Full practice authority for nurse practitioners could help curb those distressing rates, NP leader says.
Rising maternal death rates, caused in part by "maternity deserts" with little or no access to prenatal or delivery services, could be curbed if all states granted full practice authority to nurse practitioners (NPs), says April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of the American Association of Nurse Practitioners (AANP).
Between 2019 and 2020, the maternal death rate went up 14%, with higher rates for Black and Hispanic women, according to the National Center for Health Statistics.
Primary reasons are access to care and social determinates of health (SDOH), but the crisis has been further aggravated by pandemic restrictions and fear of infection, says Kapu, who oversees midwifery practices and women's health nurse practitioners as associate dean for clinical and community partnerships at Vanderbilt University's School of Nursing.
Pregnant women feared COVID exposure, but also questioned the safety of vaccinations for them and their unborn child, she says.
"Now the science has evolved, and we have the evidence to demonstrate the efficacy and safety of vaccinations for pregnant women," she says. "But early on, that was the big concern; fear of not knowing exactly how being exposed to COVOD would impact the unborn baby as well as the children at home."
But other obstacles to a safe pregnancy persist. SDOH such as economic status, transportation, occupation, housing, and even geographic location can affect whether a pregnant woman is able to make the prenatal appointments with her obstetrician for the duration of the pregnancy.
Maternal deserts are a particular challenge for pregnant women. About 35% of all U.S. counties are "total maternity deserts"—no access to prenatal or delivery services—and another 54% are considered partial deserts.
These are substantial percentages in that they equate to 7 million women not having access to maternity care, Kapu says.
"A mom not being able to access healthcare for regular prenatal checks, being able to have those discussions with their nurse practitioner about nutrition, regular diagnostic tests that come along with pregnancy, understanding if the mother has any comorbidities and how that effects their health—these factors are important to maternal health and being able to access that healthcare is critical," she says.
Access to good healthcare also affect the patient's ability to get the medication, supplements, and even food that they need for a healthy pregnancy—and this is where NPs can fill the gap, Kapu says.
"Quite often, moms don't have access to healthy foods. They don't have access to fruits, vegetables, grains, nuts, and things that they need throughout the pregnancy," she says. "So [NPs] need to figure out how to get access for them so they can get that important nutrition."
If the mother is lacking something or requires additional assistance to get the food or supplements she needs, NPs can connect them with programs that can assist them, Kapu says.
"It's important that they get prenatal care as soon as possible," she says, "because if they're going to need to apply for an assistance program, it should be done as quickly as they can so that assistance can kick in during their prenatal period."
"The supplements cost money; some moms can't afford that," Kapu said. "If they have to choose between food for their children over supplements, they'll probably not get the supplement; so, we have to figure out how to get those supplements for those moms."
Pushing for full practice authority
While more women's health NPs have begun moving to rural areas to practice, some states don't allow them—regardless of specialization—to practice to the full extent of their training.
Full practice authority legislation, which has been embraced by the National Academy of Medicine, National Governors Association, American Enterprise Institute, and many others, has been adopted in 25 states, along with Washington, D.C., streamlining healthcare delivery by granting patients full and direct access to the comprehensive services NPs are educated and clinically prepared to provide.
The National Academy of Medicine's The Future of Nursing 2020-2030 report recommends that nurses be allowed to "practice to the full extent of their education and training by removing barriers that prevent them from more fully addressing social needs and social determinants of health and improving healthcare access, quality, and value."
The American Medical Association and other physician groups, however, argue collaborations are needed for patient safety.
Not so, Kapu says.
"If nurse practitioners were able to practice to the full extent of their education, their training, and board certification," Kapu says, "we would see an increase in care across all communities and that would be hugely impactful in counties known as maternal health deserts."
“A mom not being able to access healthcare for regular prenatal checks, being able to have those discussions with their nurse practitioner about nutrition, regular diagnostic tests that come along with pregnancy, understanding if the mother has any comorbidities and how that effects their health—these factors are important to maternal health and being able to access that healthcare is critical.”
April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president, American Association of Nurse Practitioners
Jasmyne Ray is the revenue cycle editor at HealthLeaders.
KEY TAKEAWAYS
The rise in maternity death rates can be attributed to lack of care in maternal health deserts—areas with little to no access to prenatal or delivery services.
Social determinates of health, such as a woman's occupation, where they live, and what nutrition they can access, also contribute to the crisis.
Currently, 25 states and Washington, D.C., allow full practice authority to nurse practitioners.