California Reduced Maternal Mortality to Levels Seen in Other Developed Countries
Bringing Together Stakeholders to Develop Systems and Protocols
I wrote this piece several days ago. A friend sent it to a prominent ob-gyn thought leader who said the information is correct. He shared an article from Health Affairs that is even more troubling. "Over the past two decades the US has seen troubling trends in multiple measures of maternal health: Maternal mortality rates have increased by 50–70 percent.... The care of pregnant women has national importance beyond infant outcomes, as maternity care is the most frequent overall reason for hospitalization, cesarean section is the most common surgery, and Medicaid is financially responsible for half of all US births." The leading cause of maternal death is bleeding and preeclampsia. Preeclampsia is a whole-body vascular disease caused by the same epigenetic and molecular changes as other vascular disease. For some women it is very severe. It leads to high blood pressure, and small vessel disease that damages the kidney, liver, and brain. In the latter stages it causes stroke, seizures and death in a process that take days rather than decades.
Once again, this is a systems problem. California has successfully brought stakeholders together and they have reduced their maternal mortality rate to equal that of other advanced countries. "While the US maternal mortality rate has worsened in the 2010s, California has cut its rate nearly in half, from 13.1 per 100,000 live births, on average, in the baseline period of 2005–09 to a three-year average of 7.0 during 2011–a level comparable to the average rate of 7.2 in Western European countries in 2015." As the friend said, " It’s about caring first (about women), commitment, data-driven evidence and systems.
The rest of the US has maternal mortality rates three or four times that of California. What they did was very simple. "The first two years of case reviews revealed that obstetric hemorrhage and preeclampsia were the two most preventable causes of maternal mortality and the two most important drivers of maternal morbidity. These two conditions were the subject of the Collaborative’s first two toolkit task forces" which are protocols to manage pregnancy in a way that reduces the impact of these complications. How can we defend a system that does not even protect new mothers. It is time to do stop talking and do something!
The fundamental metabolic health of the mothers are at stake here. Prenatal pregnancy lifestyle optimization is essential to fend off these devastating consequences. Lifestyle medicine saves lives.