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Can 'Deadly Deliveries' Be a Wake-Up Call to Physicians, Hospitals?

Janice Simmons, for HealthLeaders Media, March 18, 2010

Overall, the number of maternal deaths is significantly understated, Cox said, because of a lack of effective data collection nationwide.

"Reform is primarily focused on healthcare coverage and reducing healthcare costs," said Rachel Ward, one of the Deadly Delivery report authors. "It does not address discrimination, systemic failures and the lack of government accountability."

The report makes 10 suggestions for reducing maternal mortality, including the creation of an Office of Maternal Health, which would be charged with improving maternal health care and outcomes and eliminating disparities.

In addition, state governments should ensure that low-income pregnant women have temporary access to Medicaid while their permanent application for coverage is pending (presumptive eligibility) and that Medicaid provides timely access to prenatal care. In cases where a woman receives prenatal care before eligibility is confirmed, states should ensure that Medicaid reimburses retroactively for services provided.

The Joint Commission has weighed in earlier this year with a Sentinel Event Alert that suggests hospitals take a series of steps to prevent maternal death or injury, such as:

  • Educating physicians and other caregivers about underlying conditions such as high blood pressure, diabetes or morbid obesity that may put women at risk if they become pregnant.
  • Using specific protocols to treat pregnant women who have, for example, experienced a change in vital signs, hemorrhage or pre eclampsia.
  • Training emergency room staff to consider whether female patients may be pregnant or recently pregnant.
  • Referring high-risk women to experienced prenatal care providers who can direct specialized services for women.

But another answer may be that health systems should simply provide more and better prenatal care. Ron Anderson, MD, CEO of Dallas-based Parkland Hospital and Health System, which delivers over 16,000 babies per year, told the Medicare Payment Advisory Commission (MedPAC) in Washington this month that as the system increased the amount of prenatal care, it decreased the number of babies born prematurity.

"Prematurity, as you know, in the United States is going up. We actually have seen a reduction over the last 20 years," he said. Through outreach programs sponsored by the hospital, the hospital now delivers prenatal care to 98% of the women—some of whom may be undocumented women—who actually come to Parkland prior to their delivery.

"The results are a reduction by almost two thirds in stillbirth, neonatal deaths, intracranial bleeds and days in the neonatal ICU—so it saves us a lot of money," Anderson said. "When we're asked why we provide prenatal care to undocumented women, the economic argument [comes to the top], but the humane argument should [as well]."

"Deadly Delivery" is a "clarion call to action to transform our healthcare system and ensure that every woman has access to high quality maternal and newborn care within a coordinated, integrated and equitable system designed to best meet the needs of mothers and their fetuses/newborns," says Maureen Corry, executive director of the New York-based Childbirth Connection, which has closely studied how to improve and transform the maternity care system.

"Rapid gains are within our reach if we apply what we know from best evidence is optimal care for mothers and babies," she adds.


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Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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