live births in 2019.”

The American Solidarity Party stands with pregnant women and especially those who are vulnerable to abortion. Our platform states that “we maintain that pregnancy, childbirth, and neonatal care must be free at the point of care so that no family need worry about the expenses of bringing a child into the world.” In recent weeks, Democratic lawmakers have held a Black Maternal Healthcare Caucus Stakeholder Summit, tied in part to the reintroduction of the Momnibus Act, a series of laws aimed at improving black maternal health outcomes. Conservatives have been calling for a reintroduction of the Care for Her Act, originally introduced in 2021, as another piece of the effort to address maternal health.

To help me flesh out some of these issues, I’ve invited collaborators for a two-part blog post. This week we’ll hear from Dr. Elisa Kolk. Dr. Kolk is a mother and a family medicine doctor and ASP member living in Michigan. Next week, National Committee member Eric Anton will help us flesh out some of the policy initiatives in the proposed legislation.

Lauren Onak: Can you explain to readers what sorts of deaths fall under the umbrella of maternal mortality? Are they largely preventable?

Dr. Kolk: This really depends on what data you are looking at. There are different committees, task forces, and other groups that are looking at this problem. Part of the problem, though, is that the data isn't always the same. For example, even the definition of pregnancy-related mortality, including the time frame, is different within two separate arms of the CDC.[1] These different groups are also analyzing different data and pulling it from different sources. So the deaths that they include, while largely overlapping, can be different.

Keeping those caveats in mind, and looking at some of the data from the CDC, mental health conditions (especially suicide and overdose), cardiovascular (heart and blood vessel) problems, infection, hemorrhage (excessive bleeding), and blood clots top the list. A summary of data from state Maternal Mortality Review Committees (MMRC) 2017–2019 reports that 84% of pregnancy-related deaths in that time period were preventable.[2]

Lauren Onak: To what does the medical community attribute the increasing maternal mortality rate?

Dr. Kolk: This is even more complicated and at this time, I don't think we know all the reasons. I couldn't find any definitive answers to this question. I think it is fair to say that part of it is that women are increasingly likely to have pre-existing conditions (like high blood pressure and diabetes) going into pregnancy that increase risks for complications.[3] There also seems to be an increase in maternal age,[5] which brings its own medical problems and risks, including increased risk of maternal mortality.[6] Lack of recognition of the warning signs for what they are, and lack of standardization for responding to those signs are problems that we're working on, and California has proved that standardized approaches lower maternal mortality.[7] And no discussion of this could possibly be complete without pointing out that the maternal mortality for our black patients and the disparity in outcomes between black and white patients is abysmal. Contributors to this likely include explicit and implicit bias in healthcare, pre,-existing chronic conditions, and even the effects of long-term stress.[8]

Lauren Onak: In your opinion, what policies need to be in place to support pregnant and postpartum women?

Dr. Kolk: Women need access to healthcare, and not just when they're pregnant. Pre-pregnancy prevention of disease and optimal treatment of the disease that is present before a woman gets pregnant would go a long way in reducing risk. Good healthcare postpartum is necessary as well: if we want to reduce those pregnancy-related deaths in the year following delivery, then making sure those moms can get good medical care is an important part [of the solution].

Women have to be able to get to medical care, or we need to be able to get medical care to women.[9] Reliable transportation can be an issue in both urban and rural areas. In rural areas, in particular, there are often not enough providers or facilities.[10] Too often, women have to travel long distances to get to a hospital where they can deliver, especially if they need specialized care like Maternal-fetal medicine (for high risk pregnancies) or the NICU. In the postpartum period, it is important to get mom and baby to physician appointments too. Alternatively, like some industrialized countries, we could get a healthcare provider to mom and baby.[11]

Thinking of health more holistically, we should be making sure women have access to good nutrition, mental healthcare, and support systems. Being a new mom is stressful enough. Add to that some kind of medical problem or postpartum depression and throw her in a situation where she has no one to help her, and it's a recipe for disaster. Moms considering breastfeeding need better access to help with lactation - and cost shouldn't be a barrier.[12] We need better delivery systems for educating parents on what to expect and what is normal vs. abnormal for both Mom and Baby. Moms need the ability (and permission from others and especially themselves) to rest and heal postpartum, not to clean the house or make dinner or, worse, go back to work too early because they can't afford to stay at home any longer. 40 percent of workers don't qualify for the Family Medical Leave Act and according to ACOG (the American College of Obstetricians and Gynecologists, only 14 percent of American workers are able to use paid leave.[13]

[1]: https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm (Accessed 8/4/2023)

[2]: https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html (Accessed 8/4/2023)

[3]: ibid

[4]: https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm (Accessed 8/4/2023)

[5]: https://www.wilsoncenter.org/event/what-explains-the-united-states-dismal-maternal-mortality-rates (Accessed 8/4/2023)

[6]: https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm (Accessed 8/4/2023)

[7]: https://www.cmqcc.org/who-we-are (Accessed 8/4/2023)

[8]: https://www.wilsoncenter.org/event/what-explains-the-united-states-dismal-maternal-mortality-rates (Accessed 8/4/2023)

[9]: https://www.wilsoncenter.org/event/what-explains-the-united-states-dismal-maternal-mortality-rates (Accessed 8/4/2023)

[10]: https://www.aafp.org/about/policies/all/birth-equity-pos-paper.html (Accessed 8/4/2023)

[11]: https://www.healthline.com/health/pregnancy/what-post-childbirth-care-looks-like-around-the-world-and-why-the-u-s-is-missing-the-mark (Accessed 8/4/2023)

[12]: ibid