Charting a Course on Maternal Mortality

HRSA Administrator George Sigounas, MS, Ph.D., addressing the participants in the HRSA Maternal Mortality Summit
"Your recommendations will hopefully provide all of us - as well as policymakers and lawmakers both here in the United States and around the world - with a roadmap to develop the initiatives we need to address and lower the rates of maternal mortality and morbidity in a decisive way." - 
HRSA Administrator George Sigounas, MS, Ph.D. 

 

HRSA staff and delegates from six foreign countries closed out the international Maternal Mortality Summit last month, after a marathon three days of brainstorming and sharing lessons learned. Every day, 800 mothers die worldwide in some phase of their pregnancy, while maternal morbidity affects 50,000 women per year in the U.S, alone.

Front row, from left: Brian LeClair, Principal Deputy Administrator; Caitlin Patenaude, OA Policy Advisor; RADM Kerry Nesseler, Dir., Office of Global Health; Dr. George Sigounas; Laura Kavanagh, Acting Associate Administrator, MCHB;  Lee Wilson, Senior Policy Advisor, MCHB; Marty Kramer, Dir., Office of Communications.
Front row, from left: Brian LeClair, Principal Deputy Administrator; Caitlin Patenaude, OA Policy Advisor; RADM Kerry Nesseler, Dir., Office of Global Health; Dr. George Sigounas; Laura Kavanagh, Acting Associate Administrator, MCHB;  Lee Wilson, Senior Policy Advisor, MCHB; Marty Kramer, Dir., Office of Communications.

 

"We need to aspire to something greater," said Dr. William Callahan of the Centers for Disease Control and Prevention. "There is no acceptable level of maternal mortality." Said Deputy U.S. Surgeon General Sylvia Trent-Adams: "More than half of women who are in rural counties lack maternity care services -- and maternal mortality rates in rural areas are as high as 29 per 100,000, compared to 18.2 in the urban areas." Overseas authorities agreed that rural maternal care delivery is an abiding challenge, even in countries with advanced care systems.
"We need to aspire to something greater," said Dr. William Callahan of the Centers for Disease Control and Prevention. "There is no acceptable level of maternal mortality." Said Deputy U.S. Surgeon General Sylvia Trent-Adams: "More than half of women who are in rural counties lack maternity care services -- and maternal mortality rates in rural areas are as high as 29 per 100,000, compared to 18.2 in the urban areas." Overseas authorities agreed that rural maternal care delivery is an abiding challenge, even in countries with advanced care systems.

 

"Though no one can ever quantify ...
the far-reaching effects of the loss of a mother,
the 700 pregnancy-related deaths in the United States each year
results in almost one billion dollars in lifetime productivity lost."

- U.S. Surgeon General Jerome Adams, M.D.

Gill Walton, chief executive of the London's Royal College of Midwives

 

​"All of the things you're doing here ... are absolutely incredible," said Gill Walton, chief executive of the London's Royal College of Midwives. "I  think you've shown it, you've actually cracked it," but proximity to help and "continuity of care" remain a steep grade in the U.S. and elsewhere. Mothers at greatest risk (those with maternal morbitites, such as hypertension and cardiovascular disease, and extreme life stressors) need close attention, close to home, by a trained provider, she said, to rapidly shrink the number of fatalities and begin to improve outcomes.

Further, women in the developed world are having babies at later ages, observed Dorothy Shaw of Canada's British Columbia Women's Hospital, which has led to sharp increases in births by cesarean section and increases in the risk of post-surgical infection.

In short, what was once considered an extreme lifesaving procedure has been normalized. And while considered a relatively safe procedure, repeated c-section births come with increased risk of complications, experts said at the summit. Walton added that older women tend to have higher body mass indexes, which increases their risk of hypertension, cardiovascular disease and other conditions that can make the surgery riskier.

Strikingly, there are now more women over age 40 giving birth in the Great Britain today than there are women under 20 doing so, Walton noted. In Brazil today, more than half of births are by c-section, said Dr. Monica Neri of the Ministry of Health. And the U.S. isn't far behind, with more than a third of births by sectioning.

From left, U.S. Surgeon General Dr. Jerome Adams; Dr. Dorothy Shaw, B.C. Women's Hospital, internationally renowned women's health authority; Dr. Monica Neri, Brazilian Ministry of Health.
From left, U.S. Surgeon General Dr. Jerome Adams; Dr. Dorothy Shaw, B.C. Women's Hospital, internationally renowned women's health authority; Dr. Monica Neri, Brazilian Ministry of Health.

 

Rwandan delegates Dr. David Ntirushwa, University Teaching Hospital of Kigali, and Dr. Albert Tuyishme, Rwanda Health Information System, have helped pioneer data integration to improve outcomes; HRSA Office of Global Health staff and summit M.C.s Austin Demby, Dana Robinson and LCDR Charlie Darr; the Canadian delegation: Dr. Heather Scott, University of Halifax, Jocelyn Cook, Chief Scientific Officer, Society of Obstetricians and Gynaecologists, and Wei Luo, researcher.
Rwandan delegates Dr. David Ntirushwa, University Teaching Hospital of Kigali, and Dr. Albert Tuyishme, Rwanda Health Information System, have helped pioneer data integration to improve outcomes; HRSA Office of Global Health staff and summit M.C.s Austin Demby, Dana Robinson and LCDR Charlie Darr; the Canadian delegation: Dr. Heather Scott, University of Halifax, Jocelyn Cook, Chief Scientific Officer, Society of Obstetricians and Gynaecologists, and Wei Luo, researcher.

 

Dr. Elliott Main helped engineer a 50 percent reduction in maternal deaths in California between 2008 and 2013, advocated for better data collection on maternal fatalities involving hemorrhage, preeclampsia and C-section births -- and widespread information-sharing among hospitals and public health departments to increase accountability for outcomes and initiate better practices, sooner.

Dr. Main, left, Medical Dir. of The California Maternal Quality Care Collaborative. The state, which now conducts regular reviews of maternal deaths and has promulgated a widely used death certificate that improves causal reporting statewide in such cases. At right, the CDC's Shanna Cox outlined that agency's many efforts to promote data reporting and analysis. Among them is a new initiative with six states and multiple  jurisdictions to build a more uniform maternal mortality analysis system that dives deeper on the inter-related causes of a mother's death.
Dr. Main, left, Medical Dir. of The California Maternal Quality Care Collaborative. The state, which now conducts regular reviews of maternal deaths and has promulgated a widely used death certificate that improves causal reporting statewide in such cases. At right, the CDC's Shanna Cox outlined that agency's many efforts to promote data reporting and analysis. Among them is a new initiative with six states and multiple  jurisdictions to build a more uniform maternal mortality analysis system hrsa exit disclaimer that dives deeper on the inter-related causes of a mother's death.

 

"If you have a complication in pregnancy like preeclampsia, you can have a stroke and be in the intensive care unit for a couple of weeks before you die," Main said in a recent interview hrsa exit disclaimer, making it less likely to be properly reported and investigated as a death related to maternity.

Watch highlights from the summit.

Review data from the CDC's Pregnancy Mortality Surveillance System.

Date Last Reviewed:  June 2018