While the number of maternal deaths has decreased over time, it remains an issue.
The United States has the highest maternal mortality rate among developed countries, especially for minorities.
“We know that there is disparity in the numbers of women who die in different races, and when you look at the New York State ratio, black women are dying at a rate of 3.2 to 1.”
Black women are three times as likely to die in childbirth than white women. Also, an increasing majority of pregnancy related deaths are found to have been covered by Medicaid.
“We’re trying to figure out is this an issue of access to health care, follow up, medical conditions, providers who give care, and who do we get to the bottom of it,” NYS Dept. of Health Commissioner Dr. Howard Zucker said.
The NYSDOH is trying to answer those questions and more through a taskforce compiled of health experts from universities, hospitals, and midwives. They held seven listening sessions throughout the state to try and narrow down some of the causes such as obesity, age and access to health care.
“The reality is there is not one single item that needs to be fixed,” Zucker said. “This is going to end up being multiple issues that need to be tackled together.”
After Tuesday’s meeting, officials expressed hope in finding solutions quickly so they can be drafted into legislative bills as soon as the coming year.
“Any time someone is delivering a baby, it should be the happiest time of their life,” Zucker said. “And if there is any problem, even one complication, it’s the responsibility of the state to get to the bottom of it and to solve it.”
Some initiatives discussed during the meeting include:
Establishing the Maternal Mortality Review Board — At the recommendation of the Governor’s Council on Women and Girls, DOH established the Maternal Mortality Review Board, composed of health professionals from a cross-section of stakeholders around the state who serve and/or are representative of the diversity of women statewide, to work in collaboration with the American College of Obstetricians and Gynecologists and the City of New York to review each maternal death in New York State. The Board, which will convene in early 2019, is tasked with making policy recommendations to DOH to improve maternal outcomes by reducing maternal mortalities and morbidities, and recommendations would specifically contemplate racial and economic disparities.
Launching the Best Practice Summit with Hospitals and OB-GYNs — The Governor, in partnership with the Greater New York Hospital Association, Healthcare Association of New York State, ACOG, and other stakeholders, will launch a summit this year to discuss the issue of maternal mortality and morbidity, including racial disparities. The Summit will address statistics, best practices, community awareness, medical school curricula, graduate medical education, and practicing physician training, with the goal of implementing immediate measures and identifying future action items to improve maternal care and management.
Piloting the Expansion of Medicaid Coverage for Doulas — DOH will pilot the expansion of Medicaid coverage for doulas in early 2019. Doulas are non-medical birth coaches who assist a woman before, during, or after childbirth if needed. Certified doulas have been shown to increase positive health outcomes, including reducing birth complications for the mother and the baby.
Supporting Centering Pregnancy Demonstrations — New York will increase support for a program included in the Governor’s State of the State First 1,000 Days of Life initiative, known as Centering Pregnancy. The program is designed to enhance pregnancy outcomes through a combination of prenatal education and social support and has been associated with reduced incidence of preterm birth and low birth weight, lower incidence of gestational diabetes and postnatal depression, higher breastfeeding rates and better inter-pregnancy spacing. Centering Pregnancy has also been shown to narrow the disparity in preterm birth rates between black women and white women.
Requiring Continuing Medical Education and Curriculum Development — The Governor calls on the State Board for Medicine to require appropriate practitioners to participate in continuing medical education on maternal mortalities/morbidities and disparate racial outcomes. Additionally, DOH will work with medical schools, including SUNY’s four medical schools, to build materials on maternal mortality/morbidity and disparate racial outcomes into their medical school curriculum, graduate medical education and training for practicing physicians. SUNY has established a statewide working group to coordinate efforts across middle schools and they have identified key experts who will advise on various aspects of the curriculum and training programs.
Expanding the New York State Perinatal Quality Collaborative — The State has expanded its collaboration with hospitals across New York State to review best practices to address hemorrhaging and implement new clinical guidelines to reduce maternal mortality. Over 80 hospitals are engaged voluntarily in this effort, led and coordinated by the Department of Health. This collaborative has identified key metrics for measuring success in reducing maternal hemorrhage, as well as drafted clinical guidelines which will ultimately be used across the state to improve quality care.
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